Cognitive impairment and brain atrophy in patients with newly diagnosed aggressive lymphoma undergoing standard chemotherapy: a normative analysis

Objective Cancer-related cognitive impairment (CRCI) can impact daily-life functioning of people with aggressive lymphoma. While many studies have examined the neural substrates implicated in CRCI, most have used group-based analyses, which may mask individual differences. In the present study, we used normative analysis to examine longitudinal changes in cognitive functioning and brain morphology at the level of the individual patient. Methods Nine participants with newly diagnosed aggressive lymphoma underwent neuropsychological assessment and anatomical MR before and 6–8 weeks after chemotherapy. Cognitive test scores were converted to T- scores and classified as impaired if ≤ 30. Deviations in cortical thickness and surface area in the superior frontal gyrus (SFG) and anterior cingulate cortex (ACC) were computed at the level of the individual using the novel CentileBrain tool, with z -scores below \(\:-\)1.96 and above 1.96 classified as infranormal and supranormal, respectively. Results Analyses revealed substantial between-subject variability over time and across outcome measures. Cognitive impairments in executive function and verbal memory were identified in three participants before and/or after chemotherapy. CentileBrain results showed seven participants had infranormal cortical thickness and/or surface area in the SFG at one or both time points, and one patient had infranormal values in the ACC. No participants exhibited supranormal values in either region at any time point. Conclusions Our findings provide a valuable foundation for developing more personalised interventions tailored to the specific cognitive and neural profiles of lymphoma survivors, paving the way for improved clinical care to alleviate and mitigate the impact of CRCI on long-term quality of life.