Chemotherapy and Cognitive Impairment: Treatment Options

Abstract

Chemotherapy has improved survival rates in patients with many of the common cancers. However, there is reliable evidence that, as a result of treatment, a subset of cancer survivors experience cognitive problems that can last for many years after the completion of chemotherapy. The etiology of this phenomenon is largely unknown, and currently there are no proven treatments. This article explores the clinical and preclinical literature on potential therapies for chemotherapy-induced cognitive impairments. Emerging results suggest that both pharmacological and behavioral approaches may offer patients some benefits. However, research in this area has been limited and is sometimes fraught with methodological flaws. As a result, it is difficult to draw definite conclusions regarding treatment efficacy. These issues, along with predictors of cognitive decline, are discussed in the light of possible interventions.

The Effects of Chemotherapy on Cognitive Function in a Mouse Model: A Prospective Study

“…Chemotherapy produces numerous physiologic effects on the central nervous system that could account for cognitive deficits. These include oxidative stress, neuroinflammation, and suppression of new cell production (neurogenesis) and nerve growth factors (1,27,28). A better understanding of these putative mechanisms is essential for minimizing the impact of anticancer drugs on cognition and for developing biologic treatments.…”

“…If frontal lobe functions are indeed amenable to recovery, that could have important implications for treatment (28). The most successful cognitive rehabilitation programs are those that focus on executive function under frontal lobe control and emphasize the effective use of appropriate strategies (29,30).…”

Antidepressant use and risk of central nervous system metastasis

“…Preclinical studies indicate that they could also be used to treat 'chemobrain', the chemotherapy-induced alteration in cognition, which occurs in some cancer patients [249][250][251]. In a study of terminally ill cancer patients, 12.7% were prescribed antidepressants for depression, while an additional 4.2% were prescribed antidepressants for pain treatment [252].…”

Er cytostatika skadelig for hjernen?

“…Dette gjør det vanskelig å fastslå betydningen av cytostatika for seg. Hukommelsestrening og fysisk aktivitet har dokumentert effekt mot kognitiv dysfunksjon (15), men dette er ikke klart vist hos kreftpasienter etter cytostatikabehandling (16,17).…”