title: Cognitive impairment in the first year after breast cancer diagnosis: A prospective cohort study.
abstract: OBJECTIVE
  The objective of this study was to assess the relation between cancer treatments and incident cognitive impairment in breast cancer patients, taking into account the levels of anxiety before treatment.
  
  
  METHODS
  We conducted a prospective cohort study with 418 newly diagnosed breast cancer patients with no cognitive impairment, defined as values at least 1.5 standard deviations below age- and education-adjusted cut-offs in the Montreal Cognitive Assessment (MoCA), at baseline. The Hospital Anxiety and Depression Scale and MoCA were used for evaluations before treatment and at 1-year after diagnosis. We used Poisson regressions to compute adjusted relative risks (RR) and corresponding 95% confidence intervals (95%CI) to identify predictors of cognitive impairment.
  
  
  RESULTS
  The median (Percentile 25, Percentile 75) MoCA score before treatment was 24 (21, 26). A total of 8.1% (95%CI: 5.8, 11.2) of the patients presented incident cognitive impairment during the follow-up. There was a statistically significant interaction between anxiety at baseline and the effect of chemotherapy on the incidence of cognitive impairment (P for interaction = 0.028). There was a significantly increased risk of incident cognitive impairment among patients with no anxiety prior to treatment with schemes including doxorubicin and cyclophosphamide (adjusted RR = 4.22, 95%CI: 1.22, 14.65).
  
  
  CONCLUSIONS
  There was a statistically significant association between chemotherapy and cognitive impairment, but only among women with no anxiety at baseline.
authors.affiliation: Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal.
authors.forename: Mariana
authors.initials: M
authors.lastname: Ramalho
authors.affiliation: ISPUP - EPIUnit, Universidade do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Fontes
authors.affiliation: ISPUP - EPIUnit, Universidade do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Ruano
authors.affiliation: ISPUP - EPIUnit, Universidade do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal; Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, 4200-075, Porto, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Pereira
authors.affiliation: ISPUP - EPIUnit, Universidade do Porto, Rua das Taipas, nº135, 4050-600, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. Electronic address: nlunet@med.up.pt.
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology*; D060825:Cognitive Dysfunction / Q000453:epidemiology* / Q000209:etiology; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016012:Poisson Distribution; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012306:Risk; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents
keywords: Antineoplastic protocols; Anxiety; Breast cancer; Cognition disorders