|Title:||Neurocognitive function deficits and the associated brain networks in patients with gynecological cancer|
|Subject:||Hong Kong Polytechnic University -- Dissertations|
Generative organs, Female -- Cancer -- Patients
|Pages:||xii, 121 pages : color illustrations|
|Abstract:||Objectives: The objectives of this study were (1) to explore Chinese gynecological cancer patients' perceived neurocognitive complaints and relevant supportive care needs after primary cancer treatment; (2) to assess neurocognitive functioning, structural and functional brain networks in Chinese gynecological cancer patients pre- and post-chemotherapy; (3) to examine the possible neural mechanism of neurocognitive function deficits in gynecological cancer patients. Methods: This study was divided into two parts (mixed qualitative and quantitative study components) and three study stages. The first stage of this study used a qualitative approach to explore neuropsychological issues among Chinese gynecological cancer patients. Based on the first stage findings, the study's second stage adopted a longitudinal approach to detect neurocognitive function deficits of gynecological cancer patients, and functional brain network changes in Chinese gynecological cancer patients at pre- and post-chemotherapy, while additionally including age-matched healthy subjects as the control group. In order to explore the possible neurobiological basis of CRCI, the final study stage used a multimodal magnetic resonance imaging approach to assess changes in brain networks, and neurochemical properties of patients pre- and post-chemotherapy. Results: A total of 31 gynecological cancer patients were recruited in the qualitative study stage. Of that total, 20 women (64.5%) reported cognitive complaints after cancer treatment. The most common neurocognitive complaint was loss of concentration (n=17, 85.0%). Perceived contributing factors to these neurocognitive complaints included chemotherapy (n=15, 75.0%), and aging (n=8, 40.0%). These cognitive problems most commonly impacted daily living (n=20, 100%). The findings of first study stage indicated that cognitive complaints and neuropsychological problems have greatly impacted these women's daily lives, social functioning and quality of life. Hence, the second study stage focused on the detection of neuropsychological problems in gynecological cancer patients. This study stage recruited 40 subjects, with 20 subjects in each group (gynecological cancer patients versus healthy controls). Results of the second study stage found that 35% of patients had mild neurocognitive function deficits at the time of cancer diagnosis, and neuropsychological measures were significantly associated with functional brain networks. During the post-chemotherapy assessment, there were significant differences in the mean scores of neurocognitive tests (including digit span tests, verbal memory, and psychomotor speed tests) (all Ps < 0 .05). Longitudinal graph analysis revealed statistically significant differences in the patient group, with significant decreases in both local efficiency (P < 0.01) and global efficiency (P = 0.04). Lower raw TMT-A scores were significantly associated with lower local efficiency (r = 0.37, P = 0.03). Lower verbal memory scores were statistically significant and associated with lower global efficiency (r = 0.54, P = 0.02) in the patient group, but not in the healthy control group. Using magnetic resonance spectroscopy in the final study stage, there was a significant decrease of relative concentration in NAA (N-acetylaspartate) in the patient group, in comparison with healthy controls. Diffusion tensor imaging data indicated that the global and local connectome properties in the patient group were lower than in the healthy controls. Hence, on a microstructural level, the possible underlying mechanism of CRCI may be attributed to an increase in demyelination and a reduction of the neuronal viability of white matter in the hippocampus.|
Conclusions: This study demonstrated there is a growing body of research on neurocognitive complaints in women with gynecological cancer. The qualitative part of this study improved understanding of neurocognitive complaints, which could subsequently facilitate the development of relevant therapeutic interventions for the prevention of neurocognitive function deficits in this study population. The quantitative part of this study found that the risk of functional brain networks and neurocognitive function changes following chemotherapy could potentially guide patients in making appropriate treatment decisions, and help healthcare professionals prioritize patients for early intervention. By using a multimodal imaging approach, the quantitative study also provides novel insights into the neurobiological basis of neurocognitive function deficits in the human brain that have been induced by cancer and/or its treatment.
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