title: Cognitive and brain structural changes in a lung cancer population.
abstract: BACKGROUND
  No study has examined structural brain changes specifically associated with chemotherapy in a lung cancer population. The aim of this cross-sectional study was to assess differences in brain structure between small-cell lung cancer patients (C+) following chemotherapy, non-small-cell lung cancer patients (C-) before chemotherapy and healthy controls (HC).
  
  
  METHODS
  Twenty-eight small-cell lung cancer patients underwent a neuropsychological assessment and a structural magnetic resonance imaging, including T1-weighted and diffusion tensor imaging to examine gray matter density and white matter (WM) integrity, respectively, 1 month following completion of platinum-based chemotherapy. This group was compared with 20 age and education-matched non-small-cell lung cancer patients before receiving chemotherapy and 20 HC.
  
  
  RESULTS
  Both C+ and C- groups exhibited cognitive impairment compared with the HC group. The C+ group performed significantly worse than HC in verbal fluency and visuospatial subtests; C- performed significantly worse than both C+ and HC in verbal memory. Voxel-based morphometry analysis revealed lower gray matter density in the insula and parahippocampal gyrus bilaterally, and left anterior cingulate cortex in C+ compared with HC. Diffusion tensor imaging indices showed focal decreased WM integrity in left cingulum and bilateral inferior longitudinal fasciculus in the C+ group and more widespread decreased integrity in the C- group compared with the HC group.
  
  
  CONCLUSIONS
  This study demonstrates that lung cancer patients exhibit cognitive impairment before and after chemotherapy. Before the treatment, C- showed verbal memory deficits as well as a widespread WM damage. Following treatment, the C+ group performed exhibited lower visuospatial and verbal fluency abilities, together with structural gray matter and WM differences in bilateral regions integrating the paralimbic system.
authors.affiliation: *Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; †Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Duran i Reynals, L'Hospitalet del Llobregat, Barcelona, Spain; ‡Department of Psychiatry and Behavioral Sciences, Neurocognitive Research Laboratory, Memorial Sloan-Kettering Cancer Center, New York, New York; §Radiation Oncology Department, Hospital Germans Trias i Pujol, ICO Badalona, Barcelona, Spain; Departments of ‖Radiation Oncology and ¶Medical Oncology, Lung Cancer Unit, ICO Duran i Reynals, L'Hospitalet del Llobregat, Barcelona, Spain; #Department of Basic Psychology, Campus Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; and **Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Simó
authors.forename: James C
authors.initials: JC
authors.lastname: Root
authors.forename: Lucía
authors.initials: L
authors.lastname: Vaquero
authors.forename: Pablo
authors.initials: P
authors.lastname: Ripollés
authors.forename: Josep
authors.initials: J
authors.lastname: Jové
authors.forename: Tim
authors.initials: T
authors.lastname: Ahles
authors.forename: Arturo
authors.initials: A
authors.lastname: Navarro
authors.forename: Felipe
authors.initials: F
authors.lastname: Cardenal
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruna
authors.forename: Antoni
authors.initials: A
authors.lastname: Rodríguez-Fornells
mesh_terms: D001921:Brain / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies