Author Interviews, Breast Cancer, Cancer Research, Cognitive Issues / 20.01.2020
PPIs Linked to Worse Cognitive Issues in Breast Cancer Survivors
MedicalResearch.com Interview with:
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Annelise Madison[/caption]
Annelise Madison
Lead author of the study
Graduate Student in Clinical Psychology
Ohio State
MedicalResearch.com: What is the background for this study?
Response: Recently, there have been some reports of cognitive problems among those using proton pump inhibitors (PPIs). Some breast cancer survivors use PPIs during and after treatment to manage gastrointestinal side effects of cancer treatment or to prevent damage to the gut lining.
We were interested in whether PPI use among breast cancer survivors related to cognitive problems. We conducted secondary analyses on data from three studies with breast cancer survivors. We found that breast cancer survivors taking PPIs reported cognitive problems that were between 20-29% worse than those reported by non-users.
Annelise Madison[/caption]
Annelise Madison
Lead author of the study
Graduate Student in Clinical Psychology
Ohio State
MedicalResearch.com: What is the background for this study?
Response: Recently, there have been some reports of cognitive problems among those using proton pump inhibitors (PPIs). Some breast cancer survivors use PPIs during and after treatment to manage gastrointestinal side effects of cancer treatment or to prevent damage to the gut lining.
We were interested in whether PPI use among breast cancer survivors related to cognitive problems. We conducted secondary analyses on data from three studies with breast cancer survivors. We found that breast cancer survivors taking PPIs reported cognitive problems that were between 20-29% worse than those reported by non-users.
Dr. Halima Amjad[/caption]
Halima Amjad, MD, MPH
Post-doctoral Fellow
Johns Hopkins University School of Medicine
Division of Geriatric Medicine and Gerontology
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Amjad: Safety is an important aspect of dementia care. Dementia is underdiagnosed, however, and there is limited understanding of safety issues in people with undiagnosed dementia. We wanted to better understand potentially unsafe activities and living conditions in all older adults with dementia and specifically examine these activities in undiagnosed dementia. We found that in all study participants with probable dementia, the prevalence of driving, cooking, managing finances, managing medications, or going to physician visits alone was over 20%. The prevalence was higher in older adults with probable dementia without a diagnosis, and even after accounting for sociodemographic, medical, and physical impairment factors, the odds of engaging in these activities was over 2.0 in undiagnosed versus diagnosed probable dementia. Potentially unsafe living conditions including unmet needs and performance on cognitive tests were similar between these groups.
Dr. Zhenmei Zhang[/caption]
Zhenmei Zhang, Ph.D.
Associate Professor
Department of Sociology
Michigan State University
East Lansing, MI48824
MedicalResearch.com: What is the background for this study?
Dr. Zhang: Blacks are especially hard hit by cognitive impairment and dementia. Recent estimates of dementia prevalence and incidence were substantially higher for blacks than whites. Reducing racial/ethnic disparities in dementia has been identified as a national priority by the National Alzheimer’s Project Act, which was signed into law by President Obama in 2011. So I really want to contribute to the ongoing discussion of the origins and pathways through which racial disparities in cognitive impairment is produced. If we have a better understanding of the factors contributing to racial disparities in cognitive impairment in later life, more effective interventions can be conducted to reduce the racial disparities.
Dr. Michael Johnson[/caption]
Michael A. Johnson Ph.D
Associate Professor
Department of Chemistry
University of Kansas
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Johnson: We undertook these studies because chemotherapy induced cognitive dysfunction, also known as ‘chemobrain’, has become a major health issue in recent years. For example, up to a third of patients who have undergone chemotherapy treatment for breast cancer have reported symptoms of chemobrain. These symptoms may include loss of verbal and visual memory as well as decreased mental flexibility and difficulty focusing.
For this study, we wanted to understand how treatment with chemotherapeutic agents affects the ability of neurons to communicate. An impairment of neurotransmitter release would imply that communication is hindered. This inability to communicate normally could contribute to cognitive dysfunction.
We initially measured the release of dopamine in a region of the brain called the striatum. Our measurement of dopamine in this region was motivated by two key issues: its importance in cognitive function and our ability to measure it with high temporal resolution. From a cognitive standpoint, dopamine is important because the striatum helps translate signals, received from the cortex, into plans by forwarding wanted signals to other parts of the brain and suppressing unwanted signals. Fortunately, we can easily measure dopamine release using an electrochemical technique called fast-scan cyclic voltammetry. This method allows us to not only measure how much dopamine is released from a living brain slice, but also it affords us the capability to measure how quickly dopamine is taken back up. We also measured serotonin release using this method.
Our main finding was that the ability of neurons to release dopamine was impaired after carboplatin treatment. We also found that serotonin release was similarly impaired. These release impairments corresponded to a decrease in cognitive ability of the treated rats.
Dr. Bo Qin[/caption]
Bo (Bonnie) Qin, Ph.D.
Postdoctoral Scholar
Rutgers Cancer Institute of New Jersey
New Brunswick, NJ 08903
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Qin: Preventing or delaying the age-related cognitive decline that typically precedes the onset of dementia is particularly important considering that no effective strategies for dementia treatment have been identified. Vascular conditions such as hypertension are thought to be risk factors for cognitive decline, but important gaps in the literature on this topic remain.
Randomized clinical trials of blood pressure-lowering treatments for reducing the risk of cognitive decline or dementia have largely failed to achieve beneficial effects. However, over the past 6 years, scientific evidence has accumulated that blood pressure variability over monthly or yearly visits may lead to greater risk of stroke and small and larger vessel cerebrovascular diseases. They could lead to subsequent changes related to cognitive dysfunction among older adults. We, therefore, hypothesized that blood pressure variability between visits is associated with a faster rate of cognitive function among older adults.
