Innovations In Clinical Neuroscience

JAN-FEB 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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36 ICNS Innovations in Clinical Neuroscience • January–February 2018 • Volume 15 • Number 1–2 R E V I E W I It is estimated that there will be approximately 70 million cancer survivors worldwide by the year 2020. 1,2 Cognitive impairment is commonly observed in patients with cancer and those in remission. 3–6 A national cross-sectional survey reported that a history of cancer was associated with a 40-percent increased likelihood of self-reported memory problems. 7 In a recent review, Janelsins et al 4 noted that up to 30 percent of patients with cancer exhibit cognitive impairment prior to treatment, 75 percent might have measurable cognitive impairment during treatment, and 35 percent of cancer survivors will continue to exhibit cognitive difficulties in the months to years that follow treatment. Cognitive impairment can have a negative impact on daily functioning, quality of life, and capacity to work among patients with cancer and those in remission. Consequently, it is clear that increased attention is needed to fully understand the presence and nature of cognitive impairment in patients with cancer and those in remission. DIRECT EFFECTS OF CANCER ON COGNITION Cancer-related cognitive changes and impairment might be due to the cancer itself. Impairments associated with brain tumors often are specific to the lesion location, such as occipital tumors that result in visual deficits. The location and momentum of the lesion (i.e., the rate of tumor growth that can result in the destruction, crowding, displacement, and infiltration of brain tissue) influence the presence, intensity, and pattern of resulting cognitive changes in patients with brain tumors. 8 Wefel et al 9 reported that patients with high-grade gliomas often demonstrate greater cognitive impairment overall compared to those with low-grade gliomas, which might be attributed to greater invasion and/or increased pressure in nearby normal brain tissue. Up to 90 percent of patients with brain metastases exhibit some cognitive impairment prior to treatment, with the degree of impairment correlated with total lesion volume rather than the number of metastatic lesions. 10 Patients with brain tumors can experience impairments in attention, memory, and executive function. 11–15 A general, more diffuse frontal- subcortical pattern of cognitive impairment often occurs in addition to the specific cognitive deficits related to specific location of the cancer in patients with brain tumors. A systematic review of 17 studies of cognitive functioning in patients with low-grade glioma reported a wide range, 19 to 83 percent, of prevalence of cognitive impairments, which was attributed to multiple differences across studies, including the characteristics of the glioma (e.g., type, location, and size), the time of measurement, the A B S T R A C T This brief review explores the areas of cognitive impairment that have been observed in cancer patients and survivors, the cognitive assessment tools used, and the management of the observed cognitive changes. Cognitive changes and impairment observed in patients with cancer and those in remission can be related to the direct effects of cancer itself, nonspecific factors or comorbid conditions that are independent of the actual disease, and/or the treatments or combination of treatments administered. Attention, memory, and executive functioning are the most frequently identified cognitive domains impacted by cancer. However, the prevalence and extent of impairment remains largely unknown due to marked differences in methodology, definitions of cognitive impairment, and the assessment measures used. Assessment of cognitive functioning is an important and necessary part of a comprehensive oncological care plan. Research is needed to establish a better understanding of cognitive changes and impairments associated with cancer so that optimal patient outcomes can be achieved. Keywords: Cognition, cognitive impairment, cancer, chemotherapy, treatment, neuropsychological assessment Cognitive Impairment Associated with Cancer: A Brief Review by J. CARA PENDERGRASS, PhD; STEVEN D. TARGUM, MD; and JOHN E. HARRISON, BSc (Hons), PhD, CPsychol, CSci Drs. Pendergrass and Targum are with Bracket Global and Clintara LLC, A Bracket Company, in Boston, Massachusetts. Dr. Harrison is with the Alzheimer's Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center in Amsterdam, Netherlands; Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, United Kingdom; and Metis Cognition Ltd, Park House, Kilmington Common in Wiltshire, United Kingdom. Innov Clin Neurosci. 2017;15(1–2):36–44 FUNDING: Funding provided by Bracket Global LLC. DISCLOSURES: Drs. Pendergrass and Targum are employees of Bracket LLC. In the last two years, Dr. Harrison has received consultancy fees and honoraria from the following organizations: Abbvie; Access to Quality; Amgen; Anavex; AstraZeneca; Avonex; Avraham; Axon; Axovant; Biogen Idec; Boehringer Ingelheim; Bracket; Cambridge Brain Sciences; Catenion; CRF Health; DeNDRoN; Eisai; Eli Lilly; EnVivo Pharma; Enzymotec; ePharmaSolutions; Forum Pharma; Fresh Forward; GfHEu; Heptares; Janssen AI; Johnson & Johnson; Kaasa Health; Kyowa Hakko Kirin; Lundbeck; MedAvante; Merck; Mind Agilis; MyCognition; Neurim; Neurocog; Neurotrack; Novartis; Nutricia; Orion Pharma; Pfizer; Pharmanet/i3; Prana Biotech; PriceSpective; Probiodrug; Prophase; Prostrakan; Regeneron; Reviva; Roche; Sanofi; Servier; Shire; Takeda; TCG; TransTech Pharma & Velacor. He has additionally received royalties from Oxford University Press and Blackwell Publishers, holds patents with MyCognition and has share options in Neurotrack. He has also presented on behalf of Medscape & Lundbeck in CME accredited speaker bureau programs. CORRESPONDENCE: Steven D. Targum, MD; Email:

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