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{{Post-chemotherapy cognitive impairment | {{SI}} | ||
''' | {{CMG}} {{AE}} {{Fs}}, {{MV}} | ||
{{SK}} 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|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]] [[Polymorphism|nucleotide polymorphism]], [[Apolipoprotein E]] [[gene]], and [[BDNF]] [[Gene mutation|gene mutations]]. Post-chemotherapy cognitive impairment is more commonly observed among middle aged and [[elderly]] [[Patient|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 [[Magnetic resonance imaging|MRI]] may detect accurate measurement of therapy-induced changes in [[Grey matter|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.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref> | |||
{{ | ==Classification== | ||
There is no classification system for post-chemotherapy cognitive impairment.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref> | |||
==[[ | ==Pathophysiology== | ||
*The [[pathogenesis]] of post-chemotherapy cognitive impairment is not fully understood.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref> | |||
*However, the underlying [[pathophysiology]] is believed to be caused by direct [[neurotoxicity]]. | |||
*[[Genes]] involved the development of post-chemotherapy cognitive impairment, include:<ref name="NgLee2017">{{cite journal|last1=Ng|first1=Terence|last2=Lee|first2=Ying Yun|last3=Chae|first3=Jung-woo|last4=Yeo|first4=Angie Hui Ling|last5=Shwe|first5=Maung|last6=Gan|first6=Yan Xiang|last7=Ng|first7=Raymond C. H.|last8=Chu|first8=Pat Pak Yan|last9=Khor|first9=Chiea Chuen|last10=Ho|first10=Han Kiat|last11=Chan|first11=Alexandre|title=Evaluation of plasma brain-derived neurotrophic factor levels and self-perceived cognitive impairment post-chemotherapy: a longitudinal study|journal=BMC Cancer|volume=17|issue=1|year=2017|issn=1471-2407|doi=10.1186/s12885-017-3861-9}}</ref><ref name="AhlesLi2014">{{cite journal|last1=Ahles|first1=Tim A.|last2=Li|first2=Yuelin|last3=McDonald|first3=Brenna C.|last4=Schwartz|first4=Gary N.|last5=Kaufman|first5=Peter A.|last6=Tsongalis|first6=Gregory J.|last7=Moore|first7=Jason H.|last8=Saykin|first8=Andrew J.|title=Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: the impact ofAPOEand smoking|journal=Psycho-Oncology|volume=23|issue=12|year=2014|pages=1382–1390|issn=10579249|doi=10.1002/pon.3545}}</ref> | |||
:*[[COMT]] nucleotide polymorphism | |||
:*[[Apolipoprotein E]] | |||
:*[[Brain-derived neurotrophic factor|Brain-derived neurotropic factor]] ([[Brain-derived neurotrophic factor|BDNF) gene]] | |||
==[[ | ==Causes== | ||
* Common [[Chemotherapeutic agent|chemotherapeutic]] agents causing post-chemotherapy cognitive impairment, include:<ref name="polink">Aleah J. McHenry, MSN, RN. Management of Chemotherapy Induced Cognitive Impairment. http://www.oncolink.org/resources/article.cfm?id=1057 Accesed on May 18, 2016</ref> | |||
:*[[Cyclophosphamide]] | |||
:*[[5-fluorouracil]] | |||
:*[[Methotrexate]] | |||
== | ==Differentiating Post-Chemotherapy Cognitive Impairment from Other Diseases== | ||
*Post-chemotherapy cognitive impairment must be differentiated from other diseases that cause cognitive impairment (such as, [[Inattentiveness|lack of attention]], orientation to time and space), such as:<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref> | |||
:*[[Dehydration]] | |||
:*[[Infection]] | |||
:*[[Sepsis]] | |||
== | ==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.<ref name="JanelsinsKesler2014">{{cite journal|last1=Janelsins|first1=Michelle C.|last2=Kesler|first2=Shelli R.|last3=Ahles|first3=Tim A.|last4=Morrow|first4=Gary R.|title=Prevalence, mechanisms, and management of cancer-related cognitive impairment|journal=International Review of Psychiatry|volume=26|issue=1|year=2014|pages=102–113|issn=0954-0261|doi=10.3109/09540261.2013.864260}}</ref> | |||
== | ===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: | ||
* High number of cycles of [[chemotherapy]].<ref name="polink">Aleah J. McHenry, MSN, RN. Management of Chemotherapy Induced Cognitive Impairment. http://www.oncolink.org/resources/article.cfm?id=1057 Accesed on May 18, 2016</ref> | |||
[[ | *[[Smoking]]<ref name="AhlesLi2014" /> | ||
= | |||
== | == Screening == | ||
There is insufficient evidence to recommend routine [[Screening (medicine)|screening]] for Post-chemotherapy cognitive impairment. | |||
* [ | == Natural History, Complications and Prognosis== | ||
*The majority of patients with post-chemotherapy cognitive impairment are initially [[asymptomatic]].<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref> | |||
*Early clinical features, include: | |||
:*[[Inattentiveness|Lack of attention]] | |||
:*[[Memory loss]] | |||
:*Problems to recall | |||
:*Lack of orientation | |||
*If left untreated, [[Patients With Cervical Artery Dissection|patients]] with post-chemotherapy cognitive impairment may progress to develop severe [[cognitive impairment]]. | |||
*Common [[complications]] of post-chemotherapy cognitive impairment, include:<ref name="polink">Aleah J. McHenry, MSN, RN. Management of Chemotherapy Induced Cognitive Impairment. http://www.oncolink.org/resources/article.cfm?id=1057 Accesed on May 18, 2016</ref> | |||
:*Decreased executive function | |||
:*[[Cerebrovascular disease|Cerebrovascular disorders]] | |||
:*[[Focal neurologic signs|Focal neurological deficits]] | |||
*[[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: | |||
::*[[Anxiety]] | |||
::*[[Depression]] | |||
*Post-chemotherapy cognitive impairment is usually [[asymptomatic]] at [[diagnosis]]. | |||
*[[Symptoms and Signs|Symptoms]] of post-chemotherapy cognitive impairment may include the following:<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref> | |||
:*[[Memory loss]] | |||
:*[[Inattention|Lack of attention]] | |||
:*Difficult language [[fluency]] | |||
:*Poor calculation and recall | |||
:*[[Loss of appetite]] | |||
:*[[Irritability]] or constant [[mood swings]] | |||
:*Hopelessness | |||
=== 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.<ref name="polink">Aleah J. McHenry, MSN, RN. Management of Chemotherapy Induced Cognitive Impairment. http://www.oncolink.org/resources/article.cfm?id=1057 Accesed on May 18, 2016</ref> | |||
=== Laboratory Findings === | |||
*There are no specific laboratory findings associated with post-chemotherapy cognitive impairment.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref><ref name="AhlesLi20142">{{cite journal|last1=Ahles|first1=Tim A.|last2=Li|first2=Yuelin|last3=McDonald|first3=Brenna C.|last4=Schwartz|first4=Gary N.|last5=Kaufman|first5=Peter A.|last6=Tsongalis|first6=Gregory J.|last7=Moore|first7=Jason H.|last8=Saykin|first8=Andrew J.|title=Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: the impact ofAPOEand smoking|journal=Psycho-Oncology|volume=23|issue=12|year=2014|pages=1382–1390|issn=10579249|doi=10.1002/pon.3545}}</ref> | |||
*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: | |||
**Behavioral interventions | |||
***[[Relaxation]] | |||
***[[Exercise]] | |||
***Group therapy | |||
***Brain-training programs | |||
** Pharmacologic interventions | |||
*** [[Modafinil]] | |||
*** [[Methylphenidate]] | |||
*** [[Donepezil]] | |||
=== Surgery === | |||
[[Surgery]] is not recommended for patients with post-chemotherapy cognitive impairment. | |||
=== Primary Prevention === | |||
There are no [[Primary prevention|primary preventive]] measures available for post-chemotherapy cognitive impairment. | |||
=== Secondary Prevention === | |||
There are no secondary prevention measures available for post-chemotherapy cognitive impairment. | |||
<br /> | |||
==References== | |||
{{Reflist|2}} | |||
[[Category: Oncology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | [[Category:Oncology]] | ||
[[Category: | [[Category:Medicine]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
Latest revision as of 17:17, 22 October 2019
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
- The pathogenesis of post-chemotherapy cognitive impairment is not fully understood.[1]
- However, the underlying pathophysiology is believed to be caused by direct neurotoxicity.
- Genes involved the development of post-chemotherapy cognitive impairment, include:[2][3]
- COMT nucleotide polymorphism
- Apolipoprotein E
- Brain-derived neurotropic factor (BDNF) gene
Causes
- Common chemotherapeutic agents causing post-chemotherapy cognitive impairment, include:[4]
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:
- High number of cycles of chemotherapy.[4]
- Smoking[3]
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:
- Lack of attention
- Memory loss
- Problems to recall
- Lack of orientation
- If left untreated, patients with post-chemotherapy cognitive impairment may progress to develop severe cognitive impairment.
- Common complications of post-chemotherapy cognitive impairment, include:[4]
- Decreased executive function
- Cerebrovascular disorders
- Focal neurological deficits
- 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:
- Post-chemotherapy cognitive impairment is usually asymptomatic at diagnosis.
- Symptoms of post-chemotherapy cognitive impairment may include the following:[1]
- Memory loss
- Lack of attention
- Difficult language fluency
- Poor calculation and recall
- Loss of appetite
- Irritability or constant mood swings
- Hopelessness
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:
- Behavioral interventions
- Relaxation
- Exercise
- Group therapy
- Brain-training programs
- Pharmacologic interventions
- Behavioral interventions
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
- ↑ 1.0 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.
- ↑ 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.
- ↑ 3.0 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.
- ↑ 4.0 4.1 4.2 4.3 Aleah J. McHenry, MSN, RN. Management of Chemotherapy Induced Cognitive Impairment. http://www.oncolink.org/resources/article.cfm?id=1057 Accesed on May 18, 2016
- ↑ 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.
- ↑ 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.