Katharine Vearncombe

Is cognitive functioning detrimentally affected after early, induced menopause?

Objective: Investigations into the cognitive effects of surgically and chemically induced menopause are frequently combined with naturally occurring menopause and hormone therapy. However, there is some evidence that women who undergo surgical menopause may experience more cognitive decline post surgery as well as more benefit from subsequent hormone therapy use than women who experience naturally occurring menopause. Little is known about the effects of chemically induced menopause on cognitive function. The aim of this review was to examine whether premature menopause affects cognitive functioning. Design: PubMed, MEDLINE, and PsychINFO searches of the literature published from 1988 to 2007 pertaining to the understanding of the relationships between induced menopause and cognitive dysfunction were reviewed. Those combining induced menopause with natural menopause, those involving a disease process (eg, dementia), and animal studies were excluded. Results and Conclusions: Although smaller prospective studies have found that surgical menopause is associated with specific deficits in the memory (visual and verbal) and verbal fluency domains, larger randomized, controlled trials have generally found no effect of surgical menopause on cognitive functioning. The effects of chemical menopause are harder to assess as only three prospective trials have explicitly investigated the effect of induced menopause in the context of breast cancer treatment, and the results remain inconclusive. However, as surgical and chemical menopause both comprise the abrupt withdrawal of estrogen, there is the potential that this process may exert neurobiological effects that are different from those occurring with natural menopause and further prospective investigations comprising pre- and postsurgical/chemotherapy neuropsychological assessments are warranted.

Cognitive effects of chemotherapy-induced menopause in breast cancer

This study examined whether chemotherapy-induced menopause affects cognitive functioning in women with early breast cancer. The neuropsychological performance of 121 breast cancer patients (age M = 49.62, SD = 8.11, range = 25.25–67.92) treated with chemotherapy was assessed pre-chemotherapy, as well as 1, 6, and 18 months post-chemotherapy completion. Linear mixed modeling was used to evaluate the data. Type of menopause (pre, chemotherapy-induced, and post menopause) was found to significantly interact with cognitive performance on two cognitive variables. Specifically, chemotherapy-induced menopausal women did not show any significant changes in performance on an abstract reasoning task, while the pre-menopausal and post-menopausal groups significantly improved over time. A significant interaction on a test of finger dexterity and coordination was also found, although inspection of the results indicated that this was due to a significant improvement in the pre-menopausal groups at 6 months post chemotherapy. After chemotherapy most cognitive variables showed improvements over time, although two indicators of verbal memory showed significant declines immediately after chemotherapy, with improvement by 18 months post completion. The current study found little evidence to suggest that chemotherapy-induced menopause broadly affects cognitive functioning after treatment administration. However, longer follow-up assessments are warranted to assess the long-term effects of combined chemotherapy and endocrine treatment.

Predictors of financial capacity performance in older adults using the Financial Competence Assessment Inventory

BACKGROUND Declines in financial capacity in later life may arise from both neurocognitive and/or psychiatric disorders. The influence of socio-demographic, cognitive, health, and psychiatric variables on financial capacity performance was explored. METHODS Seventy-six healthy community-dwelling adults and 25 older patients referred for assessment of financial capacity were assessed on pertinent cognitive, psychiatric, and financial capacity measures, including Addenbrookes Cognitive Examination - Revised (ACE-R), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), selected Neuropsychiatric Inventory (NPI) items, Financial Competence Assessment Inventory (FCAI), and Social Vulnerability Scale (SVS). RESULTS The internal consistency of the debt management subscale of the FCAI was relatively poor in our sample. Financial capacity performance differed between controls and patients. In our sample, performance on the FCAI was predicted by Mini-Mental State Examination, IQCODE, and GAI, but not by ACE-R, GDS, NPI items, or SVS (adjusted R(2) = 0.7059). CONCLUSIONS Anxiety but not depression predicted financial capacity performance, possibly reflecting relatively low variance of depressive symptoms in this sample. Current cognitive decline as measured by the informant-rated IQCODE was more highly correlated to financial capacity than either educational attainment or ACE-R scores. Lack of significance of ACE-R data may reflect the instruments decreased sensitivity to domains relevant to financial capacity, compared with more detailed neuropsychological assessment tools. The FCAI displayed fairly robust psychometric properties apart from the debt management subscale.

Promoting the use of enduring powers of attorney in older adults: A literature review

This review aims to identify factors that facilitate the establishment of enduring powers of attorney (EPOAs), and those that create a barrier to their establishment. The primary aim was to provide guidance about how to encourage future planning while people are cognitively able to make such important decisions. A detailed search of the literature was conducted to identify research looking at the motivating factors behind putting future‐planning strategies in place. The literature highlighted a number of broad areas motivating the establishment of EPOAs, including: demographic factors; intrapersonal and personality factors; health and psychological factors; cognitive factors; and socio‐emotional factors. While a number of factors play a role in determining whether or not a person establishes an EPOA, the factor most malleable to change is the awareness and knowledge of older adults and their families regarding the utility of EPOAs.

Impact of health, treatment and psychological factors on cognitive functioning after chemotherapy for early breast cancer

The aim of the current study was to review the extent that physical health, treatment and psychological factors contribute to cognitive dysfunction after chemotherapy for breast cancer. PubMed, Medline and PsychINFO searches of the literature published from 1995 to 2008 pertaining to chemotherapy for breast cancer and cognitive dysfunction were reviewed. There is currently insufficient evidence available to evaluate the effect of indirect factors (health, treatment and psychological) on cognitive functioning after chemotherapy. Fatigue and changes in endocrine function are the most frequently investigated factors, although conclusions are limited due to methodological shortcomings. The impact of other health and treatment factors has been inadequately addressed, with many variables examined in only one of the 22 reviewed studies. Importantly, although depression and anxiety can significantly influence neuropsychological test performance, mood has been inconsistently measured and analysed in regards to cognitive performance in this literature. In addition, indirect factors may affect cognitive domains differently, requiring further investigation of specific domains after chemotherapy. Because chemotherapy can negatively affect numerous organ systems and as yet no systematic investigations of health, treatment or psychological factors have been conducted, the authors conclude that it is currently premature to attribute all cognitive change after chemotherapy treatment to cytotoxic drugs.

Latent class piecewise linear trajectory modelling for short-term cognition responses after chemotherapy for breast cancer patients

This paper investigates the impact of chemotherapy on cognitive function of breast cancer patients and whether this response is homogeneous for all patients. Latent class piecewise linear trajectory (growth) models were employed to describe changes and identify subgroups in three Auditory Verbal Learning Test measures (learning, immediate retention and delayed recall) in 130 breast cancer patients taken at three time periods: before chemotherapy and 1 and 6 months post-chemotherapy. Two distinct subgroups of women exhibiting different patterns of response were identified for learning and delayed recall and three for immediate retention. The groups differed in level (intercept) at 1 month post-chemotherapy and patterns of decline and recovery. Binomial and multinomial logistic regressions on the latent classes found that age, initial National Adult Reading Test (NART)-predicted IQ, stage of cancer and the initial Functional Assessment of Cancer Therapy-Breast subscale (or subsets thereof) to be significant predictors of classes.

Memory loss after adjuvant chemotherapy for breast cancer: a preliminary analysis of mediating variables utilizing cross-sectional correlations and multilevel longitudinal analysis

General Sessions [#11-82] S5–S23 Poster Discussion Sessions [#101-511] S24–S40 Poster Session I [#1001-1119] S41–S83 Poster Session II [#2001-2121] S84–S125 Poster Session III [#3001-3113] S126–S165 Poster Session IV [#4001-4117] S166–S206 Poster Session V [#5001-5119 (excl. 5015)] S207–S246 Poster Session VI [#6001-6119 plus 5015] S247–S287 Author index for abstracts S288–S302

The utility of the social vulnerability scale as a predictor of financial capacity in dementia patients

Abstract from the International Psychogeriatric Association Reinventing Aging through Innovation 15th International Congress, 6-9 September 2011, The Hague, Netherlands.Use of prescription medications for various conditions is highly prevalent in older adults, often leading to the use of multiple medications. The resulting polypharmacy is widely recognized as a risk factor for many negative outcomes, but less is known about the risks of specific types of medication upon cognitive functions. Benzodiazepines are commonly prescribed for the treatment of anxiety and insomnia, among other conditions. While dependency with continued use has been the subject of much concern over this type of medication, other literature has suggested an increased risk of cognitive impairment with chronic use of benzodiazepines. The nature of the cognitive changes and the domains of cognitive function most likely to be affected have differed across various studies. Here we describe the associations between measures of various domains of cognitive functioning and benzodiazepine use in 2879 older Canadian adults from the Canadian Study of Health and Aging (CSHA; 64.3% female, mean age 81.0 years, SD=7.44). These people underwent a comprehensive medical and psychosocial evaluation that included a record of medications used, in addition to a complete personal and medical history. The CSHA was a community-based epidemiological study of the prevalence of dementia and its associated risk factors in over 10,000 Canadians. Benzodiazepines were classified according to their half-life: short (under 12 hours), medium (12 to 40 hours) or long half-life (over 40 hours); 35 elderly people were excluded since they were taking more than one class of benzodiazepine. A comprehensive neuropsychological battery that assessed the major domains of cognitive functioning was administered to all participants who completed the CSHA clinical assessment. Neuropsychological test scores for the domains of short- and long-term memory, abstract reasoning, judgement, visuoconstruction, and language formed were the primary independent variables, while gender, age, and years of education were used as covariates in logistic regression models predicting use of each class of drug. Education was not a significant covariate for any analysis. Gender proved to be a significant covariate in the case of the medium-half life drugs, but not for the other two classes. Age was a significant covariate for the majority of test scores for the short and long half-life drugs. After controlling for the covariates, the results showed a broader range of cognitive impairments with the use of short half-life benzodiazepines than with the medium half-life or the long half-life benzodiazepine compounds. Six cognitive measures, assessing abstract reasoning and comprehension, verbal fluency, verbal memory, and visuoconstruction skills (BlockDesign), showed poorer performance among those who used short half-life benzodiazepines, two measures, those of abstract reasoning and comprehension, showed impaired performance by those using medium half-life benzodiazepines, and three measures, for abstract reasoning, verbal memory, and visuoconstruction skills, showed lower performance by those taking long halflife benzodiazepines. Wechsler Similarities, the measure of abstract reasoning, was the only showing significant differences common across all three drug class models. Results are discussed in terms of both the relative extent of lower neuropsychological test scores and the context of increasing evidence of impaired functioning associated with benzodiazepine use.