Post-chemotherapy cognitive impairment: Difference between revisions

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==Overview==
==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.<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> 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.<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 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 gray and white matter volumes. Recent studies suggest further investigation on the underlying mechanisms of cognitive impairment.<ref name="wiki">Post-chemotherapy cognitive impairment. Wikipedia. https://en.wikipedia.org/wiki/Post-chemotherapy_cognitive_impairment Accessed on May 18, 2016 </ref>
'''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==
==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>
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==
==Classification==
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==Pathophysiology==
==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>
*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.  
*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>
*[[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
:*[[COMT]] nucleotide polymorphism
:*Apolipoprotein E
:*[[Apolipoprotein E]]
:*BDNF gene  
:*[[Brain-derived neurotrophic factor|Brain-derived neurotropic factor]] ([[Brain-derived neurotrophic factor|BDNF) gene]]


==Causes==
==Causes==
* Common causes 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>
* 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]]
:*[[Cyclophosphamide]]
:*[[5-fluorouracil]]
:*[[5-fluorouracil]]
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==Differentiating Post-Chemotherapy Cognitive Impairment from Other Diseases==
==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:<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>
*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]]
:*[[Dehydration]]
:*[[Infection]]
:*[[Infection]]
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=== Prevalnce ===
=== Prevalnce ===


* The prevalence of post-chemotherapy cognitive impairment remains unknown but pproximately 20-30% of patients that undergo chemotherapy experience some level of post-chemotherapy cognitive impairment.<ref name="wiki" />
* 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===
===Age===
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==Risk Factors==
==Risk Factors==
The most common risk factor in the development of post-chemotherapy cognitive impairment include:
The most common [[risk factor]] in the development of post-chemotherapy cognitive impairment include:


* 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>
* 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" />
*[[Smoking]]<ref name="AhlesLi2014" />


== Screening[edit | edit source] ==
== Screening ==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
There is insufficient evidence to recommend routine [[Screening (medicine)|screening]] for Post-chemotherapy cognitive impairment.
 
OR
 
According to the [guideline name], screening for [disease name] is not recommended.
 
OR
 
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*The majority of patients with post-chemotherapy cognitive impairment are initially symptomatic.<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>
*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:
*Early clinical features, include:
:*Lack of attention
 
:*Memory loss
:*[[Inattentiveness|Lack of attention]]
:*[[Memory loss]]
:*Problems to recall
:*Problems to recall
:*Lack of orientation
:*Lack of orientation
*If left untreated, patients with post-chemotherapy cognitive impairment may progress to develop severe cognitive impairment.  
*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>
*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
:*Decreased executive function
:*[[Cerebrovascular disease|Cerebrovascular disorders]]
:*[[Cerebrovascular disease|Cerebrovascular disorders]]
:*Focal neurological deficits
:*[[Focal neurologic signs|Focal neurological deficits]]
*Prognosis will generally good, and symptoms of post-chemotherapy cognitive impairment typically disappear in about four years.
 
*[[Prognosis]] is generally good, and [[symptoms]] of post-chemotherapy cognitive impairment typically disappear in about four years.


== Diagnosis ==
== Diagnosis ==


=== Diagnostic Study of Choice ===
=== 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 ===
=== History and Symptoms ===


*Post-chemotherapy cognitive impairment is usually symptomatic at diagnosis
*Patients with post-chemotherapy cognitive impairment may have aggravating factors such as:
*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>
 
::*[[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]]
:*[[Memory loss]]
:*Lack of attention
:*[[Inattention|Lack of attention]]
:*Difficult language fluency
:*Difficult language [[fluency]]
:*Poor calculation and recall  
:*Poor calculation and recall  
:*[[Loss of appetite]]
:*[[Loss of appetite]]
:*Irritability or constant mood swings
:*[[Irritability]] or constant [[mood swings]]
:*Hopelessness  
:*Hopelessness  
*A directed history should be obtained to ascertain:
:*Aggravating factors, such as:
::*[[Anxiety]]
::*[[Depression]]


=== Physical Examination ===
=== Physical Examination ===
*Patients with post-chemotherapy cognitive impairment usually appear malnourished and pale.  
*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>
*[[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 ===
=== 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>
*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
*In some cases, elevated levels of [[apolipoprotein]] (APOE) allele may be seen in patients with post-chemotherapy cognitive impairment


=== Electrocardiogram[edit | edit source] ===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
There are no ECG findings associated with post-chemotherapy cognitive impairment.
 
===X-ray===
OR
There are no x-ray findings associated with post-chemotherapy cognitive impairment.
 
===Echocardiography or Ultrasound ===
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
There are no echocardiography/ultrasound findings associated with post-chemotherapy cognitive impairment.
 
===CT scan===
=== X-ray[edit | edit source] ===
There are no CT scan findings associated with post-chemotherapy cognitive impairment.
There are no x-ray findings associated with [disease name].
=== MRI===
 
There are no MRI findings associated with post-chemotherapy cognitive impairment.
OR
===Other Imaging Findings===
 
There are no other imaging findings associated with post-chemotherapy cognitive impairment.
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Other Diagnostic Studies===
 
There are no other diagnostic studies associated with post-chemotherapy cognitive impairment.
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
=== Echocardiography or Ultrasound[edit | edit source] ===
There are no echocardiography/ultrasound findings associated with [disease name].
 
OR
 
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
=== CT scan[edit | edit source] ===
There are no CT scan findings associated with [disease name].
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
=== MRI[edit | edit source] ===
There are no MRI findings associated with [disease name].
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
=== Other Imaging Findings[edit | edit source] ===
There are no other imaging findings associated with [disease name].
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
=== Other Diagnostic Studies[edit | edit source] ===
There are no other diagnostic studies associated with [disease name].
 
OR
 
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3]


*
*
Line 183: Line 126:
== Treatment ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*There is no treatment for post-chemotherapy cognitive impairment; the mainstay of therapy is supportive care.
*The majority of cases of post-chemotherapy cognitive impairment are self-limited and require only supportive care including:
*Common medical therapies for the treatment 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>
**Behavioral interventions
:*[[Hormonal therapy]]
***[[Relaxation]]
***[[Exercise]]
***Group therapy
***Brain-training programs
** Pharmacologic interventions
*** [[Modafinil]]
*** [[Methylphenidate]]
*** [[Donepezil]]


=== Surgery ===
=== Surgery ===
*Surgery is not recommended for patients 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>
[[Surgery]] is not recommended for patients with post-chemotherapy cognitive impairment.


=== Primary Prevention ===
=== Primary Prevention ===
*There are no primary preventive measures available 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>
There are no [[Primary prevention|primary preventive]] measures available for post-chemotherapy cognitive impairment.
*Once diagnosed and successfully treated, patients with post-chemotherapy cognitive impairment are followed-up every visit.
*Follow-up testing includes cognitive function assessments (such as, mini–mental state examination)
 
=== Secindary Prevention ===


=== Secondary Prevention ===
There are no secondary prevention measures available for post-chemotherapy cognitive impairment.
<br />
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 17:17, 22 October 2019

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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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