Abstract
Chemobrain or chemotherapy induced cognitive impairment (CICI) represents a new clinical syndrome characterised by memory, learning and motor function impairment. As numerous patients with cancer are long-term survivors, CICI represent a significant factor which may interfere with their quality of life. However, this entity CICI must be distinguished from other cognitive syndromes and addressed accordingly. At the present time, experimental and clinical research suggests that CICI could be induced by numerous factors including oxidative stress. This type of CNS injury has been previously described in cancer patients treated with common anti-neoplastic drugs such as doxorubicine, carmustine, methotrexate and cyclophosphamide. It seems that all these pharmacological factors promote neuronal death through a final common pathway represented by TNF alpha (tumour necrosis factor). However, as cancer in general is diagnosed more commonly in the aging population, the elderly oncological patient must be treated with great care since aging per se is also impacted by oxidative stress and potentiually by TNF alpha deleterious action on brain parenchyma. In this context, some patients may develop cognitive dysfunction well before the appearance of CICI. In addition, chemotherapy may worsen their cognitive function. Therefore, at the present time, there is an acute need for development of effective therapeutic methods to prevent CICI as well as new methods of early CICI diagnosis.
Highlights
Chemobrain or chemotherapy induced cognitive impairment (CICI) represents a new clinical syndrome characterised by memory, learning and motor function impairment
A significant reduction in total brain and grey matter volumes was recorded post-chemotherapy in breast cancer survivors [16,17,20]. These findings suggest that neuropsychological changes could be determined by direct CNS tissue deterioration induced by various pharmacological factors used in cancer therapy
Oxidative stress is one putative mechanism underlying chemotherapy-induced cognitive impairment associated with cancer treatment
Summary
Cognitive impairment described in cancer patients is determined by numerous factors. Perhaps the most important is related to the origin and location of the tumour. The aging factor must be carefully considered as cancer is encountered in significant numbers in an aging population In this setting, preliminary changes suggestive of dementia could be already present before cancer development and chemotherapy. In the realm of chemotherapy induced cancer impairment (CICI), the oxidative stress represents one of the most common etio-pathological factor leading to significant neurobiological changes. It is of paramount importance to note that a significant number of chemotherapeutic drugs exert their anti-neoplastic action by inducing oxidative stress in malignant tissue as well as in the brain and other organs and systems. Morphological changes suggestive of oxidative stress injury after cyclophosphamide, one of the most common chemotherapeutic agents, are represented by significant abnormalities in granular and neuronal dendrites as well as spine density and immaturity of spines [32]
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