Cognitive Dysfunction and AIs
This is a twist on the usual discussion about cognitive dysfunction/chemobrain for women receiving (or who have received) chemotherapy. For years, I have heard from women who were taking hormonal treatments that they believed they, too, had some congitive issues. It is always impossible to sort out what might be due to normal aging, diminishment of estrogen, stress, and what is directly attributable to the medication.
This summary from MedScape does not really answer any questions, but it nicely lays out the problems and is a good educational tool. Here is the introduction and abstract and then a link to read more:
Abstract and Introduction
As mortality in breast cancer patients has improved, morbidity of treatment has become increasingly important. Cognitive dysfunction has been considered as a morbid condition that may possibly result from aromatase inhibitor therapy, the standard treatment in postmenopausal, estrogen/progesterone receptor-positive breast cancer patients. Chemotherapy has been associated with cognitive dysfunction through neuropsychological testing and neurological functional imaging, but the relationship between estrogen and cognition remains largely unexplained. In focusing on aromatase inhibitor therapy, most of the studies yielding mixed results have been limited by confounders and small numbers of populations studied. This article briefly summarizes the major studies evaluating aromatase inhibitor therapy and cognitive dysfunction while considering new directions in future study design.
Aromatase inhibitors (AIs) have emerged as the standard therapy for postmenopausal patients with estrogen/progesterone receptor-positive breast cancer. As adjuvant therapy, treatment is typically recommended for approximately 5 years. Endocrine therapy decreases annual recurrence odds by 39% and annual odds of death by 31%, irrespective of the use of chemotherapy, patient age, menopausal status and axillary lymph node status, but this benefit must be balanced with treatment side effects, one of those possibly being cognitive decline. As mortality has improved, the issues of treatment-related morbidity have grown increasingly more important in breast cancer survivors. Cognition impairment from AI therapy will become more of an issue to consider as clinical trials are looking at the role of AI beyond 5 years.