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{{CMG}} {{AE}} {{MV}}
{{CMG}} {{AE}} {{MV}}
   
   
{{SK}} Synonym 1; Synonym 2; Synonym 3
{{SK}} Chemotherapy-induced cognitive dysfunction; Chemo brain; Chemo fog; Chemobrain; PCCI
   
   
==Overview==
==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.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref> 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.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref> 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.<ref name="wiki">Post-chemotherapy cognitive impairment. Wikipedia. https://en.wikipedia.org/wiki/Post-chemotherapy_cognitive_impairment Accessed on May 18, 2016 </ref>


==Historical Perspective==
*Post-chemotherapy cognitive impairment was first discovered and described in 1980.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>


==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==
==Classification==
*Post-chemotherapy cognitive impairment may be classified according to [classification method] into [number] subtypes/groups:
*There is no classification system for post-chemotherapy cognitive impairment.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>
:*[group1]
 
:*[group2]
:*[group3]
*Other variants of post-chemotherapy cognitive impairment include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
==Pathophysiology==
==Pathophysiology==
*The pathogenesis of post-chemotherapy cognitive impairment is characterized by [feature1], [feature2], and [feature3].
*The pathogenesis of post-chemotherapy cognitive impairment is not fully understood.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>
*The [gene name] gene/Mutation in [gene name] has been associated with the development of post-chemotherapy cognitive impairment, involving the [molecular pathway] pathway.
*However, the underlying pathophysiology is believed to be caused by direct neurotoxicity.  
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of post-chemotherapy cognitive impairment.
*Genes involved the development of post-chemotherapy cognitive impairment, include:<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of post-chemotherapy cognitive impairment.
:*COMT nucleotide polymorphism
:*Apolipoprotein E
:*BDNF gene
*On gross pathology, characteristic findings of post-chemotherapy cognitive impairment, include:<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>
:*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==
==Causes==
* Post-chemotherapy cognitive impairment may be caused by either [cause1], [cause2], or [cause3].
* Common causes of post-chemotherapy cognitive impairment, include:<ref name="polink">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</ref>
* Post-chemotherapy cognitive impairment is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
:*[[Cyclophosphamide]]
* There are no established causes for post-chemotherapy cognitive impairment.
:*[[5-fluorouracil]]
:*[[Methotrexate]]
==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:
==Differentiating Post-Chemotherapy Cognitive Impairment from Other Diseases==
:*[Differential dx1]
*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:<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>
:*[Differential dx2]
:*[[Dehydration]]
:*[Differential dx3]
:*[[Infection]]
:*[[Sepsis]]
 
==Epidemiology and Demographics==
==Epidemiology and Demographics==
* The prevalence of post-chemotherapy cognitive impairment is approximately [number or range] per 100,000 individuals worldwide.
* Post-chemotherapy cognitive impairment is rare.
* In [year], the incidence of post-chemotherapy cognitive impairment was estimated to be [number or range] cases per 100,000 individuals in [location].
* 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.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>
===Age===
===Age===
*Patients of all age groups may develop post-chemotherapy cognitive impairment.
*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.  
*Post-chemotherapy cognitive impairment is more commonly observed among patients aged [age range] years old.
===Gender===  
*Post-chemotherapy cognitive impairment is more commonly observed among [elderly patients/young patients/children].
*Females are slightly more commonly affected with post-chemotherapy cognitive impairment than males.<ref name="wiki">Post-chemotherapy cognitive impairment. Wikipedia. https://en.wikipedia.org/wiki/Post-chemotherapy_cognitive_impairment Accessed on May 18, 2016 </ref>
===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===
===Race===
*There is no racial predilection for post-chemotherapy cognitive impairment.
*There is no racial predilection for post-chemotherapy cognitive impairment.<ref name="wiki">Post-chemotherapy cognitive impairment. Wikipedia. https://en.wikipedia.org/wiki/Post-chemotherapy_cognitive_impairment Accessed on May 18, 2016 </ref>
 
*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==
==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].
*The most common risk factor in the development of post-chemotherapy cognitive impairment are number of cycles of chemotherapy.<ref name="polink">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</ref>
   
   
== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*The majority of patients with post-chemotherapy cognitive impairment remain asymptomatic for [duration/years].  
*The majority of patients with post-chemotherapy cognitive impairment are initially symptomatic.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*Early clinical features, include:
*If left untreated, [#%] of patients with post-chemotherapy cognitive impairment may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
:*Lack of attention 
*Common complications of post-chemotherapy cognitive impairment include [complication 1], [complication 2], and [complication 3].
:*Memory loss
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with post-chemotherapy cognitive impairment is approximately [#%].
:*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:<ref name="polink">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</ref>
:*Decreased executive function
:*[[Cerebrovascular disease|Cerebrovascular disorders]]
:*Focal neurological deficits
*Prognosis will generally good, and symptoms of post-chemotherapy cognitive impairment typically disappear in about four years.
 
== Diagnosis ==
== 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 ===
=== Symptoms ===
*Post-chemotherapy cognitive impairment is usually asymptomatic.
*Post-chemotherapy cognitive impairment is usually symptomatic at diagnosis
*Symptoms of post-chemotherapy cognitive impairment may include the following:
*Symptoms of post-chemotherapy cognitive impairment may include the following:<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>
:*[symptom 1]
:*[[Memory loss]]
:*[symptom 2]
:*Lack of attention
:*[symptom 3]
:*Difficult language fluency
:*[symptom 4]
:*Poor calculation and recall
:*[symptom 5]
:*[[Loss of appetite]]
:*[symptom 6]
:*Irritability or constant mood swings
:*Hopelessness
*A directed history should be obtained to ascertain:
:*Aggravating factors, such as:
::*[[Anxiety]]  
::*[[Depression]]
 
=== Physical Examination ===
=== Physical Examination ===
*Patients with post-chemotherapy cognitive impairment usually appear [general appearance].
*Patients with post-chemotherapy cognitive impairment usually appear malnourished and pale.  
*Physical examination may be remarkable for:
*Physical examination shows no remarkable findings for patients with post-chemotherapy cognitive impairment.<ref name="polink">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</ref>
:*[finding 1]
 
:*[finding 2]
:*[finding 3]
:*[finding 4]
:*[finding 5]
:*[finding 6]
=== Laboratory Findings ===
=== Laboratory Findings ===
*There are no specific laboratory findings associated with post-chemotherapy cognitive impairment.
*There are no specific laboratory findings associated with post-chemotherapy cognitive impairment.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>
*In some cases, elevated levels of [[apolipoprotein]] (APOE) allele may be seen in patients 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===
===Imaging Findings===
*There are no [imaging study] findings associated with post-chemotherapy cognitive impairment.
*There are no imaging findings associated with post-chemotherapy cognitive impairment.
*In some cases, MRI may detect accurate measurement of therapy-induced changes in gray and white matter volumes.
*[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 ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*There is no treatment for post-chemotherapy cognitive impairment; the mainstay of therapy is supportive care.
*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:<ref name="polink">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</ref>
*The mainstay of therapy for post-chemotherapy cognitive impairment is [medical therapy 1] and [medical therapy 2].
:*[[Hormonal therapy]]
*[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 ===
*Surgery is the mainstay of therapy for post-chemotherapy cognitive impairment.
*Surgery is not recommended for patients with post-chemotherapy cognitive impairment.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>
*[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 ===
=== Prevention ===
*There are no primary preventive measures available for post-chemotherapy cognitive impairment.
*There are no primary preventive measures available for post-chemotherapy cognitive impairment.<ref name="pmid21600374">{{cite journal |vauthors=Janelsins MC, Kohli S, Mohile SG, Usuki K, Ahles TA, Morrow GR |title=An update on cancer- and chemotherapy-related cognitive dysfunction: current status |journal=Semin. Oncol. |volume=38 |issue=3 |pages=431–8 |year=2011 |pmid=21600374 |pmc=3120018 |doi=10.1053/j.seminoncol.2011.03.014 |url=}}</ref>
*Once diagnosed and successfully treated, patients with post-chemotherapy cognitive impairment are followed-up every visit.
*Effective measures for the primary prevention of post-chemotherapy cognitive impairment include [measure1], [measure2], and [measure3].
*Follow-up testing includes cognitive function assessments (such as, mini–mental state examination)


*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].
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
   
   
[[Category: Oncology]]
[[Category: Oncology]]

Latest revision as of 20:42, 18 May 2016

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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; 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.[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:[1]
  • COMT nucleotide polymorphism
  • Apolipoprotein E
  • BDNF gene
  • On gross pathology, characteristic findings of post-chemotherapy cognitive impairment, include:[1]
  • 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:[3]

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 are number of cycles of chemotherapy.[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:[3]
  • Prognosis will generally good, and symptoms of post-chemotherapy cognitive impairment typically disappear in about four years.

Diagnosis

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.[3]

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

Imaging Findings

  • There are no imaging findings associated with post-chemotherapy cognitive impairment.
  • In some cases, MRI may detect accurate measurement of therapy-induced changes in gray and white matter volumes.

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:[3]

Surgery

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

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)

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 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. ↑ 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
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