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.
SourceAvailable from: Yili Zhang[Show abstract] [Hide abstract]
ABSTRACT: Doxorubicin (DOX) is an anthracycline used widely for cancer chemotherapy. Its primary mode of action appears to be topoisomerase II inhibition, DNA cleavage, and free radical generation. However, in non-neuronal cells, DOX also inhibits the expression of dual-specificity phosphatases (also referred to as MAPK phosphatases) and thereby inhibits the dephosphorylation of extracellular signal-regulated kinase (ERK) and p38 mitogen-activated protein kinase (p38 MAPK), two MAPK isoforms important for long-term memory (LTM) formation. Activation of these kinases by DOX in neurons, if present, could have secondary effects on cognitive functions, such as learning and memory. The present study used cultures of rat cortical neurons and sensory neurons (SNs) of Aplysia to examine the effects of DOX on levels of phosphorylated ERK (pERK) and phosphorylated p38 (p-p38) MAPK. In addition, Aplysia neurons were used to examine the effects of DOX on long-term enhanced excitability, long-term synaptic facilitation (LTF), and long-term synaptic depression (LTD). DOX treatment led to elevated levels of pERK and p-p38 MAPK in SNs and cortical neurons. In addition, it increased phosphorylation of the downstream transcriptional repressor cAMP response element-binding protein 2 in SNs. DOX treatment blocked serotonin-induced LTF and enhanced LTD induced by the neuropeptide Phe-Met-Arg-Phe-NH2. The block of LTF appeared to be attributable to overriding inhibitory effects of p-p38 MAPK, because LTF was rescued in the presence of an inhibitor (SB203580 [4-(4-fluorophenyl)-2-(4-methylsulfinylphenyl)-5-(4-pyridyl)-1H-imidazole]) of p38 MAPK. These results suggest that acute application of DOX might impair the formation of LTM via the p38 MAPK pathway.The Journal of Neuroscience : The Official Journal of the Society for Neuroscience 10/2014; 34(40):13289-300. DOI:10.1523/JNEUROSCI.0538-14.2014 · 6.75 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: To provide a comprehensive review of assessment strategies used to determine cancer- and/or cancer treatment-related cognitive changes. Review and synthesis of review articles, databased resources. Although several assessment strategies have been used to determine cancer- and/or cancer treatment-related cognitive changes, definitive standards have yet to be established. Further studies are needed to provide insight into practical and sensitive assessment tools to recognize cognitive changes that can be used in the clinical setting. The nurse's awareness of cognitive concerns is essential for patient education and determination of when patients may need to be referred for more extensive evaluations.Seminars in Oncology Nursing 11/2013; 29(4):270-9. DOI:10.1016/j.soncn.2013.08.007
[Show abstract] [Hide abstract]
ABSTRACT: ABSTRACT To assess the effects of chemoimmunotherapy on post chemotherapy cognitive impairments (PCCI) in B-cell Non-Hodgkin-Lymphoma (NHL) patients, we used objective and subjective measures of cognitive functions in combination with serum parameters and neuroelectric recordings. Self-perceived status of cognition, fatigue and emotional functioning were reduced in patients (n=30) compared to healthy controls (n=10). Cognitive performance was impaired in NHL patients compared to the controls and a norm sample (n=1179). PCCI was more severe in patients treated with Rituximab and Bendamustine (BR) than in patients who received Rituximab in combination with the CHOP-polychemotherapy (R-CHOP). NHL patients` individual alpha peak frequency and serum brain-derived neurotrophic factor (BDNF) levels correlated with accuracy in the objective cognition test. Higher serum IL-6 concentrations were associated with higher fatigue levels. NHL patients and especially those who were treated with BR are affected by PCCI. BDNF and IL-6 might be involved in the pathogenesis of PCCI and fatigue.Leukemia & lymphoma 04/2014; DOI:10.3109/10428194.2014.915546 · 2.61 Impact Factor