ABSTRACT Since the inception of functional magnetic resonance imaging (fMRI) in the early 1990s, ... more ABSTRACT Since the inception of functional magnetic resonance imaging (fMRI) in the early 1990s, clinicians and researchers have been interested in the potential utility of this technology for replacement of the intracarotid amobarbital test (IAT). The IAT, or Wada test, is an invasive angiographic procedure, with some potential risks, that currently serves as the conventional standard for lateralization of language, memory, and other functions. The IAT is used primarily in patients under consideration for neurosurgery to treat epilepsy, but also in other neurosurgical populations (e.g., motor cortex tumor, arteriovenous malformation in language association cortex, etc.). If a valid assessment paradigm could be created, the advantages of fMRI assessment of memory and language functions over the IAT would be obvious. Functional MRI is a repeatable, noninvasive procedure with no significant known health risks for most individuals. It is also very flexible and can be readily modified to assess the clinical questions at issue for a particular patient. In addition, a recent cost analysis demonstrated considerable savings of total direct costs for fMRI over IAT.1
The purpose of this multicenter, prospective, randomized, placebo-controlled study was to evaluat... more The purpose of this multicenter, prospective, randomized, placebo-controlled study was to evaluate and compare the efficacy of two cognitive rehabilitation interventions (Memory and Attention Adaptation Training (MAAT) and Attention Builders Training (ABT)), with and without pharmacologic enhancement (i.e., with methylphenidate (MPH) or placebo), for treating persistent cognitive problems after traumatic brain injury (TBI). Adults with a history of TBI at least four months prior to study enrollment with either objective cognitive deficits or subjective cognitive complaints were randomized to receive MPH or placebo and MAAT or ABT, yielding four treatment combinations: MAAT/MPH (N=17), ABT/MPH (N=19), MAAT/placebo (N=17), and ABT/placebo (N=18). Assessments were conducted pre-treatment (baseline) and after six weeks of treatment (post-treatment). Outcome measures included scores on neuropsychological measures and subjective rating scales. Statistical analyses used linear regression m...
BackgroundThe relationship between amyloid and tau deposition and episodic memory‐related brain a... more BackgroundThe relationship between amyloid and tau deposition and episodic memory‐related brain activity is understudied. Our goal was to determine the association between brain activation on fMRI during encoding of complex scenes and amyloid and tau deposition on PET.Methods91 individuals from the Indiana Memory and Aging Study (36 cognitively normal (CN), 27 subjective cognitive decline (SCD), 28 mild cognitive impairment (MCI)) underwent amyloid ([18F]florbetapir or [18F]florbetaben) and [18F]flortaucipir PET, structural and functional MRI, and clinical and cognitive testing. The fMRI task was a scene encoding paradigm in which the participant is asked to try to remember a set of complex scenes relative to viewing a scrambled control image. Amyloid Centiloid (CL) and tau SUVR images were generated using standard methods. Amyloid positivity was defined as global cortical CL≥21. Areas activated during the task (“main effect” (ME)) across all participants were determined (Figure 1A). Mean BOLD signals from ME regions, the entorhinal cortex (EC), and the inferior parietal lobule (IPL) were extracted. Mean cortical amyloid CL and tau SUVR from the bilateral EC, IPL, and lateral temporal lobe (LTL) were also extracted. Tau and amyloid were non‐normally distributed, so Spearman correlation models were used to evaluate the relationship of scene encoding activation and PET. Age, diagnosis, and sex were evaluated as covariates but did not change the observed pattern of results.ResultsSignificant association between tau and scene encoding activation was observed (Figure 1B). When limited to amyloid‐positive individuals only (n=28), the observed associations were considerably stronger between scene encoding activation and both amyloid CL level and tau deposition (Figure 1C‐E). Similar results were observed when limiting to the CN and SCD groups.ConclusionAmyloid and tau deposition are associated with reduced brain activity during episodic memory encoding in older adults at risk for AD. These findings suggest that brain function is another important biomarker to consider in both the temporal sequencing of biomarkers (Jack et al. 2013) and the A/T/N framework. Future studies in larger samples are warranted. Reference: Jack et al. (2013) Lancet Neurology.
Breast Cancer Research and Treatment, Nov 24, 2021
Purpose:Older cancer patients are susceptible to long-term effects of chemotherapy, including can... more Purpose:Older cancer patients are susceptible to long-term effects of chemotherapy, including cancer-related cognitive decline and impairments to quality of life. Taxane-based chemotherapies are associated with physical declines among older women and may negatively impact cognitive performance. We sought to examine whether changes in objective and subjective measures of cognitive performance and well-being differ among older breast cancer survivors as a function of taxane-based chemotherapy treatment regimens.Methods:Individual-level data was pooled and harmonized from two large prospective studies of older (greater than 60 years) breast cancer survivors. Assessments were conducted prior to systemic therapy and up to 36-months after. Cognitive performance was assessed with objective (working memory, processing speed and executive functions) and subjective tests and physical, emotional and functional well-being was also assessed.Results:One hundred and sixty-seven (M age = 67.3 years) women, with 116 receiving chemotherapy with taxanes and 51 without taxanes contributed data. Declines in subjective cognition for both groups were significant between pre-treatment and 12-month follow-up. Significant improvements were seen on a measure of objective cognition (working memory) from 12 to 36-months. Measures of well-being improved from prior to systemic therapy to 12-months. Longitudinal changes across all measures did not vary as a function of receipt of taxane-based treatment.Conclusion:Older women who received treatment with taxanes did not have greater declines in cognitive performance or well-being than women receiving other chemotherapy regimens. Despite older cancer survivors being at greater risk for negative outcomes, treatment with taxane-based chemotherapies does not appear to exacerbate these health consequences.
Cancer- and treatment-related cognitive dysfunction (CRCD) is a common challenge faced by patient... more Cancer- and treatment-related cognitive dysfunction (CRCD) is a common challenge faced by patients diagnosed with non-central nervous system (CNS) cancer. It has become increasingly recognized that multiple factors likely play a role in these symptoms, including the cancer disease process, systemic treatments (e.g., chemotherapy and endocrine therapies), and risk factors that may predispose an individual to both cancer and cognitive dysfunction. As the field has evolved, advanced neuroimaging techniques have been applied to better understand the neural correlates of CRCD. This review focuses on structural neuroimaging findings related to CRCD in adult non-CNS cancer populations, including examination of gray matter volume/density and white matter integrity differences between cancer patients and comparison groups, as well as emerging findings regarding structural network abnormalities. Overall, this literature has demonstrated consistent findings of reduced gray matter volume/density and white matter integrity in cancer patients relative to comparison groups. These are most prominent in individuals treated with chemotherapy, though alterations have also been noted in those treated with anti-estrogen and androgen-deprivation therapies. Alterations in gray and white matter structural network connectivity have also been identified. These structural abnormalities have been observed most prominently in frontal and temporal brain regions, and have been shown to correlate with subjective and objective cognitive function, as well as with physiological and clinical variables, helping to inform understanding of CRCD mechanisms. To date, however, structural neuroimaging techniques have not been utilized in systematic studies of potential CRCD treatments, suggesting a potentially fruitful avenue for future research.
ABSTRACT Since the inception of functional magnetic resonance imaging (fMRI) in the early 1990s, ... more ABSTRACT Since the inception of functional magnetic resonance imaging (fMRI) in the early 1990s, clinicians and researchers have been interested in the potential utility of this technology for replacement of the intracarotid amobarbital test (IAT). The IAT, or Wada test, is an invasive angiographic procedure, with some potential risks, that currently serves as the conventional standard for lateralization of language, memory, and other functions. The IAT is used primarily in patients under consideration for neurosurgery to treat epilepsy, but also in other neurosurgical populations (e.g., motor cortex tumor, arteriovenous malformation in language association cortex, etc.). If a valid assessment paradigm could be created, the advantages of fMRI assessment of memory and language functions over the IAT would be obvious. Functional MRI is a repeatable, noninvasive procedure with no significant known health risks for most individuals. It is also very flexible and can be readily modified to assess the clinical questions at issue for a particular patient. In addition, a recent cost analysis demonstrated considerable savings of total direct costs for fMRI over IAT.1
The purpose of this multicenter, prospective, randomized, placebo-controlled study was to evaluat... more The purpose of this multicenter, prospective, randomized, placebo-controlled study was to evaluate and compare the efficacy of two cognitive rehabilitation interventions (Memory and Attention Adaptation Training (MAAT) and Attention Builders Training (ABT)), with and without pharmacologic enhancement (i.e., with methylphenidate (MPH) or placebo), for treating persistent cognitive problems after traumatic brain injury (TBI). Adults with a history of TBI at least four months prior to study enrollment with either objective cognitive deficits or subjective cognitive complaints were randomized to receive MPH or placebo and MAAT or ABT, yielding four treatment combinations: MAAT/MPH (N=17), ABT/MPH (N=19), MAAT/placebo (N=17), and ABT/placebo (N=18). Assessments were conducted pre-treatment (baseline) and after six weeks of treatment (post-treatment). Outcome measures included scores on neuropsychological measures and subjective rating scales. Statistical analyses used linear regression m...
BackgroundThe relationship between amyloid and tau deposition and episodic memory‐related brain a... more BackgroundThe relationship between amyloid and tau deposition and episodic memory‐related brain activity is understudied. Our goal was to determine the association between brain activation on fMRI during encoding of complex scenes and amyloid and tau deposition on PET.Methods91 individuals from the Indiana Memory and Aging Study (36 cognitively normal (CN), 27 subjective cognitive decline (SCD), 28 mild cognitive impairment (MCI)) underwent amyloid ([18F]florbetapir or [18F]florbetaben) and [18F]flortaucipir PET, structural and functional MRI, and clinical and cognitive testing. The fMRI task was a scene encoding paradigm in which the participant is asked to try to remember a set of complex scenes relative to viewing a scrambled control image. Amyloid Centiloid (CL) and tau SUVR images were generated using standard methods. Amyloid positivity was defined as global cortical CL≥21. Areas activated during the task (“main effect” (ME)) across all participants were determined (Figure 1A). Mean BOLD signals from ME regions, the entorhinal cortex (EC), and the inferior parietal lobule (IPL) were extracted. Mean cortical amyloid CL and tau SUVR from the bilateral EC, IPL, and lateral temporal lobe (LTL) were also extracted. Tau and amyloid were non‐normally distributed, so Spearman correlation models were used to evaluate the relationship of scene encoding activation and PET. Age, diagnosis, and sex were evaluated as covariates but did not change the observed pattern of results.ResultsSignificant association between tau and scene encoding activation was observed (Figure 1B). When limited to amyloid‐positive individuals only (n=28), the observed associations were considerably stronger between scene encoding activation and both amyloid CL level and tau deposition (Figure 1C‐E). Similar results were observed when limiting to the CN and SCD groups.ConclusionAmyloid and tau deposition are associated with reduced brain activity during episodic memory encoding in older adults at risk for AD. These findings suggest that brain function is another important biomarker to consider in both the temporal sequencing of biomarkers (Jack et al. 2013) and the A/T/N framework. Future studies in larger samples are warranted. Reference: Jack et al. (2013) Lancet Neurology.
Breast Cancer Research and Treatment, Nov 24, 2021
Purpose:Older cancer patients are susceptible to long-term effects of chemotherapy, including can... more Purpose:Older cancer patients are susceptible to long-term effects of chemotherapy, including cancer-related cognitive decline and impairments to quality of life. Taxane-based chemotherapies are associated with physical declines among older women and may negatively impact cognitive performance. We sought to examine whether changes in objective and subjective measures of cognitive performance and well-being differ among older breast cancer survivors as a function of taxane-based chemotherapy treatment regimens.Methods:Individual-level data was pooled and harmonized from two large prospective studies of older (greater than 60 years) breast cancer survivors. Assessments were conducted prior to systemic therapy and up to 36-months after. Cognitive performance was assessed with objective (working memory, processing speed and executive functions) and subjective tests and physical, emotional and functional well-being was also assessed.Results:One hundred and sixty-seven (M age = 67.3 years) women, with 116 receiving chemotherapy with taxanes and 51 without taxanes contributed data. Declines in subjective cognition for both groups were significant between pre-treatment and 12-month follow-up. Significant improvements were seen on a measure of objective cognition (working memory) from 12 to 36-months. Measures of well-being improved from prior to systemic therapy to 12-months. Longitudinal changes across all measures did not vary as a function of receipt of taxane-based treatment.Conclusion:Older women who received treatment with taxanes did not have greater declines in cognitive performance or well-being than women receiving other chemotherapy regimens. Despite older cancer survivors being at greater risk for negative outcomes, treatment with taxane-based chemotherapies does not appear to exacerbate these health consequences.
Cancer- and treatment-related cognitive dysfunction (CRCD) is a common challenge faced by patient... more Cancer- and treatment-related cognitive dysfunction (CRCD) is a common challenge faced by patients diagnosed with non-central nervous system (CNS) cancer. It has become increasingly recognized that multiple factors likely play a role in these symptoms, including the cancer disease process, systemic treatments (e.g., chemotherapy and endocrine therapies), and risk factors that may predispose an individual to both cancer and cognitive dysfunction. As the field has evolved, advanced neuroimaging techniques have been applied to better understand the neural correlates of CRCD. This review focuses on structural neuroimaging findings related to CRCD in adult non-CNS cancer populations, including examination of gray matter volume/density and white matter integrity differences between cancer patients and comparison groups, as well as emerging findings regarding structural network abnormalities. Overall, this literature has demonstrated consistent findings of reduced gray matter volume/density and white matter integrity in cancer patients relative to comparison groups. These are most prominent in individuals treated with chemotherapy, though alterations have also been noted in those treated with anti-estrogen and androgen-deprivation therapies. Alterations in gray and white matter structural network connectivity have also been identified. These structural abnormalities have been observed most prominently in frontal and temporal brain regions, and have been shown to correlate with subjective and objective cognitive function, as well as with physiological and clinical variables, helping to inform understanding of CRCD mechanisms. To date, however, structural neuroimaging techniques have not been utilized in systematic studies of potential CRCD treatments, suggesting a potentially fruitful avenue for future research.
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