TY - JOUR
T1 - Perioperative considerations in patients with chemotherapy-induced cognitive impairment
T2 - a narrative review
AU - Guran, Ekin
AU - Hu, Jian
AU - Wefel, Jeffrey S.
AU - Chung, Caroline
AU - Cata, Juan P.
N1 - Publisher Copyright:
© 2022 British Journal of Anaesthesia
PY - 2022/12
Y1 - 2022/12
N2 - Patients with cancer may suffer from a decline in their cognitive function after various cancer therapies, including surgery, radiation, and chemotherapy, and in some cases, this decline in cognitive function persists even years after completion of treatment. Chemobrain or chemotherapy-induced cognitive impairment, a well-established clinical syndrome, has become an increasing concern as the number of successfully treated cancer patients has increased significantly. Chemotherapy-induced cognitive impairment can originate from direct neurotoxicity, neuroinflammation, and oxidative stress, resulting in alterations in grey matter volume, white matter integrity, and brain connectivity. Surgery has been associated with exacerbating the inflammatory response associated with chemotherapy and predisposes patients to develop postoperative cognitive dysfunction. As the proportion of patients living longer after these therapies increases, the magnitude of impact and growing concern of post-treatment cognitive dysfunction in these patients has also come to the fore. We review the clinical presentation, potential mechanisms, predisposing factors, diagnostic methods, neuropsychological testing, and imaging findings of chemotherapy-induced cognitive impairment and its intersection with postoperative cognitive dysfunction.
AB - Patients with cancer may suffer from a decline in their cognitive function after various cancer therapies, including surgery, radiation, and chemotherapy, and in some cases, this decline in cognitive function persists even years after completion of treatment. Chemobrain or chemotherapy-induced cognitive impairment, a well-established clinical syndrome, has become an increasing concern as the number of successfully treated cancer patients has increased significantly. Chemotherapy-induced cognitive impairment can originate from direct neurotoxicity, neuroinflammation, and oxidative stress, resulting in alterations in grey matter volume, white matter integrity, and brain connectivity. Surgery has been associated with exacerbating the inflammatory response associated with chemotherapy and predisposes patients to develop postoperative cognitive dysfunction. As the proportion of patients living longer after these therapies increases, the magnitude of impact and growing concern of post-treatment cognitive dysfunction in these patients has also come to the fore. We review the clinical presentation, potential mechanisms, predisposing factors, diagnostic methods, neuropsychological testing, and imaging findings of chemotherapy-induced cognitive impairment and its intersection with postoperative cognitive dysfunction.
KW - chemobrain
KW - chemofog
KW - chemotherapy-induced cognitive impairment
KW - perioperative neurocognitive disorders
KW - postoperative cognitive dysfunction
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UR - http://www.scopus.com/inward/citedby.url?scp=85140045422&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2022.08.037
DO - 10.1016/j.bja.2022.08.037
M3 - Review article
C2 - 36270848
AN - SCOPUS:85140045422
SN - 0007-0912
VL - 129
SP - 909
EP - 922
JO - British journal of anaesthesia
JF - British journal of anaesthesia
IS - 6
ER -