***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 Adjuvant chemotherapy for breast cancer can have adverse effects on cognition shortly after administration . Whether chemotherapy has any long-term effects on cognition is largely unknown , yet it becomes increasingly relevant because of the widespread use of chemotherapy for early-stage breast cancer and the improved survival . We investigated whether cyclophosphamide , methotrexate , and fluorouracil ( CMF ) chemotherapy for breast cancer is associated with worse cognitive performance more than 20 years after treatment . PATIENTS AND METHODS This case-cohort study compared the cognitive performance of patients with breast cancer who had a history of adjuvant CMF chemotherapy treatment ( six cycles ; average time since treatment , 21 years ; n = 196 ) to that of a population -based sample of women never diagnosed with cancer ( n = 1,509 ) . Participants were between 50 and 80 years of age . Exclusion criteria were ever use of adjuvant endocrine therapy , secondary malignancy , recurrence , and /or metastasis . RESULTS The women exposed to chemotherapy performed significantly worse than the reference group on cognitive tests of immediate ( P = .015 ) and delayed verbal memory ( P = .002 ) , processing speed ( P < .001 ) , executive functioning ( P = .013 ) , and psychomotor speed ( P = .001 ) . They experienced fewer symptoms of depression ( P < .001 ) , yet had significantly more memory complaints on two of three measures that could not be explained by cognitive test performance . CONCLUSION Survivors of breast cancer treated with adjuvant CMF chemotherapy  more than 20 years ago perform worse , on average , than r and om population controls on neuropsychological tests . The pattern of cognitive problems is largely similar to that observed in patients shortly after cessation of chemotherapy . This study suggests that cognitive deficits following breast cancer diagnosis and subsequent CMF chemotherapy can be long lasting Background Cognitive problems in breast cancer patients are common after systemic treatment , particularly chemotherapy . An increasing number of fMRI studies show altered brain activation in breast cancer patients after treatment , suggestive of neurotoxicity . Previous prospect i ve fMRI studies administered a single cognitive task . The current study employed two task paradigms to evaluate whether treatment-induced changes depend on the probed cognitive domain . Methods Participants were breast cancer patients scheduled to receive systemic treatment ( anthracycline-based chemotherapy + /- endocrine treatment , n = 28 ) , or no systemic treatment ( n = 24 ) and no-cancer controls ( n = 31 ) . Assessment took place before adjuvant treatment and six months after chemotherapy , or at similar intervals . Blood oxygen level dependent ( BOLD ) activation and performance were measured during an executive functioning task and an episodic memory task . Group-by-time interactions were analyzed using a flexible factorial design . Results Task performance did not differ between patient groups and did not change over time . Breast cancer patients who received systemic treatment , however , showed increased parietal activation compared to baseline with increasing executive functioning task load compared to breast cancer patients who did not receive systemic treatment . This hyperactivation was accompanied by worse physical functioning , higher levels of fatigue and more cognitive complaints . In contrast , in breast cancer patients who did not receive systemic treatment , parietal activation normalized over time compared to the other two groups . Conclusions Parietal hyperactivation after systemic treatment in the context of stable levels of executive task performance is compatible with a compensatory processing account of hyperactivation or maintain adequate performance levels . This over-recruitment of brain regions depends on the probed cognitive domain and may represent a response to decreased neural integrity after systemic treatment . Overall these results suggest different neurobehavioral trajectories in breast cancer patients depending on treatment type Objective : To assess patterns of regional brain activation in response to varying working memory loads shortly after mild traumatic brain injury ( MTBI ) . Background : Many individuals complain of memory difficulty shortly after MTBI . Memory performance in these individuals can be normal despite these complaints . Methods : Brain activation patterns in response to a working memory task ( auditory n-back ) were assessed with functional MRI in 12 MTBI patients within 1 month of their injury and in 11 healthy control subjects . Results : Brain activation patterns differed between MTBI patients and control subjects in response to increasing working memory processing loads . Maximum intensity projections of statistical parametric maps in control subjects showed bifrontal and biparietal activation in response to a low processing load , with little additional increase in activation associated with the high load task . MTBI patients showed some activation during the low processing load task but significantly increased activation during the high load condition , particularly in the right parietal and right dorsolateral frontal regions . Task performance did not differ significantly between groups . Conclusion : MTBI patients differed from control subjects in activation pattern of working memory circuitry in response to different processing loads , despite similar task performance . This suggests that injury-related changes in ability to activate or to modulate working memory processing re sources may underlie some of the memory complaints after MTBI PURPOSE We previously evaluated fatigue , menopausal symptoms , and cognitive dysfunction in patients receiving adjuvant therapy for breast cancer and matched healthy women . Here we report assessment of these women 1 and 2 years later . PATIENTS AND METHODS Patients without relapse and controls were evaluated by the Functional Assessment of Cancer Treatment-General Quality of Life question naire , with subscales for fatigue and endocrine symptoms , and by the High Sensitivity Cognitive Screen . RESULTS There were 104 , 91 , and 83 patients and 102 , 81 , and 81 controls assessed at baseline and at 1 and 2 years , respectively . Median Functional Assessment of Cancer Treatment-Fatigue scores ( range , 0 to 52 ) for patients improved from 31 ( on chemotherapy ) to 43 and 45 at 1 and 2 years , respectively , but were stable in controls ( 46 to 48 ) . Median Functional Assessment of Cancer Treatment-Endocrine Symptoms scores ( range , 0 to 72 ) for patients improved from 57 ( on chemotherapy ) to 59 and 61 at 1 and 2 years , respectively , and were stable in controls ( 64 to 65 ) . Differences between patients and controls remained significant for these scales . The incidence of moderate-severe cognitive dysfunction by the High Sensitivity Cognitive Screen  decreased in patients from 16 % ( on chemotherapy ) to 4.4 % and 3.8 % and in controls from 5 % to 3.6 % and 0 % at 1 and 2 years , respectively . There were minimal differences between estrogen receptor-positive patients who started hormonal therapy ( mainly tamoxifen ) after chemotherapy and estrogen receptor-negative patients who did not . Differences in quality of life between patients and controls were significant only at baseline . CONCLUSION Fatigue , menopausal symptoms , and cognitive dysfunction are important adverse effects of chemotherapy that improve in most patients . Hormonal treatment has minimal impact on them 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 PURPOSE To prospect ively examine alterations in working memory ( WM ) -associated brain activation related to breast cancer and treatment by using functional magnetic resonance imaging . PATIENTS AND METHODS Patients treated with chemotherapy ( CTx+ ; n = 16 ) or without chemotherapy ( CTx- ; n = 12 ) and healthy controls ( n = 15 ) were scanned during an n-back task at baseline ( after surgery but before radiation , chemotherapy , and /or antiestrogen treatment ) , 1 month after completion of chemotherapy ( M1 ) , and 1 year later ( Y1 ) , or at yoked intervals for CTx- and controls . SPM5 was used for all image analyses , which included cross-sectional between-group and group-by-time interaction and longitudinal within-group analyses , all using a statistical threshold of 0.001 . RESULTS At baseline , patients with cancer showed increased bifrontal and decreased left parietal activation compared with controls . At M1 , both cancer groups showed decreased frontal hyperactivation compared with controls , with increased hyperactivation at Y1 . These cross-sectional findings were confirmed by group-by-time interaction analyses , which showed frontal activation decreases from baseline to M1 in patients compared with controls . Within-group analyses showed different patterns of longitudinal activation change by treatment group ( CTx+ or CTx- ) , with prominent alterations in the frontal lobes bilaterally . CONCLUSION Significant frontal lobe hyperactivation to support WM was found in patients with breast cancer . Superimposed on this background , patients showed decreased frontal activation at M1 , with partial return to the previously abnormal baseline at Y1 . These functional changes correspond to frontal lobe regions where we previously reported structural changes in this cohort and provide prospect i ve , longitudinal data that further eluci date mechanisms underlying cognitive effects related to breast cancer and its treatment The aim of this study is to use functional magnetic resonance imaging ( fMRI ) to prospect ively examine pre-treatment predictors of post-treatment fatigue and cognitive dysfunction in women treated with adjuvant chemotherapy for breast cancer . Fatigue and cognitive dysfunction often co-occur in women treated for breast cancer . We hypothesized that pre-treatment factors , unrelated to chemotherapy per se , might increase vulnerability to post-treatment fatigue and cognitive dysfunction .  Patients treated with ( n = 28 ) or without chemotherapy ( n = 37 ) and healthy controls ( n = 32 ) were scanned coincident with pre- and one-month post-chemotherapy during a verbal working memory task ( VWMT ) and assessed for fatigue , worry , and cognitive dysfunction . fMRI activity measures in the frontoparietal executive network were used in multiple linear regression to predict post-treatment fatigue and cognitive function . The chemotherapy group reported greater pre-treatment fatigue than controls and showed compromised neural response , characterized by higher spatial variance in executive network activity , than the non-chemotherapy group . Also , the chemotherapy group reported greater post-treatment fatigue than the other groups . Linear regression indicated that pre-treatment spatial variance in executive network activation predicted post-treatment fatigue severity and cognitive complaints , while treatment group , age , hemoglobin , worry , and mean executive network activity levels did not predict these outcomes . Pre-treatment neural inefficiency ( indexed by high spatial variance ) in the executive network , which supports attention and working memory , was a better predictor of post-treatment cognitive and fatigue complaints than exposure to chemotherapy per se . This executive network compromise could be a pre-treatment neuromarker of risk , indicating patients most likely to benefit from early intervention for fatigue and cognitive dysfunction Adjuvant chemotherapy is associated with improvements in long-term cancer survival . However , reports of cognitive impairment following treatment emphasize the importance of underst and ing the long-term effects of chemotherapy on brain functioning . Cognitive deficits found in chemotherapy patients suggest a change in brain functioning that affects specific cognitive domains such as attentional processing and executive functioning . This study examined the processes potentially underlying these changes in cognition by examining brain functional connectivity pre- and post-chemotherapy in women with breast cancer . Functional connectivity examines the temporal correlation between spatially remote brain regions in an effort to underst and how brain networks support specific cognitive functions . Nine women diagnosed with breast cancer completed a functional magnetic resonance imaging ( fMRI ) session before chemotherapy , 1 month after , and 1 year after the completion of chemotherapy . Seed-based functional connectivity analyses were completed using seeds in the intraparietal sulcus ( IPS ) to examine connectivity in the dorsal anterior attention network and in the posterior cingulate cortex ( PCC ) to examine connectivity in the default mode network . Results showed decreased functional connectivity 1 month after chemotherapy that partially returned to baseline at 1 year in the dorsal attention network . Decreased connectivity was seen in the default mode network at 1 month and 1 year following chemotherapy . In addition , increased subjective memory complaints were noted at 1 month and 1 year post-chemotherapy . These findings suggest a detrimental effect of chemotherapy on brain functional connectivity that is potentially related to subjective cognitive assessment In the present study , we sought to investigate which brain structures are recru 
    Output:
    
Although there was heterogeneity in the neuropsychological measures used to assess executive functioning , tests could be grouped into the subcomponents they assessed .
Inhibition appears relatively spared from the effects of chemotherapy , whereas impairments in shifting and updating are more commonly found following chemotherapy .