Sandbox: Post-chemotherapy cognitive impairment

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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.
  • There are no genes associated with the development of post-chemotherapy cognitive impairment.
  • 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 [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
  • [Differential dx1]
  • [Differential dx2]
  • [Differential dx3]

Epidemiology and Demographics

  • The prevalence of post-chemotherapy cognitive impairment is approximately [number or range] per 100,000 individuals worldwide.
  • In [year], the incidence of post-chemotherapy cognitive impairment was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

  • Patients of all age groups may develop post-chemotherapy cognitive impairment.
  • Post-chemotherapy cognitive impairment is more commonly observed among patients aged [age range] years old.
  • Post-chemotherapy cognitive impairment is more commonly observed among [elderly patients/young patients/children].

Gender

  • Post-chemotherapy cognitive impairment affects men and women equally.
  • [Gender 1] are more commonly affected with post-chemotherapy cognitive impairment than [gender 2].
  • The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race

  • There is no racial predilection for post-chemotherapy cognitive impairment.
  • Post-chemotherapy cognitive impairment usually affects individuals of the [race 1] race.
  • [Race 2] individuals are less likely to develop 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 remain asymptomatic for [duration/years].
  • Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
  • If left untreated, [#%] of patients with post-chemotherapy cognitive impairment may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
  • Common complications of post-chemotherapy cognitive impairment include [complication 1], [complication 2], and [complication 3].
  • Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with post-chemotherapy cognitive impairment is approximately [#%].

Diagnosis

Diagnostic Criteria

  • The diagnosis of post-chemotherapy cognitive impairment is made when at least [number] of the following [number] diagnostic criteria are met:
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]
  • [criterion 4]

Symptoms

  • Post-chemotherapy cognitive impairment is usually asymptomatic.
  • Symptoms of post-chemotherapy cognitive impairment may include the following:
  • [symptom 1]
  • [symptom 2]
  • [symptom 3]
  • [symptom 4]
  • [symptom 5]
  • [symptom 6]

Physical Examination

  • Patients with post-chemotherapy cognitive impairment usually appear [general appearance].
  • Physical examination may be remarkable for:
  • [finding 1]
  • [finding 2]
  • [finding 3]
  • [finding 4]
  • [finding 5]
  • [finding 6]

Laboratory Findings

  • There are no specific laboratory findings associated with post-chemotherapy cognitive impairment.
  • A [positive/negative] [test name] is diagnostic of post-chemotherapy cognitive impairment.
  • An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of post-chemotherapy cognitive impairment.
  • Other laboratory findings consistent with the diagnosis of post-chemotherapy cognitive impairment include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Imaging Findings

  • There are no [imaging study] findings associated with post-chemotherapy cognitive impairment.
  • [Imaging study 1] is the imaging modality of choice for post-chemotherapy cognitive impairment.
  • On [imaging study 1], post-chemotherapy cognitive impairment is characterized by [finding 1], [finding 2], and [finding 3].
  • [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

  • Post-chemotherapy cognitive impairment may also be diagnosed using [diagnostic study name].
  • Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

  • There is no treatment for post-chemotherapy cognitive impairment; the mainstay of therapy is supportive care.
  • The mainstay of therapy for post-chemotherapy cognitive impairment is [medical therapy 1] and [medical therapy 2].
  • [Medical therapy 1] acts by [mechanism of action1].
  • Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

  • Surgery is the mainstay of therapy for post-chemotherapy cognitive impairment.
  • [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of post-chemotherapy cognitive impairment.
  • [Surgical procedure] can only be performed for patients with [disease stage] post-chemotherapy cognitive impairment.

Prevention

  • There are no primary preventive measures available for post-chemotherapy cognitive impairment.
  • Effective measures for the primary prevention of post-chemotherapy cognitive impairment include [measure1], [measure2], and [measure3].
  • Once diagnosed and successfully treated, patients with post-chemotherapy cognitive impairment are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

References