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Nicotinic treatment of post-chemotherapy subjective cognitive impairment: a pilot study.

ABSTRACT: PURPOSE:Persistent chemotherapy-related cognitive impairment (pCRCI) is commonly reported following cancer treatment and negatively affects quality of life; however, there is currently no pharmacological treatment indicated for pCRCI. This pilot study obtained preliminary data regarding the use of transdermal nicotine patches as a therapeutic strategy for women with pCRCI to (1) reduce subjective cognitive complaints and (2) enhance objective cognitive performance in breast, colon, lymphoma, or ovarian cancer survivors with pCRCI. METHODS:Participants were randomized to either placebo (n?=?11) or transdermal nicotine (n?=?11) for 6 weeks, followed by 2 weeks of treatment withdrawal for a total of 8 weeks. Participants were assessed using both subjective and objective measures of cognitive functioning at five visits before, during, and after treatment. RESULTS:Over the course of the study, women in both groups improved substantially in severity of self-reported cognitive complaints measured by Functional Assessment of Cancer Therapy-Cognitive Function Perceived Cognitive Impairments regardless of treatment arm. Additionally, objective cognitive performance measures improved in both groups; however, there was no significant difference in improvement between groups. CONCLUSIONS:Due to a large placebo response, we were unable to determine if a drug effect was present. However, we did observe substantial improvement in self-reported cognitive symptoms, likely resulting from factors related to participation in the trial rather than specific drug treatment effects. TRIAL REGISTRATION:The study was registered with clinicaltrials.gov (trial registration: NCT02312943). IMPLICATIONS FOR CANCER SURVIVORS:These results suggest that women with pCRCI can exhibit improvement in subjective cognition, with attention paid to symptoms and close follow-up over a short period of time.

SUBMITTER: Vega JN

PROVIDER: S-EPMC6993088 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Nicotinic treatment of post-chemotherapy subjective cognitive impairment: a pilot study.

Vega Jennifer N JN Albert Kimberly M KM Mayer Ingrid A IA Taylor Warren D WD Newhouse Paul A PA

Journal of cancer survivorship : research and practice 20190723 5

<h4>Purpose</h4>Persistent chemotherapy-related cognitive impairment (pCRCI) is commonly reported following cancer treatment and negatively affects quality of life; however, there is currently no pharmacological treatment indicated for pCRCI. This pilot study obtained preliminary data regarding the use of transdermal nicotine patches as a therapeutic strategy for women with pCRCI to (1) reduce subjective cognitive complaints and (2) enhance objective cognitive performance in breast, colon, lymph ...[more]

PMID: 31338732

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Project description:BackgroundCognitive impairment is commonly reported in patients receiving chemotherapy, but the acuity of onset is not known. This study utilized the psychomotor vigilance test (PVT) and trail-making test B (TMT-B) to assess cognitive impairment immediately post-chemotherapy.MethodsPatients aged 18-80?years receiving first-line intravenous chemotherapy for any stage of breast or colorectal cancer were eligible. Patient symptoms, peripheral neuropathy and Stanford Sleepiness Scale were assessed. A five-minute PVT and TMT-B were completed on a tablet computer pre-chemotherapy and immediately post-chemotherapy. Using a mixed linear regression model, changes in reciprocal transformed PVT reaction time (mean 1/RT) were assessed. A priori, an increase in median PVT reaction times by >?20?ms (approximating PVT changes with blood alcohol concentrations of 0.04-0.05?g%) was considered clinically relevant.ResultsOne hundred forty-two cancer patients (73 breast, 69 colorectal, median age 55.5?years) were tested. Post-chemotherapy, mean 1/RT values were significantly slowed compared to pre-chemotherapy baseline (p?=?0.01). This corresponded to a median PVT reaction time slowed by an average of 12.4?ms. Changes in PVT reaction times were not correlated with age, sex, cancer type, treatment setting, or use of supportive medications. Median post-chemotherapy PVT reaction time slowed by an average of 22.5?ms in breast cancer patients and by 1.6?ms in colorectal cancer patients. Post-chemotherapy median PVT times slowed by >?20?ms in 57 patients (40.1%). Exploratory analyses found no statistically significant association between the primary outcome and self-reported anxiety, fatigue or depression. TMT-B completion speed improved significantly post-chemotherapy (p?=?0.03), likely due to test-retest phenomenon.ConclusionsPVT reaction time slowed significantly immediately post-chemotherapy compared to a pre-chemotherapy baseline, and levels of impairment similar to effects of alcohol consumption in other studies was seen in 40% of patients. Further studies assessing functional impact of cognitive impairment on patients immediately after chemotherapy are warranted.

Project description:BACKGROUND:Discrimination between early-stage dementia and other cognitive impairment diagnoses is central to enable appropriate interventions. Previous studies indicate that dual-task testing may be useful in such differentiation. The objective of this study was to investigate whether dual-task test outcomes discriminate between groups of individuals with dementia disorder, mild cognitive impairment, subjective cognitive impairment, and healthy controls. METHODS:A total of 464 individuals (mean age 71?years, 47% women) were included in the study, of which 298 were patients undergoing memory assessment and 166 were cognitively healthy controls. Patients were grouped according to the diagnosis received: dementia disorder, mild cognitive impairment, or subjective cognitive impairment. Data collection included participants' demographic characteristics. The patients' cognitive test results and diagnoses were collected from their medical records. Healthy controls underwent the same cognitive tests as the patients. The mobility test Timed Up-and-Go (TUG single-task) and two dual-task tests including TUG (TUGdt) were carried out: TUGdt naming animals and TUGdt months backwards. The outcomes registered were: time scores for TUG single-task and both TUGdt tests, TUGdt costs (relative time difference between TUG single-task and TUGdt), number of different animals named, number of months recited in correct order, number of animals per 10?s, and number of months per 10?s. Logistic regression models examined associations between TUG outcomes pairwise between groups. RESULTS:The TUGdt outcomes "animals/10?s" and "months/10?s" discriminated significantly (p <?0.001) between individuals with an early-stage dementia diagnosis, mild cognitive impairment, subjective cognitive impairment, and healthy controls. The TUGdt outcome "animals/10?s" showed an odds ratio of 3.3 (95% confidence interval 2.0-5.4) for the groups dementia disorders vs. mild cognitive impairment. TUGdt cost outcomes, however, did not discriminate between any of the groups. CONCLUSIONS:The novel TUGdt outcomes "words per time unit", i.e. "animals/10?s" and "months/10?s", demonstrate high levels of discrimination between all investigated groups. Thus, the TUGdt tests in the current study could be useful as complementary tools in diagnostic assessments. Future studies will be focused on the predictive value of TUGdt outcomes concerning dementia risk for individuals with mild cognitive impairment or subjective cognitive impairment.

Project description:Cardiovascular disease (CVD) is a risk factor for cognitive impairment in the elderly. Manifestations of subclinical CVDs can be found in patients with cognitive impairment. The aim of the present study was to test the hypothesis that patients with mild cognitive impairment (MCI) have different magnetic resonance imaging (MRI)-derived regional myocardial motion indices compared with healthy controls.Eleven MCI patients (age, 65.5 years ±5.9; range, 55-81 years old) and 11 sex-/age-matched healthy volunteers were enrolled. All of the participants underwent a head MRI and cardiac MRI. Global cortical atrophy (GCA) was graded on the head MRI. The left ventricular ejection fraction (LVEF) and regional strain, strain rate, displacement and velocity were measured on cine images. The GCA scores, global cardiac function and regional myocardial motion indices were compared between MCI patients and healthy controls using the t-test.MCI patients had a higher GCA score than healthy controls (p?=?0.048). However, there was no significant difference in LVEF between MCI patients and controls. Compared to healthy controls, MCI patients had a lower peak radial strain (29.1%?±?24.1% vs. 46.4%?±?43.4%, p?<?0.001), lower peak diastolic radial strain rate (3.2?±?2.4 s-?1 vs. 6.0?±?3.0 s-?1, p?<?0.001), lower peak diastolic circumferential strain rate (2.5?±?2.1 s-?1 vs. 3.2?±?2.1 s-?1, p?=?0.002), lower peak systolic radial displacement (4.2?±?2.2 mm vs. 5.2?±?3.3 mm, p?=?0.002), lower peak diastolic radial velocity (31?±?18 mm/s vs. 45?±?33 mm/s, p?<?0.001), and lower peak diastolic circumferential velocity (178?±?124 degree/s vs. 217?±?131 degree/s, p?=?0.005).MRI-derived regional myocardial strain, strain rate and velocity were found to be different between MCI patients and healthy controls. Regional myocardial motion indices have the potential to become novel quantitative imaging biomarkers for representing the risk of neurodegenerative disorders, such as Alzheimer's disease (AD).

Dataset Information

Nicotinic treatment of post-chemotherapy subjective cognitive impairment: a pilot study.

Publications

Nicotinic treatment of post-chemotherapy subjective cognitive impairment: a pilot study.

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