Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN.
Clinical Neuroscience Research Unit, Department of Psychiatry, University of Vermont Robert Larner M.D. College of Medicine, Burlington, VT.
Am J Geriatr Psychiatry. 2017 Dec;25(12):1415-1426. doi: 10.1016/j.jagp.2017.04.001. Epub 2017 Apr 6.
Advances in cancer treatment are producing a growing number of cancer survivors; therefore, issues surrounding quality of life during and following cancer treatment have become increasingly important. Chemotherapy-related cognitive impairment (CRCI) is a problem that is commonly reported following the administration of chemotherapy treatment in patients with cancer. Research suggests that CRCI can persist for months to years after completing treatment, which has implications for the trajectory of normal and pathologic cognitive aging for the growing number of long-term cancer survivors. These problems are particularly relevant for older individuals, given that cancer is largely a disease of older age, and the number of patients with cancer who are aged 65 years or older will increase dramatically over the coming decades. This review will briefly summarize empirical findings related to CRCI, discuss CRCI in older patients with cancer, propose potential causative hypotheses, and provide a canonical patient case to illustrate how CRCI presents clinically. Finally, potential intervention strategies for CRCI will be highlighted and issues to consider when evaluating older patients with a history of cancer will be discussed.
癌症治疗的进展使得越来越多的癌症幸存者出现;因此,癌症治疗期间和治疗后的生活质量问题变得越来越重要。化疗相关认知障碍(CRCI)是癌症患者接受化疗治疗后常报告的一个问题。研究表明,CRCI 在完成治疗后可能会持续数月至数年,这对越来越多的长期癌症幸存者的正常和病理认知衰老轨迹产生影响。这些问题在老年人中尤为相关,因为癌症主要是一种老年疾病,而且年龄在 65 岁或以上的癌症患者人数在未来几十年将大幅增加。这篇综述将简要总结与 CRCI 相关的实证研究结果,讨论老年癌症患者的 CRCI,提出潜在的因果假说,并提供一个典型的患者病例来说明 CRCI 的临床表现。最后,将强调 CRCI 的潜在干预策略,并讨论评估有癌症病史的老年患者时需要考虑的问题。