Cognitive impairment associated with chemotherapy

Abstract

Rak dojke je najčešći zloćudni tumor u žena, a svaka deseta žena će ga dobiti tijekom svog života. “Post-chemotherapy cognitive impairment (PCCI)” ili „Chemotherapy related cognitive impairment (CRCI)“ je pojava kognitivnog deficita koji se javlja u otprilike trećine pacijenata nakon provedene kemoterapije. Neki od simptoma uključuju: nemogućnost obavljanja više stvari istovremeno (eng. multitasking), zbunjenost, zaboravljivost, slabo prisjećanje, iscrpljenost itd. U posljednjih 20 godina istraživanja na ovom području su ustvrdila povezanost između sistemske adjuvantne kemoterapije i kognitivnih promjena, što je potvrđeno i s nekoliko meta-analiza. Oštećenja su najčešće bila vezana uz pamćenje, izvršne funkcije, brzinu obrade informacija, orijentaciju u prostoru i verbalne sposobnosti. Iako promjene u pacijenata prema neuropsihološkim testovima mogu biti vrlo blage, one svejedno imaju snažan utjecaj na kvalitetu života. Strukturne studije su uz pomoć MR-a otkrile smanjenje gustoće sive tvari i volumena, DTI-em su otkrivene promjene cjelovitosti bijele tvari i volumena. Prozor u rad mozga su otvorile funkcionalne studije korištenjem fMR-a, koji je pokazao post-terapijske promjene u mozgu, prilikom rješavanja zadataka koji su ispitivali sjećanje i izvršne funkcije, te obrazac povezanosti mozga u odmoru. U većini slučajeva problemi s pamćenjem su privremeni, stoga je terapija usmjerena na pomaganje pacijentima da se nauče nositi sa simptomima. Razvijanje standardne terapije je otežano, obzirom da simptomi nerijetko variraju među pacijentima. Neki od pokušaja liječenja farmakoterapijskim pripravcima uključuju: metilfenidat, modafinil i donepezil.Breast cancer is the most common invasive cancer in women and one in ten women will be diagnosed during her life time. “Post – chemotherapy cognitive impairment (PCCI)” or „Chemotherapy related cognitive impairment (CRCI)“ is a phenomenon of cognitive decline that occurs approximately in one third of patients over the course of their chemotherapy. Some of the symptoms are: inability to multitask, confusion, forgetfulness, poor recall, exhaustion etc. Two decades of research, primarily in the breast cancer patient population, has confirmed an association between cognitive changes and systemic adjuvant chemotherapy as confirmed by several metaanalyses. Across cognitive studies, the specific domains affected have been relatively consistent, and include memory, executive function, processing speed, and verbal and spatial abilities. Although the changes may be relatively mild as measured by current psychometric methods, such mild cognitive dysfunction may have a very significant impact on quality of life. Structural changes detected include decreased gray matter density and volume on anatomic MRI and alteration in white matter integrity and volume on diffusion tensor imaging (DTI). fMRI studies have demonstrated post-treatment changes in brain activation during memory and executive tasks and in resting brain connectivity pattern. Developing standard therapy is difficult, given that symptoms often vary among patients. In most cases, memory problems are temporary, so the therapy is focused on helping patients to learn to cope with the symptoms. Attempts using medications include: methylphenidate, modafinil and donepezil