Introduction: Studies investigating the long-term effects of breast cancer treatment on cognition in older women with breast cancer are lacking, even though preserving cognition is highly valued by... Show moreIntroduction: Studies investigating the long-term effects of breast cancer treatment on cognition in older women with breast cancer are lacking, even though preserving cognition is highly valued by the older population. Specifically, concerns have been raised regarding the detrimental effects of endocrine therapy (ET) on cognition. Therefore, we investigated cogni-tive functioning over time and predictors for cognitive decline in older women treated for early breast cancer.Methods: We prospectively enrolled Dutch women aged >70 years with stage I-III breast can-cer in the observational CLIMB study. The Mini-Mental State Examination (MMSE) was performed before ET initiation and after 9, 15 and 27 months. Longitudinal MMSE scores were analysed and stratified for ET. Linear mixed models were used to identify possible pre-dictors of cognitive decline.Results: Among the 273 participants, the mean age was 76 years (standard deviation 5), and 48% received ET. The mean baseline MMSE score was 28.2 (standard deviation 1.9). Cogni-tion did not decline to clinically meaningful differences, irrespective of ET. MMSE scores of women with pre-treatment cognitive impairments slightly improved over time (significant interaction terms) in the entire cohort and in women receiving ET. High age, low educational level and impaired mobility were independently associated with declining MMSE scores over time, although the declines were not clinically meaningful.Conclusion: Cognition of older women with early breast cancer did not decline in the first two years after treatment initiation, irrespective of ET. Our findings suggest that the fear of declining cognition does not justify the de-escalation of breast cancer treatment in older women. 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Show less
We examined the development of international adoptees from infancy to young adulthood, and factors influencing developmental outcomes in middle childhood, adolescence and young adulthood. The... Show moreWe examined the development of international adoptees from infancy to young adulthood, and factors influencing developmental outcomes in middle childhood, adolescence and young adulthood. The results for cognitive development (Chapter 2) showed that early malnutrition influenced cognitive and health-related outcomes, but its consequences did not extend to socioeconomic success later in life. The human brain seems capable of adapting to changing environmental influences, but earlier placement in a positive family environment should be preferred (see also Chapter 1). The adoptees in the Leiden Longitudinal Adoption Study were exposed to few adversities due to their early adoptive placement, and the combination with the nurturing environment of a permanent adoptive family resulted in positive cognitive and socio-emotional outcomes (Chapters 2 and 3). Our results for longitudinal (sensitivity) and concurrent relations (reactivity to infant crying) with attachment representations in young adulthood (Chapters 3 and 4) clearly point to this role of the family environment in predicting social-emotional outcomes. High parenting quality is important, also in families where children do not share a common genetic basis with their parents. In sum, adoption can be seen as a positive intervention and the (adoptive) family environment matters for children growing up from infants to young adults. Show less
