Chemo Brain: A Decade of Evidence

Jeffrey S. Wefel, PhD; Alice Goodman, MA

Disclosures

November 01, 2013

In This Article

Efforts to Determine Risk for Dysfunction

Medscape: Are studies under way to investigate which patients are at risk for chemo brain?

Dr. Wefel: We are conducting a National Institutes of Health-funded, longitudinal, multimodal imaging, genetic, and neuropsychological study to determine biomarkers that can identify women before treatment who are at increased risk of developing chemotherapy-related cognitive dysfunction.[13] The women will undergo structural and functional MRI studies, a comprehensive battery of neuropsychological tests, and blood tests both before and after chemotherapy; these findings will be compared with those in women with breast cancer not treated with chemotherapy, as well as healthy controls.

We will examine whether brain connectivity and activation on imaging studies, alone or in combination with certain genotypes, predict which women are at increased risk. The study focuses on women older than 60 years, because we hypothesize that cancer and cancer therapy may accelerate the aging process and push women into a trajectory of abnormal age-associated cognitive decline.

At present, we are unable to identify the subset of patients who will go on to experience treatment-related cognitive dysfunction. If we can identify biomarkers that predict risk, we will have a window of opportunity to consider risk-adapted therapies and, ultimately, interventional approaches to prevent or reduce risk and maximize the safety and efficacy of life-preserving cancer therapies.

Medscape: Are men and women equally affected?

Dr. Wefel: The effect of gender on the development of chemo brain is of great interest, but most of the published work has been done in women with breast cancer. However, a small set of studies has demonstrated cognitive decline in men with testicular cancer as well as men with prostate cancer treated with luteinizing hormone analogues.[14,15,16,17] Evidence regarding the cognitive side effects of chemotherapy in men with other cancers remains to be elucidated, as is true of many cancer types regardless of gender.

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