Regional brain activation during verbal declarative memory in metastatic breast cancer.
OBJECTIVE
To determine the neurofunctional basis of verbal memory dysfunction in women with metastatic breast cancer. This objective was based on previous research suggesting memory and other cognitive deficits in this population. We attempted to determine if verbal memory impairments were related to the most commonly studied disease parameters including adjuvant chemotherapy and chronic stress-related disruption of limbic system structures.


METHODS
We used functional magnetic resonance imaging to test our hypothesis that women with breast cancer would show significantly lower brain activation during verbal declarative memory tasks compared with age and education-matched healthy female controls. We also assessed several stress-related variables including diurnal cortisol levels to test our hypothesis that women with breast cancer would show higher stress and this would contribute to brain activation deficits during memory tasks.


RESULTS
Women with breast cancer had significantly lower prefrontal cortex activation during the memory encoding condition compared with controls. However, the breast cancer group showed significantly greater activation than controls during the recall condition in multiple, diffuse brain regions. There were no significant differences between the groups in stress-related variables. Women who were treated with cyclophosphamide, methotrexate, and 5-fluorouracil chemotherapy showed lower prefrontal cortex activation during memory encoding.


CONCLUSIONS
These results suggest that women with metastatic breast cancer may be at risk for verbal memory impairments as a result of altered functional brain activation profiles. These findings may be associated with chemotherapy type and/or other aspects of the breast cancer disease process.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305-5795, USA. skesler@stanford.edu
Shelli R
SR
Kesler
F Chris
FC
Bennett
Misty L
ML
Mahaffey
David
D
Spiegel
D001921:Brain / Q000503:physiopathology; D001943:Breast Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008568:Memory; D008569:Memory Disorders / Q000503:physiopathology*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009483:Neuropsychological Tests; D014705:Verbal Behavior
D006854:Hydrocortisone