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The goal of this intervention is to investigate whether transcranial Direct Current Stimulation (tDCS) can alleviate Cancer-Related Cognitive Impairment (CRCI) in breast cancer survivors, as measured by changes in brain structures and cognitive performance. To assess the efficacy of tDCS, the investigators will compare outcomes between participants receiving active stimulation and those receiving sham stimulation (a placebo condition where participants believe they are receiving stimulation, but are not).
Participants will:
Cancer-Related Cognitive Impairment (CRCI) is common among breast cancer (BC) survivors, manifesting as deficits in memory, attention, and processing speed, further affecting their quality of life. CRCI is likely multifactorial, influenced by demographic and genetic factors, neuroinflammation, and neuroplasticity changes. On the one hand, obesity is a known risk factor for BC and a poorer prognosis. On the other hand, it is linked to neuroinflammation and structural brain changes that contribute to cognitive impairment. However, its role in exacerbating CRCI remains unclear. Understanding this relationship is crucial for optimizing cognitive rehabilitation strategies. Transcranial Direct Current Stimulation (tDCS) is a promising neuromodulation technique that enhances neuroplasticity, and its potential for home-based application could improve treatment feasibility. This study aims to (1) evaluate the effectiveness of home-based tDCS in improving cognitive function in BC survivors and (2) examine obesity as a potential moderator of treatment outcomes. The investigators will conduct a double-blind, sham-controlled tDCS intervention over six weeks, collecting cognitive assessments and dietary data before, during, and after the intervention. MRI scans will be acquired pre- and post-intervention to assess structural and functional changes in cognition-related regions.
Participants will complete five phases over seventeen weeks: baseline, intervention (acute schedule), intervention (continuing schedule), short-term follow-up, and long-term follow-up:
Cognitive assessment includes three cognitive tests representing three domains known to be impaired following breast cancer (Small et al., 2019):
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Active tDCS | Experimental |
| |
| sham tDCS | Sham Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| active tDCS | Device | The anodal electrode will be placed over the left DLPFC (F3), and the cathodal electrode will be placed over the right supraorbital area (FP2). The current will be gradually ramped up to 2mA over 30 seconds, held constant at 2mA for 29 minutes, and then gradually ramped down to 0mA over the final 30 seconds. |
| Measure | Description | Time Frame |
|---|---|---|
| Attention at post-intervention | Performance in the Matching Cards task under active tDCS compared to sham: the mean number of correct trials. | From baseline to the end of the intervention at 6 weeks |
| Short-term episodic memory at post-intervention | Performance in the dot memory task under active tDCS compared to sham: the mean Euclidean distance score. The mean Euclidean distance score reflects the distance between the original red dot locations and the recalled locations. | From baseline to the end of the intervention at 6 weeks |
| Processing speed at post-intervention | Performance in Symbol Search task under active tDCS compared to sham: prompt-level median response latency for correct trials. | From baseline to the end of the intervention at 6 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Attention at short-term follow-up | Performance in the Matching Cards task under active tDCS compared to sham: the mean number of correct trials. | From baseline to 3 weeks after the end of the intervention |
| Short-term episodic memory at short-term follow-up |
| Measure | Description | Time Frame |
|---|---|---|
| Dynamics of attention skills throughout the intervention | Performance in the Matching Cards task under active tDCS compared to sham: the mean number of correct trials from each prompted assessment. | From baseline to week 1-3-5 during the the intervention |
| Dynamics of short-term episodic memory skills throughout the intervention |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Manon Chédeville, Doctoral Researcher | Contact | +358 50 326 4109 | manon.chedeville@helsinki.fi |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Psychology, Faculty of Medicine, University of Helsinki | Recruiting | Helsinki | Uusimaa | 00200 | Finland |
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| ID | Term |
|---|---|
| D009765 | Obesity |
| D050177 | Overweight |
| ID | Term |
|---|---|
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
| D001835 | Body Weight |
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Minimization will be applied to allocate participants to the active or sham tDCS group following a 1:1 ratio. The selected prognostic factors include prior chemotherapy (yes/no), menopausal status (pre/post), and obesity (WHtR ≥ 0.54 = living with obesity; WHtR < 0.54 = not living with obesity).
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|
| sham tDCS | Device | The anodal electrode will be placed over the left DLPFC (F3), and the cathodal electrode will be placed over the right supraorbital area (FP2). The current will be initially ramped up to 2mA over 30 seconds and immediately ramped back down to 0mA. |
|
Performance in the dot memory task under active tDCS compared to sham: the mean Euclidean distance score. The mean Euclidean distance score reflects the distance between the original red dot locations and the recalled locations. |
| From baseline to 3 weeks after the end of the intervention |
| Processing speed at short-term follow-up | Performance in Symbol Search task under active tDCS compared to sham: prompt-level median response latency for correct trials. | From baseline to 3 weeks after the end of the intervention |
| Attention at long-term follow-up | Performance in the Matching Cards task under active tDCS compared to sham: the mean number of correct trials. | From baseline to 9 weeks after the end of the intervention |
| Short-term episodic memory at long-term follow-up | Performance in the dot memory task under active tDCS compared to sham: the mean Euclidean distance score. The mean Euclidean distance score reflects the distance between the original red dot locations and the recalled locations. | From baseline to 9 weeks after the end of the intervention |
| Processing speed at long-term follow-up | Performance in Symbol Search task under active tDCS compared to sham: prompt-level median response latency for correct trials. | From baseline to 9 weeks after the end of the intervention |
| Gray matter changes at long-term follow-up | Volume of gray matter under active tDCS compared to sham. | From baseline to 9 weeks after the end of the intervention |
| Gray matter changes at long-term follow-up | Thickness of gray matter under active tDCS compared to sham. | From baseline to 9 weeks after the end of the intervention |
| White matter changes at long-term follow-up | Neurite density index under active tDCS compared to sham. | From baseline to 9 weeks after the end of the intervention |
| White matter changes at long-term follow-up | Orientation dispersion index under active tDCS compared to sham. | From baseline to 9 weeks after the end of the intervention |
| White matter changes at long-term follow-up | Free-water fraction under active tDCS compared to sham. | From baseline to 9 weeks after the end of the intervention |
| Functional connectivity strength measured by Fisher-transformed bivariate correlation coefficients changes at long-term follow-up | ROI-to-ROI functional connectivity as measured by resting-state fMRI under active tDCS compared to sham. | From baseline to 9 weeks after the end of the intervention |
| Functional connectivity strength measured by Fisher-transformed bivariate correlation coefficients changes at long-term follow-up | Seed-based functional connectivity as measured by resting-state fMRI under active tDCS compared to sham. | From baseline to 9 weeks after the end of the intervention |
Performance in the dot memory task under active tDCS compared to sham: the mean Euclidean distance score from each prompted assessment. |
| From baseline to week 1-3-5 during the the intervention |
| Dynamics of processing speed skills throughout the intervention | Performance in Symbol Search task under active tDCS compared to sham: the mean of the prompt-level median response latency for correct trials. | From baseline to week 1-3-5 during the the intervention |
| Depression and anxiety score at post-intervention | HADS score under active tDCS compared to sham. | From baseline to the end of treatment at 6 weeks |
| Depression and anxiety score at short-term follow-up | HADS score under active tDCS compared to sham. | From baseline to 3 weeks after the end of the intervention |
| Depression and anxiety score at long-term follow-up | HADS score under active tDCS compared to sham. | From baseline to 9 weeks after the end of the intervention |
| D012816 |
| Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |