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].
• In [year], [gene] mutations were first identified in the pathogenesis of post-chemotherapy cognitive impairment.
• In [year], the first [discovery] was developed by [scientist] to treat/diagnose post-chemotherapy cognitive impairment.

Classification

• Post-chemotherapy cognitive impairment may be classified according to [classification method] into [number] subtypes/groups:

• [group1]
• [group2]
• [group3]

• Other variants of post-chemotherapy cognitive impairment include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

Pathophysiology

• The pathogenesis of post-chemotherapy cognitive impairment is characterized by [feature1], [feature2], and [feature3].
• There are no genes associated with the development of post-chemotherapy cognitive impairment.
• On gross pathology, characteristic findings of post-chemotherapy cognitive impairment, include:
• On microscopic histopathological analysis, characteristic findings of post-chemotherapy cognitive impairment, include:

Causes

• The causes for post-chemotherapy cognitive impairment remain unknown.

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

• Common risk factors in the development of post-chemotherapy cognitive impairment are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

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].