Sandbox: 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 | '''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> | ||
==Historical Perspective== | ==Historical Perspective== | ||
| Line 32: | Line 32: | ||
==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 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> | ||
:*Cyclophosphamide | :*[[Cyclophosphamide]] | ||
:*5-fluorouracil | :*[[5-fluorouracil]] | ||
:*Methotrexate | :*[[Methotrexate]] | ||
==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, 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]] | ||
:*Sepsis | :*[[Sepsis]] | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
* Post-chemotherapy cognitive impairment is rare. | * Post-chemotherapy cognitive impairment is rare. | ||
* Approximately 20-30% of patients that undergo chemotherapy experience some level of post-chemotherapy cognitive impairment | * Approximately 20-30% of patients that undergo chemotherapy experience some level of post-chemotherapy cognitive impairment. | ||
* The prevalence of post-chemotherapy cognitive impairment remains unknown.<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 prevalence of post-chemotherapy cognitive impairment remains unknown.<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> | ||
===Age=== | ===Age=== | ||
| Line 50: | Line 50: | ||
*Post-chemotherapy cognitive impairment is more commonly observed among middle aged adults and elderly patients. | *Post-chemotherapy cognitive impairment is more commonly observed among middle aged adults and elderly patients. | ||
===Gender=== | ===Gender=== | ||
*Females are slightly more commonly affected with post-chemotherapy cognitive impairment than males.<ref name="wiki"> Post-chemotherapy cognitive impairment. Wikipedia. https://en.wikipedia.org/wiki/Post-chemotherapy_cognitive_impairment Accessed on May 18, 2016 </ref> | *Females are slightly more commonly affected with post-chemotherapy cognitive impairment than males.<ref name="wiki">Post-chemotherapy cognitive impairment. Wikipedia. https://en.wikipedia.org/wiki/Post-chemotherapy_cognitive_impairment Accessed on May 18, 2016 </ref> | ||
===Race=== | ===Race=== | ||
*There is no racial predilection for post-chemotherapy 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> | *There is no racial predilection for post-chemotherapy 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> | ||
==Risk Factors== | ==Risk Factors== | ||
| Line 67: | Line 67: | ||
*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 disorders | :*[[Cerebrovascular disease|Cerebrovascular disorders]] | ||
:*Focal neurological deficits | :*Focal neurological deficits | ||
*Prognosis will generally | *Prognosis will generally good, and symptoms of post-chemotherapy cognitive impairment typically disappear in about four years. | ||
== Diagnosis == | == Diagnosis == | ||
| Line 75: | Line 75: | ||
*Post-chemotherapy cognitive impairment is usually symptomatic at diagnosis | *Post-chemotherapy cognitive impairment is usually symptomatic at diagnosis | ||
*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> | *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 | :*Lack of attention | ||
:*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: | *A directed history should be obtained to ascertain: | ||
:*Aggravating factors, such as: | :*Aggravating factors, such as: | ||
::*Anxiety | ::*[[Anxiety]] | ||
::*Depression | ::*[[Depression]] | ||
=== Physical Examination === | === Physical Examination === | ||
| Line 92: | Line 93: | ||
=== 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> | ||
*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 | ||
===Imaging Findings=== | ===Imaging Findings=== | ||
| Line 102: | Line 103: | ||
*There is no treatment for post-chemotherapy cognitive impairment; the mainstay of therapy is supportive care. | *There is no treatment for post-chemotherapy cognitive impairment; the mainstay of therapy is supportive care. | ||
*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> | *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> | ||
:*Hormonal therapy | :*[[Hormonal therapy]] | ||
=== Surgery === | === Surgery === | ||
Latest revision as of 20:42, 18 May 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: 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.[1] 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.[1] 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.[2]
Historical Perspective
- Post-chemotherapy cognitive impairment was first discovered and described in 1980.[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:[1]
- COMT nucleotide polymorphism
- Apolipoprotein E
- BDNF gene
- On gross pathology, characteristic findings of post-chemotherapy cognitive impairment, include:[1]
- No remarkable findings
- On microscopic histopathological analysis, characteristic findings of post-chemotherapy cognitive impairment, may include:
- Smaller tumor size
- Reduced cellularity
- Extensive cytoplasmic vacuolization causing tumor cells to resemble histiocytes
- Tumor necrosis
- Atrophy and marked nuclear atypia
Causes
- Common causes of post-chemotherapy cognitive impairment, include:[3]
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
- Post-chemotherapy cognitive impairment is rare.
- Approximately 20-30% of patients that undergo chemotherapy experience some level of post-chemotherapy cognitive impairment.
- The prevalence of post-chemotherapy cognitive impairment remains unknown.[1]
Age
- Post-chemotherapy cognitive impairment is more commonly observed among patients aged 40-70 years old.
- Post-chemotherapy cognitive impairment is more commonly observed among middle aged adults and elderly patients.
Gender
- Females are slightly more commonly affected with post-chemotherapy cognitive impairment than males.[2]
Race
- There is no racial predilection for post-chemotherapy cognitive impairment.[2]
Risk Factors
- The most common risk factor in the development of post-chemotherapy cognitive impairment are number of cycles of chemotherapy.[3]
Natural History, Complications and Prognosis
- The majority of patients with post-chemotherapy cognitive impairment are initially symptomatic.[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:[3]
- Decreased executive function
- Cerebrovascular disorders
- Focal neurological deficits
- Prognosis will generally good, and symptoms of post-chemotherapy cognitive impairment typically disappear in about four years.
Diagnosis
Symptoms
- Post-chemotherapy cognitive impairment is usually symptomatic 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
- A directed history should be obtained to ascertain:
- 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.[3]
Laboratory Findings
- There are no specific laboratory findings associated with post-chemotherapy cognitive impairment.[1]
- In some cases, elevated levels of apolipoprotein (APOE) allele may be seen in patients with post-chemotherapy cognitive impairment
Imaging Findings
- There are no imaging findings associated with post-chemotherapy cognitive impairment.
- In some cases, MRI may detect accurate measurement of therapy-induced changes in gray and white matter volumes.
Treatment
Medical Therapy
- There is no treatment for post-chemotherapy cognitive impairment; the mainstay of therapy is supportive care.
- Common medical therapies for the treatment of post-chemotherapy cognitive impairment, include:[3]
Surgery
- Surgery is not recommended for patients with post-chemotherapy cognitive impairment.[1]
Prevention
- There are no primary preventive measures available for post-chemotherapy cognitive impairment.[1]
- 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)
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 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.
- ↑ 2.0 2.1 2.2 Post-chemotherapy cognitive impairment. Wikipedia. https://en.wikipedia.org/wiki/Post-chemotherapy_cognitive_impairment Accessed on May 18, 2016
- ↑ 3.0 3.1 3.2 3.3 3.4 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