Sandbox: Post-chemotherapy cognitive impairment: Difference between revisions

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*If left untreated, patients with post-chemotherapy cognitive impairment may progress to develop  
*If left untreated, patients with post-chemotherapy cognitive impairment may progress to develop  
*Common complications of post-chemotherapy cognitive impairment, include:
*Common complications of post-chemotherapy cognitive impairment, include:
:*
:*Decreased executive function
:*
:*Cerebrovascular disorders
:*
:*Focal neurological deficits
*Prognosis will generally depend on the underlying cause of cancer.  
*Prognosis will generally depend on the underlying cause of cancer.


== Diagnosis ==
== Diagnosis ==

Revision as of 19:37, 18 May 2016

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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

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 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. Recent studies suggest further investigation on the underlying mechanisms of cognitive impairment.

Historical Perspective

  • Post-chemotherapy cognitive impairment was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].

Classification

  • There is no classification system for post-chemotherapy cognitive impairment.

Pathophysiology

  • The pathogenesis of post-chemotherapy cognitive impairment is not fully understood.
  • However, the underlying pathophysiology is believed to be caused by direct neurotoxicity.
  • Genes involved the development of post-chemotherapy cognitive impairment, include:
  • COMT nucleotide polymorphism
  • Apolipoprotein E
  • BDNF gene
  • On gross pathology, characteristic findings of post-chemotherapy cognitive impairment, include:
  • 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:[1]
  • 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, lack of attention, orientation to time and space), such as:
  • Dehydration
  • Infection
  • Sepsis

Epidemiology and Demographics

  • Post-chemotherapy cognitive impairment is rare
  • The prevalence of post-chemotherapy cognitive impairment remains unknown.

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.

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 are number of cycles of chemotherapy.

Natural History, Complications and Prognosis

  • The majority of patients with post-chemotherapy cognitive impairment are initially symptomatic.
  • Early clinical features, include:
  • Lack of attention
  • Problems to recall
  • Lack of orientation
  • If left untreated, patients with post-chemotherapy cognitive impairment may progress to develop
  • Common complications of post-chemotherapy cognitive impairment, include:
  • Decreased executive function
  • Cerebrovascular disorders
  • Focal neurological deficits
  • Prognosis will generally depend on the underlying cause of cancer.

Diagnosis

Diagnostic Criteria

  • The diagnosis of post-chemotherapy cognitive impairment is made with the following diagnostic criteria:
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]
  • [criterion 4]

Symptoms

  • Post-chemotherapy cognitive impairment is usually symptomatic at diagnosis
  • Symptoms of post-chemotherapy cognitive impairment may include the following:
  • [symptom 2]
  • [symptom 3]
  • [symptom 4]
  • [symptom 5]
  • [symptom 6]
  • A directed history should be obtained to ascertain:
  • Aggravating factors, such as:
  • Anxiety
  • Depression

Physical Examination

  • Patients with post-chemotherapy cognitive impairment usually appear [general appearance].
  • Physical examination may be remarkable for:
  • Temperature
  • High grade fever
  • Low grade fever
  • Rapid pulse

Laboratory Findings

  • There are no specific laboratory findings associated 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

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

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:
  • Hormonal Therapy

Surgery

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

Prevention

  • There are no 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)

References