Memory and Spatial Cognition in Breast Cancer Patients Undergoing Adjuvant Endocrine Therapy

Abstract

Introduction: It is generally accepted that estrogens play a protective role in cognitive function. Therefore, it can be expected that subtotal estrogen deprivation following aromatase inhibition will alter cognitive performance. Methods: In a cross-sectional study we investigated 80 postmenopausal women with breast cancer. Memory and spatial cognition were compared across 4 treatment groups: tamoxifen only (TAM, n = 22), aromatase inhibitor only (AI, n = 22), TAM followed by AI (‘SWITCH group', n = 15), and patients with local therapy (LT) only (surgery and radiation, n = 21). Duration of the 2 endocrine monotherapy arms prior to the assessment ranged from 1 to 3 years. The ‘SWITCH group' received 2-3 years TAM followed by at least 1 year and at most 3 years of AI. Memory and spatial cognition were investigated as planned comparisons. Investigations of processing speed, attention, executive function, visuoconstruction and self-perception of memory were exploratory. Results: With regard to general memory, AI patients performed significantly worse than the LT group (p = 0.013). Significant differences in verbal memory did not remain significant after p-value correction for multiple testing. We found no significant differences concerning spatial cognition between the groups. Conclusion: AI treatment alone significantly impairs general memory compared to the LT group.

Treatments for Breast Cancer That Affect Cognitive Function in Postmenopausal Women

“…In a small study of women, quite a long time after menopause, Arimidex for an average of 2 years (Berndt et al, 2016) caused significantly lower scores on general memory tests and attention and dramatically lower levels on verbal memory.…”

Effects of tamoxifen on cognition and language in women with breast cancer: A systematic search and a scoping review

“…We classified seven studies as considering attention an outcome and a cognitive domain possibly affected by the use of tamoxifen. These studies included objective measures that assess attention and concentration, 16,23 visual attention, 16,18,33,38,39 and distractibility 31 . The results of the studies investigating attention and concentration, visual attention, and distractibility generally suggested that tamoxifen does not negatively affect those skills 16,18,23,31,38,39 .…”

“…These studies included objective measures that assess attention and concentration, 16,23 visual attention, 16,18,33,38,39 and distractibility 31 . The results of the studies investigating attention and concentration, visual attention, and distractibility generally suggested that tamoxifen does not negatively affect those skills 16,18,23,31,38,39 . In fact, one study 38 suggested that women taking tamoxifen performed significantly better in tasks of attention/concentration compared to women taking AIs and also to women taking tamoxifen followed by AIs.…”

Estrogens - the Saviors of Cognitive Function?

“…Nonetheless, there are - somewhat in contrast to the data of clinical trials - bothersome side effects, which are sometimes the cause for incompliance or change of treatment. Hot flashes, arthralgia, weight gain, grade 1 alopecia, or diminished cognitive function as investigated by Berndt et al [1] in this issue of BREAST CARE are reported by patients in daily clinical routine. …”

“…In this issue Berndt et al [1] investigate the impact of endocrine treatment on cognitive function, in detail on memory and spatial cognition. They focused on these domains as there is evidence that they are influenced by 17β-estradiol.…”