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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. 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]] 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.
'''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==
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=== Prevalnce ===
=== 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="wiki">Post-chemotherapy cognitive impairment. Wikipedia. https://en.wikipedia.org/wiki/Post-chemotherapy_cognitive_impairment Accessed on May 18, 2016 </ref>
* 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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*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>
*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===
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.


*
*
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== 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 prevention|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)


=== 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.