Post-chemotherapy cognitive impairment

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Maria Fernanda Villarreal, M.D. [2]

Synonyms and Keywords: Chemotherapy-induced cognitive dysfunction; Chemo brain; Chemo fog; Chemobrain; PCCI

Overview

Post-chemotherapy cognitive impairment (also known as chemotherapy-induced cognitive dysfunction) is defined as the cognitive impairment that can result from chemotherapy treatment. Post-chemotherapy cognitive impairment was first discovered and described in 1980. Post-chemotherapy cognitive impairment is characterized by changes in memory, fluency, and other cognitive abilities that impeded their ability to function as they had pre-chemotherapy. Approximately 20-30% of patients that undergo chemotherapy experience some level of post-chemotherapy cognitive impairment. The exact pathogenesis of post-chemotherapy cognitive impairment is not fully understood. However, the underlying mechanisms of the disease are believed to be caused by direct neurotoxicity. Genes involved the development of post-chemotherapy cognitive impairment, include COMT nucleotide polymorphism, Apolipoprotein E gene, and BDNF gene mutations. Post-chemotherapy cognitive impairment is more commonly observed among middle aged and elderly patients. The median age at diagnosis ranges between 40-70 years old. There are no specific imaging findings associated with post-chemotherapy cognitive impairment. However, in some cases MRI may detect accurate measurement of therapy-induced changes in grey and white matter volumes. Recent studies suggest further investigation on the underlying mechanisms of cognitive impairment.

Historical Perspective

Post-chemotherapy cognitive impairment was first discovered and described in 1980 following the increasing number of breast cancer survivors.[1]

Classification

There is no classification system for post-chemotherapy cognitive impairment.[1]

Pathophysiology

Causes

Differentiating Post-Chemotherapy Cognitive Impairment from Other Diseases

  • Post-chemotherapy cognitive impairment must be differentiated from other diseases that cause cognitive impairment (such as, lack of attention, orientation to time and space), such as:[1]

Epidemiology and Demographics

Prevalnce

  • The prevalence of post-chemotherapy cognitive impairment remains unknown but approximately 20-30% of patients that undergo chemotherapy experience some level of post-chemotherapy cognitive impairment.[5]

Age

  • Post-chemotherapy cognitive impairment is more commonly observed among patients aged 40-70 years old.

Gender

  • Females are slightly more commonly affected with post-chemotherapy cognitive impairment than males.

Race

  • There is no racial predilection for post-chemotherapy cognitive impairment.

Risk Factors

The most common risk factor in the development of post-chemotherapy cognitive impairment include:

Screening

There is insufficient evidence to recommend routine screening for Post-chemotherapy cognitive impairment.

Natural History, Complications and Prognosis

  • The majority of patients with post-chemotherapy cognitive impairment are initially asymptomatic.[1]
  • Early clinical features, include:
  • Prognosis is generally good, and symptoms of post-chemotherapy cognitive impairment typically disappear in about four years.

Diagnosis

Diagnostic Study of Choice

There are no established criteria for the diagnosis of post-chemotherapy cognitive impairment. The diagnosis of post-chemotherapy cognitive impairment is based on the history and symptoms.

History and Symptoms

  • Patients with post-chemotherapy cognitive impairment may have aggravating factors such as:

Physical Examination

  • Patients with post-chemotherapy cognitive impairment usually appear malnourished and pale.
  • Physical examination shows no remarkable findings for patients with post-chemotherapy cognitive impairment.[4]

Laboratory Findings

  • There are no specific laboratory findings associated with post-chemotherapy cognitive impairment.[1][6]
  • In some cases, elevated levels of apolipoprotein (APOE) allele may be seen in patients with post-chemotherapy cognitive impairment

Electrocardiogram

There are no ECG findings associated with post-chemotherapy cognitive impairment.

X-ray

There are no x-ray findings associated with post-chemotherapy cognitive impairment.

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with post-chemotherapy cognitive impairment.

CT scan

There are no CT scan findings associated with post-chemotherapy cognitive impairment.

MRI

There are no MRI findings associated with post-chemotherapy cognitive impairment.

Other Imaging Findings

There are no other imaging findings associated with post-chemotherapy cognitive impairment.

Other Diagnostic Studies

There are no other diagnostic studies associated with post-chemotherapy cognitive impairment.

Treatment

Medical Therapy

  • The majority of cases of post-chemotherapy cognitive impairment are self-limited and require only supportive care including:

Surgery

Surgery is not recommended for patients with post-chemotherapy cognitive impairment.

Primary Prevention

There are no primary preventive measures available for post-chemotherapy cognitive impairment.

Secondary Prevention

There are no secondary prevention measures available for post-chemotherapy cognitive impairment.

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR (2011). "An update on cancer- and chemotherapy-related cognitive dysfunction: current status". Semin. Oncol. 38 (3): 431–8. doi:10.1053/j.seminoncol.2011.03.014. PMC 3120018. PMID 21600374.
  2. Ng, Terence; Lee, Ying Yun; Chae, Jung-woo; Yeo, Angie Hui Ling; Shwe, Maung; Gan, Yan Xiang; Ng, Raymond C. H.; Chu, Pat Pak Yan; Khor, Chiea Chuen; Ho, Han Kiat; Chan, Alexandre (2017). "Evaluation of plasma brain-derived neurotrophic factor levels and self-perceived cognitive impairment post-chemotherapy: a longitudinal study". BMC Cancer. 17 (1). doi:10.1186/s12885-017-3861-9. ISSN 1471-2407.
  3. 3.0 3.1 Ahles, Tim A.; Li, Yuelin; McDonald, Brenna C.; Schwartz, Gary N.; Kaufman, Peter A.; Tsongalis, Gregory J.; Moore, Jason H.; Saykin, Andrew J. (2014). "Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: the impact ofAPOEand smoking". Psycho-Oncology. 23 (12): 1382–1390. doi:10.1002/pon.3545. ISSN 1057-9249.
  4. Janelsins, Michelle C.; Kesler, Shelli R.; Ahles, Tim A.; Morrow, Gary R. (2014). "Prevalence, mechanisms, and management of cancer-related cognitive impairment". International Review of Psychiatry. 26 (1): 102–113. doi:10.3109/09540261.2013.864260. ISSN 0954-0261.
  5. Ahles, Tim A.; Li, Yuelin; McDonald, Brenna C.; Schwartz, Gary N.; Kaufman, Peter A.; Tsongalis, Gregory J.; Moore, Jason H.; Saykin, Andrew J. (2014). "Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: the impact ofAPOEand smoking". Psycho-Oncology. 23 (12): 1382–1390. doi:10.1002/pon.3545. ISSN 1057-9249.

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