| Mechanisms of chemotherapy-induced cognitive disorders: neuropsychological, pathophysiological, and neuroimaging perspectives. | |
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MedLine Citation:
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PMID: 14613048 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Recent studies have indicated the frequent occurrence of neuropsychologic deficits and cognitive complaints after systemic cancer chemotherapy. Most early reports were retrospective, but prospective longitudinal studies are underway. Although the available evidence suggests a fairly diffuse pattern of changes, memory and executive functions could be preferentially affected. Preliminary data also suggest that some individuals might be more vulnerable than others, leading to investigation of genetic and other risk factors. The greatest gap in our knowledge regarding chemotherapy-related cognitive changes is a lack of understanding of the mechanism or mechanisms that account for the observed changes. Several pathophysiological candidates include direct neurotoxic effects leading to atrophy of cerebral gray matter (GM) and/or demyelination of white matter (WM) fibers, secondary immunologic responses causing inflammatory reactions, and microvascular injury. Altered neurotransmitter levels and metabolites could constitute an additional mechanism related to neurotoxic effects. Advanced brain imaging techniques can directly or indirectly assess many of these mechanisms, but to date there has been very limited application of these tools. Morphometric magnetic resonance imaging (MRI), functional MRI (fMRI), diffusion tensor imaging (DTI), and MR spectroscopy (MRS) are noninvasive techniques that could yield important complementary data regarding the nature of neural changes after chemotherapy. Electrophysiological studies and targeted molecular imaging with positron emission tomography (PET) could also provide unique information. We review the minimal imaging data available at present and also note studies of other brain disorders or treatment effects that might serve as a model for imaging chemotherapy-induced changes. Large-scale prospective studies are needed to help isolate the pathophysiological mechanisms underlying the cognitive deficits associated with chemotherapy. |
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Authors:
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Andrew J Saykin; Tim A Ahles; Brenna C McDonald |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.; Review |
Journal Detail:
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Title: Seminars in clinical neuropsychiatry Volume: 8 ISSN: 1084-3612 ISO Abbreviation: Semin Clin Neuropsychiatry Publication Date: 2003 Oct |
Date Detail:
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Created Date: 2003-11-12 Completed Date: 2004-01-28 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 9604647 Medline TA: Semin Clin Neuropsychiatry Country: United States |
Other Details:
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Languages: eng Pagination: 201-16 Citation Subset: IM |
Affiliation:
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Brain Imaging Laboratory, Dartmouth Medical School, Lebanon, NH 03756, USA. saykin@dartmouth.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Antineoplastic Agents
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adverse effects* Brain / drug effects, pathology, physiopathology Cognition Disorders / chemically induced*, diagnosis Diagnostic Imaging Humans Neoplasms / drug therapy, psychology* |
| Grant Support | |
ID/Acronym/Agency:
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P30 CA23108/CA/NCI NIH HHS; R01 AG19771/AG/NIA NIH HHS; R01 CA101318/CA/NCI NIH HHS; R01 CA87845/CA/NCI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antineoplastic Agents |
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