Diagnostic and Treatment Approaches to Chemo Brain

Abstract

Advancements in cancer treatment and the consequent increase in post-treatment survival have brought the challenges associated with cancer therapy into sharper focus. Many treatment modalities, such as chemotherapy, are administered systemically, leading to significant systemic side effects. Cognitive impairments, including deficits in executive functions, attention, memory, word finding difficulties, and the inability to acquire new skills, can arise during and after cancer treatment, a phenomenon known as "chemo brain." Post-chemotherapy cognitive impairment can be observed at high rates and may persist long-term in nearly one-third of cases, resulting in a decline in quality of life and functional impairment. Proposed mechanisms underlying the pathophysiology of chemo brain include disruption of blood-brain barrier integrity leading to increased permeability and brain susceptibility, DNA damage and associated deficiencies in DNA repair, telomere shortening, oxidative stress, pro-inflammatory cytokines and neuroinflammation-neurotoxicity, neuronal genetic susceptibility and epigenetic changes, post-chemotherapy hormonal alterations, reactive oxygen radicals and effects, loss of spinal and dendritic arborization, microtubule disintegration, reduced neurogenesis, neurotransmitter alterations, mitochondrial dysfunction, and loss of spinal density. This review aims to evaluate the characteristics, clinical manifestations, pathophysiology, and options for prevention or treatment of chemo brain, accompanied by current literature findings, thereby contributing to the existing body of knowledge.

Keywords

• Kemobeyin
• kemoterapi
• bilişsel işlevller
• tanı
• tedavi

Kemobeyin Tanı ve Tedavi Yaklaşımları

Öz

Gelişen kanser tedavileri ve artan tedavi sonrası yaşam süreleriyle birlikte, kanser tedavisinin yol açtığı sorunlar daha belirgin hale gelmiştir. Kemoterapi gibi birçok tedavi, sistemik olarak uygulanmakta olup bu da ciddi sistemik yan etkilere neden olmaktadır. Kanser tedavisi sürecinde ve sonrasında, bilişsel kayıplar ortaya çıkabilir. Bu kayıplar, yürütücü işlevlerde bozulma, dikkat ve hafıza sorunları, kelime bulma güçlüğü ve yeni beceriler edinememe gibi belirtilerle kendini gösterebilir. Bu durum, "kemobeyin" olarak adlandırılmaktadır. Kemoterapi sonrası bilişsel bozulma yüksek oranlarda gözlemlenebilir ve bazı durumlarda uzun süreli olabilir. Bu da yaşam kalitesinde düşüşe ve işlevsellik kaybına neden olabilir. Kemobeyin patofizyolojisi üzerine öne sürülen mekanizmalar arasında, kan-beyin bariyeri bütünlüğünün bozulmasıyla geçirgenliğin ve beyin hassasiyetinin artması, deoksiriboz nükleik asit (DNA) hasarı ve buna bağlı DNA onarımı eksiklikleri, telomer kısalması, oksidatif stres, proinflamatuar sitokinler ve nöroinflamasyon-nörotoksisite, nöronal genetik yatkınlık ve epigenetik değişiklikler, kemoterapi sonrası hormonal değişiklikler, reaktif oksijen radikalleri ve etkileri, spinal ve dentritik arborizasyon kaybı, mikrotübül disentegrasyonu, azalmış nörogenesis, nörotransmitter değişiklikleri, mitokondrial disfonksiyon ve spinal dansite kaybı yer almaktadır. Bu derleme, güncel literatür bilgileri eşliğinde kemobeyin özellikleri, klinik belirtileri, patofizyolojisi ve kemobeyini önlemeye ya da tedavisine yönelik seçeneklerin değerlendirilmesini amaçlamaktadır.

Anahtar Kelimeler

• kemoterapi
• kemobeyin
• tanı
• tedavi
• bilişsel işlevler

Kaynakça

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