Potential mechanisms for chemotherapy-induced impairments in cognitive function.
OBJECTIVE
To review the domains of cognitive function and their corresponding neuroanatomic structures as well as present current evidence for neurotoxicity associated with specific chemotherapeutic agents and potential mechanisms for chemotherapy-induced cognitive impairments.


METHODS
Published research articles, review articles, and textbooks.


RESULTS
Chemotherapy does not appear to cross the blood-brain barrier when given in standard doses; however, many chemotherapy drugs have the potential to cause cognitive impairments through more than one mechanism. In addition, patient factors may be protective or place individuals at higher risk for cognitive impairments.


CONCLUSIONS
Although evidence of chemotherapy-induced impairments in cognitive function exists, no clinical studies have attempted to elucidate the mechanisms for chemotherapy-induced impairments in cognitive function. In addition, further studies are needed to determine predictive factors, potential biomarkers, and relevant assessment parameters.


CONCLUSIONS
The ability to identify high-risk patients has important implications for practice in regard to informed consent, patient education about the effects of treatment, and preventive strategies.
Jansen
Catherine
C
Kaiser Permanente Medical Center in San Francisco, University of California, USA. catherine.jansen@kp.org
Miaskowski
Christine
C
Dodd
Marilyn
M
Dowling
Glenna
G
Kramer
Joel
J
D000740:Anemia / Q000139:chemically induced / Q000503:physiopathology; D000818:Animals; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001288:Attention / Q000187:drug effects; D001812:Blood-Brain Barrier / Q000187:drug effects; D003072:Cognition Disorders / Q000139:chemically induced* / Q000451:nursing / Q000503:physiopathology*; D003520:Cyclophosphamide / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D004660:Encephalitis / Q000139:chemically induced / Q000503:physiopathology; D005472:Fluorouracil / Q000009:adverse effects; D006801:Humans; D007249:Inflammation / Q000139:chemically induced / Q000503:physiopathology; D007802:Language; D007858:Learning / Q000187:drug effects; D008568:Memory / Q000187:drug effects; D008593:Menopause / Q000187:drug effects; D008727:Methotrexate / Q000009:adverse effects; D009369:Neoplasms / Q000188:drug therapy* / Q000451:nursing; D009859:Oncology Nursing / Q000379:methods; D017239:Paclitaxel / Q000009:adverse effects; D011597:Psychomotor Performance / Q000187:drug effects; D013037:Spatial Behavior / Q000187:drug effects
D000970:Antineoplastic Agents; D004317:Doxorubicin; D003520:Cyclophosphamide; D017239:Paclitaxel; D005472:Fluorouracil; D008727:Methotrexate