Sandbox: Post-chemotherapy cognitive impairment
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 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:
- 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 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].
Treatment
Medical Therapy
- There is no treatment for post-chemotherapy cognitive impairment; the mainstay of therapy is supportive care.
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
- ↑ 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