Can Exercise Ameliorate Aromatase Inhibitor-Induced Cognitive Decline in Breast Cancer Patients?

Abstract

Aromatase inhibitors (AIs) have been commonly used as an effective adjuvant therapy in treatment of breast cancer, especially for menopausal women with estrogen receptor-positive breast cancer. Due to the nature of aromatase, the key enzyme for endogenous estrogen synthesis, inhibitory of aromatase-induced side effects, such as cognitive impairment has been reported in both human and animal studies. While extensive evidence suggested that physical exercises can improve learning and memory activity and even prevent age-related cognitive decline, basic research revealed some common pathways between exercise and estrogen signaling that affected cognitive function. This review draws on clinical and basic studies to assess the potential impact of exercise in cognitive function from women treated with AIs for breast cancer and explore the potential mechanism and effects of exercise on estrogen-related cognition.

Keywords: Aromatase inhibitors; Breast cancer; Cognition; Exercise.

Fig. 1. The relationship of mechanisms between exercise- and estrogen- induced neuroprotection

Exercise can facilitate neuroplasticity and neurogenesis through improving the expression of VEGF, IGF-1, BDNF as indicated as red lines, while the effects of estrogen on cognitive function might be mediated through estrogen receptors and regulate VEGF, IGF-1 and BDNF to exert neuroprotective functions as shown in blue lines.