5. Discussion and Conclusions
fits, cancer, cognitive impairment, impaired cognitive function
CANCER, AIDS
This first patient in the phase 1 clinical trial testing of TMS for the treatment of “chemo brain” showcased that TMS can be safely administered to individuals with chemo brain, with no significant side effects observed. Noticeably, TMS has the potential to ameliorate impaired cognitive function by altering functional connectivity, providing important lessons for feasibility and insights into the mechanisms of potential benefit. Her pre-treatment mild cognitive impairment objectively normalized after TMS, specifically improving a full standard deviation or more in tests of verbal memory (including components of immediate recall, delayed recall, learning, and response inhibition). These results show the importance of objective testing for evaluating efficacy, since the patient reported no subjective change in her difficulties with memory and concentration. This lack of subjective response may be due to her long-term adaptation to these symptoms, with coping strategies such as memory aids and remaining in the same position at work for many years; thus, these symptoms interfered with her daily life only “a little bit”. Remarkably, after 6 years of chemo brain and remaining in the same position at work due to her inability to concentrate and multi-task, she applied for and received a promotion 5–6 months after her TMS treatments. While impossible to directly attribute her TMS treatments to this momentous life change, it could be more than just coincidence.Previous studies have reported that cancer patients displaying symptoms of “chemo brain” typically show a relatively distributed pattern of functional connectivity changes, mostly in the frontal and parietal regions of the brain [In conclusion, these exciting results may explain the changes in memory and quality of life observed in the patient with CRCI. Given this specific predilection for damage to the frontal and parietal regions of the brain and the central role of the frontal–parietal network in working memory, the observed strengthening of the connectivity of the stimulated left DLPFC fits well with the objectively measured improvement in learning and memory performance and with subjective enhancements in the participants’ self-reported sleep quality.