Chemotherapy-Related Cognitive Impairment
ABSTRACT Chemotherapy-related cognitive impairment (CRCI) was first described in the 1970s, but significant recognition of CRCI did not emerge with consistency until the late 1990s. Estimates of frequency now range from 17%-75%, and evidence suggests that CRCI, or "chemobrain" as it is referred to in the lay literature, is of significant concern to patients. A variety of potentially associated factors have been identified, including age, education level, intelligence, and social support; anxiety, depression, and fatigue; disease site, stage, and comorbidities; treatment regimen, timing, duration, and concomitant therapies; and hormonal levels, cytokine levels, damage to neural progenitor cells, and the presence of the apolipoprotein E 4 allele. Controversy exists as to the most suitable neurocognitive tests to evaluate this sequeal of treatment. Neuroimaging techniques are beginning to reveal affected areas of the brain. A neuropsychologist is essential for the assessment, diagnosis, and recommendation of appropriate management strategies for this patient population. Oncology nurses should be aware of available resources, such as relevant Web sites, support groups, neuropsychologists, and cognitive retraining programs, and provide support for patients concerned about or experiencing CRCI.
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ABSTRACT: Adjuvant cancer chemotherapy can cause long-lasting, cognitive deficits. It is postulated that these impairments are due to these drugs targeting neural precursors within the adult hippocampus, the loss of which has been associated with memory impairment. The present study investigates the effects of the chemotherapy, methotrexate (MTX) on spatial working memory and the proliferation and survival of the neural precursors involved in hippocampal neurogenesis, and the possible neuroprotective properties of the antidepressant fluoxetine. Male Lister hooded rats were administered MTX (75 mg/kg, two i.v. doses a week apart) followed by leucovorin rescue (i.p. 18 h after MTX at 6 mg/kg and at 26, 42 and 50 h at 3 mg/kg) and/or fluoxetine (10 mg/kg/day in drinking water for 40 days). Memory was tested using the novel location recognition (NLR) test. Using markers, cell proliferation (Ki67) and survival (bromodeoxyuridine/BrdU), in the dentate gyrus were quantified. MTX-treated rats showed a cognitive deficit in the NLR task compared with the vehicle and fluoxetine-treated groups. Cognitive ability was restored in the group receiving both MTX and fluoxetine. MTX reduced both the number of proliferating cells in the SGZ and their survival. This was prevented by the co-administration of fluoxetine, which alone increased cell numbers. These results demonstrate that MTX induces an impairment in spatial working memory and has a negative long-term effect on hippocampal neurogenesis, which is counteracted by the co-administration of fluoxetine. If translatable to patients, this finding has the potential to prevent the chemotherapy-induced cognitive deficits experienced by many cancer survivors.Psychopharmacology 12/2010; 215(1):105-15. DOI:10.1007/s00213-010-2122-2 · 3.99 Impact Factor
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ABSTRACT: Les tumeurs cérébrales restent une maladie au pronostic très sombre, le concept de qualité de vie est donc fondamental dans cette population et est maintenant bien documenté. Il peut être affecté dans des proportions importantes par les troubles de l’humeur, la fatigue et les troubles cognitifs. Quelques interventions dans le domaine des soins de support ont montré des résultats prometteurs, et l’accent doit maintenant être mis sur le développement d’outils d’évaluation de ces soins de support, spécifiques à cette population. Brain tumor patients have a poor prognostic, so quality of life is a very important endpoint. Quality of life (QOL) is a multidimensional concept that could be affected by emotional disorders, fatigue and cognitive impairment among these patients. There are now some consistent findings on brain tumor patients’ QOL and some interventions have been studied with hopeful results. Further priorities have to be given to development of assessments of psychosocial and supportive cares’ intervention. Mots clésTumeurs cérébrales-Troubles de l’humeur-Fatigue-Troubles cognitifs-Qualité de vie KeywordsBrain tumors-Emotional disorders-Fatigue-Cognitive impairment-Quality of lifePsycho-Oncologie 06/2010; 4(2):116-122. DOI:10.1007/s11839-010-0255-5 · 0.08 Impact Factor
- Breast Care 01/2011; 6(2). DOI:10.1159/000327505 · 0.91 Impact Factor