Brain vulnerability to chemotherapy toxicities

Abstract

Chemotherapy-induced cognitive changes have been an increasing concern among cancer survivors. By using adjuvant treatment for breast cancer as the prototype, this manuscript reviews research from neuropsychological, imaging, genetic, and animal model studies that have examined the clinical presentation and potential mechanisms for cognitive changes associated with exposure to chemotherapy. An impressive body of research supports the hypothesis that a subgroup of patients is vulnerable to post-treatment cognitive changes, although not exclusively related to chemotherapy. Further, imaging and animal model studies provide accumulating evidence of putative mechanisms for chemotherapy-induced cognitive change. Models of aging are also reviewed in support of the proposal that cognitive changes associated with cancer and cancer treatments can be viewed in the context of factors that affect the trajectory of normal aging.

Keywords: brain vulnerability; cancer; chemotherapy; cognition; oncology.

Conflict of interest statement

I have no conflict of interest to report with regard to the preparation of this manuscript.

Copyright © 2012 John Wiley & Sons, Ltd.

Figures

Figure 1

Impact of Change in Brain Resources on Cognitive Performance by Age The same change in brain resources can have a minimal effect on cognitive performance in a young adult (a), a moderate effect in an older adult with high cognitive reserve (b) and a greater effect on an older adult with low cognitive reserve (c).

Figure 2

Trajectories of Cognitive Change