Tamoxefin and memory loss

**MtR** · 02-12-2010, 04:02 PM

THURSDAY, Feb. 11 (HealthDay News) -- The breast cancer drug tamoxifen -- used for three decades to treat the disease -- appears to affect cognitive abilities, including some types of memory, a new study has found.

"Our results are important for breast cancer patients because intact cognitive functioning is known to be an important precondition for well-being," said study author Christien Schilder, a doctoral student at the Netherlands Cancer Institute in Amsterdam.

After a year of taking tamoxifen (Nolvadex), women in the study scored lower on tests of verbal memory functioning and other cognitive skills than did women taking another breast cancer drug, exemestane (Aromasin).

Both drugs are considered hormone (or endocrine) therapy. Tamoxifen interferes with the activity of estrogen, which can promote the growth of breast cancer. Exemestane is an aromatase inhibitor, which decreases estrogen production in postmenopausal women.

Endocrine therapy is offered to many women with breast cancer, and "the choice for a specific endocrine agent and therapy sequence is, among others, based on the safety profile," Schilder said. "Therefore, we think that our results justify continuing research into the cognitive effects of endocrine therapy for breast cancer patients."

Schilder's study, funded by Pfizer, which makes Aromasin, was published online Feb. 8 in the Journal of Clinical Oncology.

For the study, the researchers gave neuropsychological evaluations to 299 women, including 179 with breast cancer. Testing was done at the start of the study and again after the women with breast cancer had had a year of hormone therapy -- 80 women taking tamoxifen and 99 taking exemestane.

The researchers found that tamoxifen users had lower scores in verbal memory and executive functioning -- which includes such things as being able to shift attention between two different parts of a task -- than did women without breast cancer. Women taking exemestane had smaller declines in these two areas, considered not statistically significant, compared with the healthy women, Schilder noted.

Those on tamoxifen also fared worse on information-processing speed than the exemestane users, the researchers found.

No substantial differences were found between any of the three groups in terms of visual memory, working memory, verbal fluency, reaction speed and motor speed, according to the study.

Exactly why the tamoxifen users fared worse is not known, Schilder said. "The mechanisms of action of tamoxifen on the brain are hardly known yet," she said, adding that one possibility is that tamoxifen might counteract possible beneficial action of estrogen on the brain.

Dr. Victor G. Vogel, vice president of research for the American Cancer Society, said the results were not surprising. And though the reason women on tamoxifen had more cognitive decline isn't known, he said a logical though unproven explanation is that "it may just not be good for your brain not to have estrogen."

However, Vogel emphasized that it's important to keep the study results in perspective, noting the life-saving benefits of tamoxifen.

According to the U.S. National Cancer Institute, "the benefits of tamoxifen as a treatment for breast cancer are firmly established and far outweigh the potential risks."

Said Vogel: "I'll take a little memory loss to keep my patients alive

**weldingman** · 02-12-2010, 04:22 PM

Very good info.

**Dark Geared God** · 02-12-2010, 04:33 PM

I forgot waht i was going to say..

**theCaptn'** · 02-12-2010, 06:16 PM

good post

**Glycomann** · 02-12-2010, 09:39 PM

A key component in evaluating this research is the choice of the control population. that can have a dramatic effect on the outcome. For instance the population should be a group of post menopausal women. These effects could easily be related to estrogen deficiency and not directly related to tamoxephin

**heavyiron** · 02-12-2010, 10:10 PM

Wow, very good stuff. looks like they had a control group but I need to read the whole study.

**heavyiron** · 02-12-2010, 10:16 PM

Effects of Tamoxifen and Exemestane on Cognitive Functioning of Postmenopausal Patients With Breast Cancer: Results From the Neuropsychological Side Study of the Tamoxifen and Exemestane Adjuvant Multinational Trial

Christina M. Schilder, Caroline Seynaeve, Louk V. Beex, Willem Boogerd, Sabine C. Linn, Chad M. Gundy, Hilde M. Huizenga, Johan W. Nortier, Cornelis J. van de Velde, Frits S. van Dam, and Sanne B. Schagen*
From the Departments of Psychosocial Research and Epidemiology, Neuro-oncology, and Medical Oncology, Netherlands Cancer Institute; Department of Neurology, Slotervaart Medical Center; Department of Psychology, University of Amsterdam, Amsterdam; Department of Medical Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam; Department of Medical Oncology, Radboud University Medical Center, Nijmegen; and the Departments of Medical Oncology and Surgical Oncology, Leiden University Medical Center, the Netherlands.

* To whom correspondence should be addressed. E-mail: s.schagen@nki.nl

Purpose: To evaluate the influence of adjuvant tamoxifen and exemestane on cognitive functioning in postmenopausal patients with breast cancer (BC).
Patients and Methods: Neuropsychological assessments were performed before the start (T1) and after 1 year of adjuvant endocrine treatment (T2) in Dutch postmenopausal patients with BC, who did not receive chemotherapy. Patients participated in the international Tamoxifen and Exemestane Adjuvant Multinational trial, a prospective randomized study investigating tamoxifen versus exemestane as adjuvant therapy for hormone-sensitive BC.
Results: Participants included 80 tamoxifen users (mean age, 68.7 years; range 51 to 84), 99 exemestane users (mean age, 68.3 years; range, 50 to 82), and 120 healthy controls (mean age, 66.2 years; range, 49 to 86). At T2, after adjustment for T1 performance, exemestane users did not perform statistically significantly worse than healthy controls on any cognitive domain. In contrast, tamoxifen users performed statistically significantly worse than healthy controls on verbal memory (P < .01; Cohen's d = .43) and executive functioning (P = .01; Cohen's d = .40), and statistically significantly worse than exemestane users on information processing speed (P = .02; Cohen's d = .36). With respect to visual memory, working memory, verbal fluency, reaction speed, and motor speed, no significant differences between the three groups were found.
Conclusion: After 1 year of adjuvant therapy, tamoxifen use is associated with statistically significant lower functioning in verbal memory and executive functioning, whereas exemestane use is not associated with statistically significant lower cognitive functioning in postmenopausal patients with BC. Our results accentuate the need to include assessments of cognitive effects of adjuvant endocrine treatment in long-term safety studies.

**Glycomann** · 02-13-2010, 06:56 AM

This could explain my need for spellcheck.

**Pirate!** · 02-13-2010, 07:53 AM

...funded by Pfizer, which makes Aromasin...

**njc** · 02-13-2010, 10:42 AM

Interesting study. For our purposes though I don't think that any of use are running Nolva for an entire year at a time.

**MtR** · 02-13-2010, 02:31 PM

Originally Posted by Pirate!

I saw that too, kind of takes away a little credibility IMO.

**heavyiron** · 02-14-2010, 08:10 AM

Originally Posted by MtR

I saw that too, kind of takes away a little credibility IMO.

Naw, it doesn't matter. It was a controlled study regardless of who paid for the research. This is pretty much common knowledge but no one has actually tested these meds against each other for this purpose until now.

For some time now androgen deficiency has been linked to cognative loss so since Aromasin is a steroidal aromatase inhibitor it is mildly androgenic therefore that mild androgenic property is likely what is causing the cognative function to remain.

**MtR** · 02-15-2010, 06:50 PM

Originally Posted by heavyiron.

Naw, it doesn't matter. It was a controlled study regardless of who paid for the research. This is pretty much common knowledge but no one has actually tested these meds against each other for this purpose until now.

For some time now androgen deficiency has been linked to cognative loss so since Aromasin is a steroidal aromatase inhibitor it is mildly androgenic therefore that mild androgenic property is likely what is causing the cognative function to remain.

I like it...so the more test I intake the smarter I get, intelligence through androgens? Awesome!

j/k...otherwise Ronnie Coleman would be fucking Einstein instead of Michael Clarke Duncan from The Green Mile

**heavyiron** · 02-15-2010, 07:09 PM

Originally Posted by MtR

I like it...so the more test I intake the smarter I get, intelligence through androgens? Awesome!

j/k...otherwise Ronnie Coleman would be fucking Einstein instead of Michael Clarke Duncan from The Green Mile

Keep in mind these studies are often in women who are postmenopausal so they can be VERY androgen deficient to the point of ill effects. If a guy is running T and taking a SERM it does not really apply since he has sufficient androgens. Now if he is in PCT and his T is almost nil your article would have application to the male using the SERM.

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