***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To examine the impact of age and cognitive reserve on cognitive functioning in patients with breast cancer who are receiving adjuvant treatments .  PATIENTS AND METHODS Patients with breast cancer exposed to chemotherapy ( n = 60 ; mean age , 51.7 years ) were evaluated with a battery of neuropsychological and psychological tests before treatment and at 1 , 6 , and 18 months after treatment . Patients not exposed to chemotherapy ( n = 72 ; mean age , 56.6 years ) and healthy controls ( n = 45 ; mean age , 52.9 years ) were assessed at matched intervals . RESULTS Mixed-effects modeling revealed significant effects for the Processing Speed and Verbal Ability domains . For Processing Speed , a three-way interaction among treatment group , age , and baseline cognitive reserve ( P < .001 ) revealed that older patients with lower baseline cognitive reserve who were exposed to chemotherapy had lower performance on Processing Speed compared with patients not exposed to chemotherapy ( P = .003 ) and controls ( P < .001 ) . A significant group by time interaction for Verbal Ability ( P = .01 ) suggested that the healthy controls and no chemotherapy groups improved over time . The chemotherapy group failed to improve at 1 month after treatment but improved during the last two follow-up assessment s. Exploratory analyses suggested a negative effect of tamoxifen on Processing Speed ( P = .036 ) and Verbal Memory ( P = .05 ) in the no-chemotherapy group . CONCLUSION These data demonstrated that age and pretreatment cognitive reserve were related to post-treatment decline in Processing Speed in women exposed to chemotherapy and that chemotherapy had a short-term impact on Verbal Ability . Exploratory analysis of the impact of tamoxifen suggests that this pattern of results may be due to a combination of chemotherapy and tamoxifen BACKGROUND Owing to its neurotoxicity , allogeneic hematopoietic stem cell transplantation ( HSCT ) carries risks for cognitive impairment . In this multicenter study , we prospect ively evaluated cognitive functioning and its medical and demographic correlates in patients undergoing allogeneic HSCT .  METHODS A total of 102 patients were consecutively assessed prior to ( T0 ) , 100 ± 20 days ( T1 ) after , and 12 ± 1 months ( T2 ) after HSCT ( 61 % men , 41 % acute myeloid leukemia ) . A comprehensive neuropsychological test battery was applied to evaluate attention , memory , executive function , and fine motor function , summing up into 14 test scores . RESULTS Before and after HSCT , patients performed below test norms in up to 50 % of the test scores . Patients were mostly impaired on word fluency ( 24 % , T0 ) , fine motor function , and verbal delayed recall ( 19 % each , T2 ) . Impairment on ≥ 1/5 cognitive domains occurred in 47 % ( T0 ) and 41 % ( T2 ) of the patients . Performance ( mean z-scores ) partially improved over time ( i.e. , visual span forward , verbal learning , and word fluency ) . However , from baseline to T2 , 16 % of the patients showed reliable decline on ≥ 3/14 test scores ( reliable change index method ) . For the majority of neuropsychological subtests , no associations with conditioning intensity , total body irradiation , graft-versus-host disease , cyclosporine treatment , and length of hospital stay were found . Age and premorbid intelligence level were consistently associated with cognition . CONCLUSIONS Below average cognitive performance is common in this patient group . In addition , a subgroup shows reliable cognitive decline after allogeneic HSCT . Healthcare professionals should be aware of these treatment-related cognitive side effects PURPOSE Prospect i ve evaluation of chronic radiation effects on the healthy adult brain using neuropsychological testing of intelligence , attention , and memory . METHODS AND MATERIAL S 58 patients ( 43 + /- 10 yr ) undergoing hyperfractionated total body irradiation ( TBI ) ( TBI , 14.4 Gy , 12 x 1.2 Gy in 4 days ) before bone marrow or peripheral blood stem cell transplantation  were prospect ively included . Twenty-one recurrence-free long-term survivors were re-examined 6 - 36 months ( median 27 months ) after completion of TBI . Neuropsychological testing included assessment of general intelligence , attention , and memory using normative , st and ardized psychometric tests . Mood status was controlled , as well . Test results are given as IQ scores ( population mean 100 ) or percentiles for attention and memory ( population mean 50 ) . RESULTS The 21 patients showed normal baseline test results of IQ ( 101 + /- 13 ) and attention ( 53 + /- 28 ) , with memory test scores below average ( 35 + /- 21 ) . Test results of IQ ( 98 + /- 17 ) , attention ( 58 + /- 27 ) , and memory ( 43 + /- 28 ) showed no signs of clinical ly measurable radiation damage to higher CNS ( central nervous system ) functions during the follow-up . The mood status was improved . CONCLUSION The investigation of CNS toxicity after hyperfractionated TBI showed no deterioration of test results in adult recurrence-free patients with tumor-free CNS . The median follow-up of 27 months will be extended PURPOSE Research has documented cognitive deficits both before and after high-dose treatment followed by allogeneic hematopoietic cell transplantation ( HCT )  , with partial recovery by 1 year . This study prospect ively examined the trajectory and extent of long-term cognitive dysfunction , with a focus on 1 to 5 years after treatment . PATIENTS AND METHODS  Allogeneic HCT recipients completed st and ardized neuropsychological tests including  information processing speed ( Trail Making A and Digit Symbol Substitution Test )  ,  verbal memory ( Hopkins Verbal Learning Test-Revised )  ,  executive function ( Controlled Oral Word Association Test and Trail Making B )  , and  motor dexterity and speed ( Grooved Pegboard ) .  Survivors ( n = 92 ) were retested after 80 days and 1 and 5 years after transplantation . Case-matched controls ( n = 66 ) received testing at the 5-year time point . A Global Deficit Score ( GDS ) summarized overall impairment . Response profiles were analyzed using linear mixed effects models . RESULTS Survivors recovered significant cognitive function from post-transplantation ( 80 days ) to 5 years in all tests ( P < .0001 ) except verbal recall ( P > .06 ) . Between 1 and 5 years , verbal fluency improved ( P = .0002 ) , as did executive function ( P < .01 ) , but motor dexterity did not ( P > .15 ) , remaining below controls ( P < .0001 ) and more than 0.5 st and ard deviation below population norms . In GDS , 41.5 % of survivors and 19.7 % of controls had mild or greater deficits ( NcNemar test = 7.04 , P = .007 ) . CONCLUSION Although neurocognitive function improved from 1 to 5 years after HCT , deficits remained for more than 40 % of survivors . Risk factors , mechanisms and rehabilitation strategies need to be identified for these residual deficits Longitudinal data of neurocognitive functions and quality of life ( QOL ) were obtained for a cohort of 25 patients followed before transplant and through the first year after haematopoietic stem cell transplantation ( SCT ) .  A battery of neuropsychological tests and two self-report question naires were used to assess neurocognitive functions , QOL and psychological functioning . In comparison to normative data , up to one-fourth of the patients experienced impaired functioning on several cognitive domains before SCT . R and om regression modelling revealed a slight improvement in the mean group scores of memory tasks over time , especially for younger patients .  Impairment in neurocognitive functions was positively related to depression and anger at baseline , and to the emotional functioning scale at follow-up . These preliminary results emphasize the significance of a pre-treatment assessment and the need of a large baseline sample in future longitudinal studies to overcome the expected dropout rate of more than 50 % PURPOSE Total body irradiation ( TBI ) in preparation for bone marrow transplantation ( BMT ) is a routine treatment of hematological malignancy . A retrospective and a prospect i ve group study of long-term cerebral side effects was performed , with a special emphasis on neurobehavioral toxicity effects . METHODS AND MATERIAL S Twenty disease-free patients treated with hyperfractionated TBI ( 14.4 Gy , 12 x 1.2 Gy , 4 days ) , 50 mg/kg cyclophosphamide , and autologous BMT ( mean age 38 years , range 17 - 52 years ; age at TBI 35 years , 16 - 50 years ; follow-up time 32 months , 9 - 65 months ) participated in a neuropsychological , neuroradiological , and neurological examination . Data were compared to 14 patients who were investigated prior to TBI . Eleven patients with renal insufficiencies matched for sex and age ( 38 years , 20 - 52 years ) served as controls . In a longitudinal approach , neuropsychological follow-up data were assessed in 12 long-term survivors ( 45 years , 23 - 59 years ; follow-up time 8.8 years , 7 - 10.8 years ; time since diagnosis 10.1 years , 7.5 - 14.2 years ) . RESULTS No evidence of neurological deficits was found in post-TBI patients except one case of peripheral movement disorder of unknown origin . Some patients showed moderate brain atrophy . Neuropsychological assessment showed a subtle reduction of memory performance of about one st and ard deviation . Cognitive decline in individual patients appeared to be associated with pretreatment ( brain irradiation , intrathecal methotrexate ) . Ten-years post disease onset , survivors without pretreatment showed behavioral improvement up to the premorbid level . CONCLUSION The incidence of long-term neurobehavioral toxicity was very low for the present TBI/BMT regimen During bone marrow or haematopoietic stem-cell transplantation ( HSCT ) , potentially neurotoxic treatments are used . Previous studies identified cognitive disturbances in patients treated with HSCT  , but prospect i ve studies with longitudinal assessment are sparse . We examined cognitive functions up to 20 months after a first baseline assessment in 101 patients undergoing HSCT and in 82 reference patients with a haematological malignancy treated with non-myeloablative cancer therapies .  Baseline findings revealed no between-group differences and demonstrated mild cognitive impairments in both groups . Follow-up analyses showed no significant changes over time , though poorer performance in attention and executive function , and psychomotor function was found in HSCT patients . Our results suggest limited HSCT-related cognitive dysfunctions . Additional follow-up is necessary to assess long-term effects The growing numbers of survivors of innovative cancer treatments  , such as hematopoietic stem cell transplantation ( HSCT )  , often report subsequent cognitive difficulties . The objective of this study was to evaluate and compare neurocognitive changes in patients with chronic myelogenous leukemia ( CML ) or primary myelodysplastic syndrome ( MDS ) after allogeneic HSCT or other therapies Objective : To determine the spectrum and frequency of neurologic sequelae after  allogeneic bone marrow transplantation ( BMT )  and to define a risk profile of the patients . Methods : A prospect i ve follow-up of 71 allogeneic bone marrow recipients 14 ± 3 months after transplantation . Patients underwent a neurologic examination , a neuropsychological test battery , and cranial MRI before and after BMT . Results : A large proportion of patients ( 65 % ) developed sequelae after BMT .  Acute complications of defined etiology occurred in 18 % of the patients and led to death in 9 % of the study population . A total of 47 % of the patients developed new neurologic abnormalities of undefined origin that were mild and subacute and predominantly affected the peripheral nervous system . The cognitive and neuroradiologic outcome was favorable in a majority of these patients , but a small subgroup exhibited cognitive deterioration and white matter lesions . Risk factor analysis identified acute graft-versus-host disease ( GvHD ) and other variables partly related to GvHD such as long-lasting immunosuppression as the main predictors of sequelae after allogeneic BMT . The authors have established an association with various factors but , owing to the observational character of this study , conclusions about the etiology of the findings are unclear . Conclusion : Neurologic complications significantly contribute to the morbidity and mortality of patients receiving allogeneic BMT .  Sub clinical abnormalities , cognitive deficits , and white matter lesions detected 1 year after BMT in a subgroup of patients may be related to more extensive CNS changes observed after transplantation in an earlier retrospective study and may be associated with the risk factor chronic GvHD/immunosuppression Although delirium is a common medical comorbidity with altered cognition as its defining feature , few publications have addressed the neuropsychological prodrome , profile , and recovery of patients tested during delirium . We characterize neuropsychological performance in 54 hemapoietic stem cell/bone marrow transplantation ( BMT ) patients shortly before , during , and after delirium and in BMT 
    Output:
    
There was agreement that cognitive impairments are evident for a subset of patients before HCT .
Age , time since transplant and TBI were not associated with changes in cognitive functioning .
Nevertheless , results from the current meta- analysis suggest that cognitive functioning does not significantly change following HCT