Brain Mechanisms of Chemotherapy-Related Cognitive Impairment in Breast Cancer Treated with Acupunc-ture:Based on Resting-State Functional Magnetic Resonance Imaging
Objective To investigate the mechanism of acupuncture in the treatment of chemotherapy-related cognitive impairment(CRCI)of breast cancer based on resting-state functional magnetic resonance imaging(rs-fMRI).Method Twenty-five patients with CRCI of breast cancer were included and treated with the acupuncture based on the method of regulating qi and blood,nourishing mind and benefiting intelligence;the selected acupoints included Zusanli(ST 36,bilateral),Xuehai(SP 10,bilateral),Tanzhong(CV 17),Zhongwan(CV 12),Qihai(CV 6),Baihui(GV 20).Fengfu(GV 16,bilateral),Xinshu(BL 15,bilateral),Tongli(HT 5,bilateral),Zhaohai(KI 6,bilateral),Yixi(BL 45,bilateral)twice a week,each time interval of 2-3 days,for 8 weeks.The scores of Montreal Cognitive Assessment(MoCA),Mini-mental State Examination(MMSE),European Cancer Research and Treatment Organization Quality of Life Questionnaire(EORTC QLQ-C30)were compared before and after acupuncture,and the effectiveness were evaluated by MoCA scale.The patients received rs-fMRI before and after treatment,and used low-frequency oscillation amplitude and functional connectivity(FC)analysis to extract the mean zALFF values of regions of interest such as bilateral anterior cingulate gyrus,bilateral hippocampus,bilateral amygdala,bilateral temporal pole middle temporal gyrus,and bilateral temporal pole supramarginal gyrus for comparison,and used the brain re-gions with statistically significant differences in the pre-and post-treatment zALFF values as the seed points for the seed-point-based FC Analysis.Correlation analyses were performed between the imaging metrics and the clinical scales.Results Twenty-four patients with CRCI of breast cancer completed treatment and follow-up.The zALFF values of the left hippocampus,left amygdala,and left temporal pole temporal gyrus in patients'rs-fMRI decreased after treatment(P＜0.05 or P＜O.01),and left temporal pole temporal gyrus and right posterior cerebellar lobe FC were elevated(t=-5.169),and MoCA scale total scores and visuospatial and executive,naming,and delayed recall cognitive scores,MMSE scale total scores,and EORTC QLQ-C30 scale mood scores were significantly higher(P＜0.05 or P＜0.01).The total effective rate of MoCA was 58.33％.The difference in zALFF values of the left temporal pole middle temporal gyrus before and after treatment was negatively correlated with the MoCA total score(r=-0.499,P=0.015),as well as the difference in abstract function(r=-0.498,P=0.016).Conclusion The acupuncture method of regulating qi and blood,nourishing mind and benefiting intelligence can improve the cognitive function of breast cancer patients with CRCI,and its mechanism may be related to improving the functional activities of hippocampus,amygdala and temporal lobe,as well as the functional connections of left temporal pole-temporal middle gyrus and right posterior cerebellar lobe.
breast canceracupunctureresting-state functional magnetic resonancechemotherapy-related cogni-tive impairment
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