Cognitive Deficits in Cancer Patients with Haematological Malignancies

Česká verzia

Authors: M. Mikulajová; V. Boleková; K. Surová
Authors place of work: Fakulta psychológie, Paneurópská vysoká škola, Bratislava
Published in the journal: Klin Onkol 2017; 30(6): 443-451
Category: Original Articles
doi: https://doi.org/10.14735/amko2017443

Summary

Background:
Cognitive deficits are one of the most common adverse effects of chemotherapy (CHT). Previous reports suggest that this is due to the so-called chemo brain syndrome, the symptoms of which manifest mainly as impairments in executive functions, speed of information processing, memory, attention, and motor speed. However, empirical evidence for these manifestations is currently ambiguous.

Methods:
The research group consisted of 26 cancer patients with haematological malignancies who had undergone chemotherapy treatment. Cognitive performance was measured by two screening cognitive tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Test (MoCA).

Results:
MMSE detected cognitive deficits in 34.6% of patients whereas MoCA identified mild or moderate cognitive impairment in up to 80.7% of patients. The highest error rates were found in tasks focused on memory, attention, spatial orientation, executive functions, and abstraction. Cognitive deficit progressed with age, but not with duration of therapy.

Conclusion:
Deficits in cognitive functions occur in a considerable number of patients after CHT, although the diagnosis depends on the sensitivity of the detection method. Screening scales usually provide the first indication of impaired cognitive functioning and may indicate the need for further neuropsychological examination. Early diagnosis of reduced cognitive functions is a prerequisite for effective psychological intervention to help patients cope with the undesirable effects of chemotherapy treatment more quickly.

Key words:
chemotherapy – cognitive dysfunction – chemo brain – cognitive screening – neuropsychological tests – psychology

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Submitted:
4. 7. 2017

Accepted:
24. 8. 2017

Zdroje

1. Freeman JR, Broshek DK. Assessing Cognitive Dysfunction in Breast Cancer: What Are the Tools? Clin Breast Cancer 2002; 3 (Suppl 3): S91–S99.

2. Janelsins M, Kesler S, Ahles T et al. Prevalence, mechanisms, and management of cancer-related cognitive impairment. Int Rev Psychiatry 2014; 26 (1): 102–113. doi: 10.3109/09540261.2013.864260.

3. Piacentine LB, Miller JF, Haberlein S et al. Perceived cognitive changes with chemotherapy for breast cancer. Appl Nurs Res 2016; 29: 9–11. doi: 10.1016/j.apnr.2015. 03.015.

4. Ren X, St Clair DK, Butterfield DA. Dysregulation of cytokine mediated chemotherapy induced cognitive impairment. Pharmacol Res 2017; 117: 267–273. doi: 10.1016/j.phrs.2017.01.001.

5. Wefel JS, Kesler SR, Noll KR et al. Clinical Characteristics, Pathophysiology, and Management of Noncentral Nervous System Cancer-Related Cognitive Impairment in Adults. CA Cancer J Clin 2015; 65 (2): 123–138. doi: 10.3322/caac.21258.

6. Vasiľková L. Vplyv liečby na kognitívne funkcie a kvalitu života u pacientov s karcinomom semenníkov. Klin Onkol 2016; 29 (4): 267–273. doi: 10.14735/amko2016267.

7. Vlčková I, Pavelková K, Kepák T et al. Změny v oblasti neurokognitívnych funkcí v důsledku léčby nádorových onemocnění dětí a dospívajících. Klin Onkol 2008; 21 (5): 294–302.

8. Argyriou AA, Assimakopoulos K, Iconomou G et al. Either Called ‘‘Chemobrain’’ or ‘‘Chemofog,’’ the Long-Term Chemotherapy-Induced Cognitive Decline in Cancer Survivors Is Real. J Pain Symptom Manage 2011; 41 (1): 126–139. doi: 10.1016/j.jpainsymman.2010.04.021.

9. Collins B, Mackenzie J, Stewart A et al. Cognitive effects of chemotherapy in post-menopausal breast cancer patients 1 year after treatment. Psychooncology 2009; 18 (2): 134–143. doi: 10.1002/pon.1379.

10. Wefel J, Lenzi R, Theriault RL et al. The Cognitive Sequelae of Standard-Dose Adjuvant Chemotherapy in Women with Breast Carcinoma. Results of a Prospective, Randomized, Longitudinal Trial. Cancer 2004; 100 (11): 2292–2299. doi: 10.1002/cncr.20272.

11. Anderson-Hanley C, Sherman ML, Riggs R et al. Neuropsychological effects of treatments for adults with cancer: A meta-analysis and review of the literature. J Int Neuropsychol Soc 2003; 9 (7): 967–982.

12. Fan HG, Houédé-Tchen N, Yi QL et al. Fatigue, Menopausal Symptoms, and Cognitive Function in Women After Adjuvant Chemotherapy for Breast Cancer: 1-and 2-Year Follow-Up of a Prospective Controlled Study. J Clin Oncol 2005; 23 (31): 8025–8032. doi: 10.1200/JCO.2005.01.6550.

13. Kam Jwy, Brenner Ca, Handy TC et al. Sustained attention abnormalities in breast cancer survivors with cognitive deficits post chemotherapy: An electrophysiological study. Clin Neurophysiol 2016; 127 (1): 369–378. doi: 10.1016/j.clinph.2015.03.007.

14. Koppelmans V, de Ruier MB, van der Lijn F et al. Global and focal brain volume in long-term breast cancer survivors exposed to adjuvant chemotherapy. Breast Cancer Res Treat 2012; 132 (3): 1099–1106. doi: 10.1007/s10549-011-1888-1.

15. de Ruiter MB, Reneman L, Boogerd W et al. Cerebral Hyporesponsiveness and Cognitive Impairment 10 Years After Chemotherapy for Breast Cancer. Hum Brain Mapp 2011; 32 (8): 1206–1219. doi: 10.1002/hbm.21102.

16. Dietrich J, Prust M, Kaiser J. Chemotherapy, cognitive impairment and hippocampal toxicity. Neuroscience 2015; 309: 224–232. doi: 10.1016/j.neuroscience.2015.06.016.

17. Koppelmans V, Breteler MM, Boogerd W et al. Late effects of adjuvant chemotherapy for adult onset non-CNS cancer; cognitive impairment, brain structure and risk of dementia. Crit Rev Oncol Hematol 2013; 88 (1): 87–101. doi: 10.1016/j.critrevonc.2013.04.002.

18. Li J, Yu L, Long Z et al. Perceived cognitive impairment in Chinese patients with breast cancer and its relationship with post-traumatic stress disorder symptoms and fatigue. Psychooncology 2015; 24 (6): 676–682. doi: 10.1002/pon.3710.

19. Hermelink K, Untch M, Lux MP et al. Cognitive function during neoadjuvant chemotherapy for breast cancer: results of a prospective, multicenter, logitudinal study. Cancer 2007; 109 (9): 1905–1913. doi: 10.1002/cncr.22610.

20. Biglia M, Bounous VE, Malabaila A et al. Objective and self-reported cognitive dysfunction in breast cancer women treated with chemotherapy: a prospective study. Eur J Cancer Care 2012; 21 (4): 485–492. doi: 10.1111/j.1365-2354.2011.01320.x.

21. Oh P. Predictors of cognitive decline in people with cancer undergoing Chemotherapy. Eur J Oncol Nurs. In press 2016.

22. Hutchinson AD, Hosking JR, Kichenadass G et al. Objective and subjective cognitive impairment following chemotherapy for cancer: A systematic review. Cancer Treat Rev 2012; 38 (7): 926–934. doi: 10.1016/j.ctrv.2012.05.002.

23. Lam YCJ, Ng T, Shwe M et al. Trajectory of self-perceived cognitive impairment: A 15-month prospective, longitudinal study in Asian early-stage breast cancer (ESBC) patients. abstract 1543. Eur J Cancer 2015; 51 (Suppl 3): 218–219. doi: 10.1016/S0959-8049 (16) 30633-5.

24. Hermelink K. Chemotherapy and Cognitive Function in Breast Cancer Patients: The So-Called Chemo Brain. J Natl Cancer Inst Monogr 2015; 2015 (51): 67–69. doi: 10.1093/jncimonographs/lgv009.

25. Bartoš A, Raisová M. Testy a dotazníky pro vyšetřování kognitivních funkcí, nálady a soběstačnosti. Praha: Mladá fronta 2015: 152.

26. Králová M, Cséfalvay Z, Marková J. Kognitívno-komunikačné poruchy pri demencii. Bratislava: Univerzita Komenského v Bratislave 2016.

27. Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12 (3): 189–198.

28. Molloy W, Clarnette R. Standardized Mini-Mental State Examination. A User’s Guide. New Grange Press 1999.

29. Rektorová I. Screeningové škály pro hodnocení demence. Neurol praxi 2011; 12 (Suppl G): 37–45.

30. Marioni RE, Chatfield M, Brayne C et al. The reliability of assigning individuals to cognitive states using the Mini Mental-State Examination: a population-based prospective cohort study. BMC Med Res Methodol 2011; 11: 127. doi: 10.1186/1471-2288-11-127.

31. Aggarwal A, Kean E. Comparison of the Folstein Mini Mental State Examination (MMSE) to the Montreal Cognitive Assessment (MoCA) as a Cognitive Screening Tool in an Inpatient Rehabilitation Setting. Neurosci Med 2010; 1: 39–42. 10.4236/nm.2010.12006.

32. Bezdíček O, Balabánová P, Havránková P et al. Srovnání české verze Montrealského kognitivního testu s Mini-Mental State pro stanovení kognitivního deficitu u Parkinsonovy nemoci. Cesk Slov Neurol N 2010; 73/106 (2): 150–156.

33. Helmi L, Meagher D, O’Mahony E et al. Agreement and conversion formula between mini-mental state examination and montreal cognitive assessment in an outpatient sample. World J Psychiatry 2016; 6 (3): 358–364. doi: 10.5498/wjp.v6.i3.358.

34. Dong Y, Sharma VK, Chan BP et al. The Montreal Cognitive Assessment (MoCA) is superior to the Mini-Mental State Examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. J Neurol Sci 2010; 299 (1-2): 15-18. doi: 10.1016/j.jns.2010.08.051.

35. Nasreddine Z, Phillips N, Bédirian V et al. The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. J Am Geriatr Soc 2005; 53 (4): 695–699. doi: 10.1111/j.1532-5415.2005.53221.x.

36. Cséfalvay Z, Marková J. Montreal Cognitive Assessment (MoCA). Slovenská verzia testu. Z. Nasreddine. Verzia 7.1. [online]. Dostupné na: http://www.mocatest.org/.

37. Wu C, Dagg P, Molgat C. A pilot study to measure cognitive impairment in patients with severe schizophrenia with the Montreal Cognitive Assessment (MoCA). Schizophr Res 2014; 158 (1–3): 151–155. doi: 10.1016/j.schres.2014.07.006.

38. Collins B, MacKenzie J, Tasca GA et al. Cognitive effects of chemotherapy in breast cancer patients: a doseresponse study. Psychooncology 2013; 22 (7): 1517–1527. doi: 10.1002/pon.3163.

39. Jara-Almonte Edwards B, Khalil P, Holmes H et al. Cognitive impairment and dementia in older cancer patients. Abstract e269. J Clin Oncol 2016; 34 (Suppl 3).

40. Iconomou G, Mega V, Koutras A et al. Prospective Assessment of Emotional Distress, Cognitive Function, and Quality of Life in Patients with Cancer Treated with Chemotherapy. Cancer 2004; 101 (2): 404–411. doi: 10.1002/cncr.20385.

41. Loh KP, Janelsins MC, Mohile SG et al. Chemotherapy-related cognitive impairment in older patients with cancer. J Geriatr Oncol 2016; 7 (4): 270–280. doi: 10.1016/j.jgo.2016.04.008.

42. Olson RA, Chhanabhai T, McKenzie M. Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases. Supportive Care in Cancer 2008; 16 (11): 1273–1278. doi: 10.1007/s00520-008-0431-3.

43. Kesler S, Hadi Hosseini SM, Heckler C et al. Cognitive Training for Improving Executive Function in Chemotherapy Treated Breast Cancer Survivors. Clin Breast Cancer 2013; 13 (4): 299–306. doi: 10.1016/j.clbc.2013.02.004.

44. Nelson W, Suls J. New Approaches to Understand Cognitive Changes Associated With Chemotherapy for Non-Central Nervous System Tumors. J Pain Symptom Manage 2013; 46 (5): 707–721. doi: 10.1016/j.jpainsymman.2012.11.005.

45. MayoClinic.org. Foundation for Medical Education and Research. [online]. Available from: http://www.mayoclinic.org/.