Peri- and Premenopausal Women More at Risk for Cognitive Impairment After Chemotherapy

AMELIA ISLAND, Florida—Peri- and premenopausal women may be more at risk for cognitive impairment than postmenopausal women as a result of adjuvant chemotherapy for breast cancer, according to preliminary data presented at the American Psychosocial Oncology Society (APOS) Third Annual Conference (abstract P3-5). The finding may help identify a susceptible population to target with intervention, said Tara J. Patton, MSPH, research specialist at the Arizona Health Sciences Center, Tucson.

"Many breast cancer patients say they have less ability to remember things after chemotherapy. We know estrogen is important for cognition, and one of the consequences of chemotherapy can be a premature menopause. We wanted to determine if menopausal status could affect results of memory tests among breast cancer patients who had received adjuvant chemotherapy," Ms. Patton said.

In their study of 41 breast cancer survivors, funded by the Susan G. Komen Breast Cancer Foundation, Ms. Patton and her colleague Kris L. Kaemingk compared women who were premenopausal at diagnosis with those who were peri—menopausal and postmenopausal regarding memory and working memory. All patients had completed chemotherapy at least 1-year prior to the evaluation. The tests given were the the Wechsler Memory Scale-Third Edition (WMS-III) Logical Memory, Rey Auditory Learning Verbal Test (RAVLT), and Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). Memory was also assessed with the WMS-III Logical Memory Ideas Recalled and RAVLT Delayed Recall. The WAIS-III WMI (Working Memory Index) was used to assess working memory. Participants also completed a medical interview that included questions about their menopausal status at diagnosis. Most (24) were postmenopausal, 11 were premenopausal, and 6 were perimenopausal.

Overall, the women who were diagnosed postmenopausally performed the best on all the memory measures. The perimenopausal women performed the worst, and premenopausal women performed intermediately (see Table).

"We were a little surprised that the perimenopausal women tended to do worse. However, this is a preliminary finding, and there were only 6 women in that group. Also, most women don't really know if they are perimenopausal. Some may have been premenopausal, but because they were put into menopause suddenly by chemotherapy, they guessed they were perimenopausal," she said.

Her research in this area is continuing, with the development of an attention intervention targeted specifically at peri- and premenopausal women.