Post-chemotherapy cognitive impairment

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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.[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 following the increasing number of breast cancer survivors.[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:[3][4]
  • COMT nucleotide polymorphism
  • Apolipoprotein E
  • BDNF gene

Causes

  • Common causes of post-chemotherapy cognitive impairment, include:[5]

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 include:

  • are number of cycles of chemotherapy.[5]
  • Smoking[4]

Screening[edit | edit source]

There is insufficient evidence to recommend routine screening for [disease/malignancy].

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

  • 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:[5]
  • Prognosis will generally good, and symptoms of post-chemotherapy cognitive impairment typically disappear in about four years.

Diagnosis

Diagnostic Study of Choice

History and 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.[5]

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

Electrocardiogram[edit | edit source]

There are no ECG findings associated with [disease name].

OR

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].

X-ray[edit | edit source]

There are no x-ray findings associated with [disease name].

OR

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].

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]

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:[5]

Surgery

  • Surgery is not recommended for patients with post-chemotherapy cognitive impairment.[1]

Primary 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)

Secindary Prevention

References

  1. Jump up to: 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 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. Jump up to: 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. 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.
  4. Jump up to: 4.0 4.1 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.