Myers Jamie S
School of Nursing, University of Kansas Medical Center, Edwardsville, Kansas, USA.
Clin J Oncol Nurs. 2009 Aug;13(4):413-21. doi: 10.1188/09.CJON.413-421.
Chemotherapy-related cognitive impairment (CRCI) was first described in the 1970s, but significant recognition of CRCI did not emerge with consistency until the late 1990s. Estimates of frequency now range from 17%-75%, and evidence suggests that CRCI, or "chemobrain" as it is referred to in the lay literature, is of significant concern to patients. A variety of potentially associated factors have been identified, including age, education level, intelligence, and social support; anxiety, depression, and fatigue; disease site, stage, and comorbidities; treatment regimen, timing, duration, and concomitant therapies; and hormonal levels, cytokine levels, damage to neural progenitor cells, and the presence of the apolipoprotein E 4 allele. Controversy exists as to the most suitable neurocognitive tests to evaluate this sequeal of treatment. Neuroimaging techniques are beginning to reveal affected areas of the brain. A neuropsychologist is essential for the assessment, diagnosis, and recommendation of appropriate management strategies for this patient population. Oncology nurses should be aware of available resources, such as relevant Web sites, support groups, neuropsychologists, and cognitive retraining programs, and provide support for patients concerned about or experiencing CRCI.
化疗相关认知障碍（CRCI）最早在20世纪70年代被描述，但直到20世纪90年代末，对CRCI的显著认识才一直出现。目前对其发生率的估计在17%至75%之间，且有证据表明，CRCI，即通俗文献中所称的“化疗脑”，是患者极为关注的问题。已确定了多种潜在相关因素，包括年龄、教育水平、智力和社会支持；焦虑、抑郁和疲劳；疾病部位、分期和合并症；治疗方案、时间、持续时间和伴随治疗；以及激素水平、细胞因子水平、神经祖细胞损伤和载脂蛋白E4等位基因的存在。对于评估这种治疗后遗症而言，最合适的神经认知测试存在争议。神经成像技术开始揭示大脑的受影响区域。神经心理学家对于评估、诊断以及为该患者群体推荐合适的管理策略至关重要。肿瘤学护士应了解可用资源，如相关网站、支持小组、神经心理学家和认知再训练项目，并为担心或正在经历CRCI的患者提供支持。
