Cancer-related Cognitive Impairment

Abstract

Abstract Cognitive impairment is reported by cancer survivors as one of the most important side-effects of treatment that impairs function and quality of life. Over 70% of cancer survivors report ongoing cognitive symptoms, approximately a third perform lower than expected on formal cognitive testing prior to receiving chemotherapy, and 20-30% have sustained cognitive impairment. Studies have shown impairment persisting up to 20 years after chemotherapy. The cognitive domains most affected are memory, processing speed and executive function. Studies generally find a dissociation between self-reported cognitive impairment (symptoms) and the results of formal neuropsychological assessments in cancer survivors. Neuroimaging studies suggest changes in grey matter volume and compromised white matter integrity in the brains of survivors who have received chemotherapy. Functional magnetic resonance imaging in breast cancer survivors show brain regions of both brain hypoactivation and hyperactivation in cancer survivors who received chemotherapy compared to those that did not or compared to non-cancer controls. The underlying mechanisms of cancer-related cognitive impairment are unknown, although some data suggest there may be a relationship with inflammatory markers and a potential genetic predisposition. There is minimal evidence for how to prevent or treat cancer-related cognitive impairment, but evidence that behavioural interventions such as cognitive rehabilitation and brain training programs can reduce cognitive symptoms. The presentation will give an overview of cancer and cancer treatment induced cognitive impairment, including incidence, duration, putative mechanisms and potential treatments to reduce and manage the challenge.