common term “chemobrain” belies the complex nature of the problem of changes in cognitive function experienced by patients with cancer. experience poorer attention learning and memory and psychomotor slowing.[5 6 Fluctuations in hormone levels that naturally occur over the course of life may also be related to changes in cognitive function. For example there is CK-636 evidence that this hormonal fluctuations that occur during a woman’s reproductive cycle and with menopause are related to variations in cognitive function and particularly to variations in verbal memory.[7 8 It is important to recognize that some patients with cancer are at greater risk for changes in cognitive function. The stress stress or depressive symptoms they experience across the trajectory of the malignancy experience may CK-636 influence their cognitive function although clinically meaningful deterioration in objectively measured cognitive function would not be expected unless a patient were experiencing clinical depressive disorder getting together with Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) criteria. It is more common that patient-reported cognitive problems are associated with changes in mood that do not necessarily meet diagnostic criteria for mood disorders.[5 6 Self-reported cognitive problems may also be associated with other symptoms such as fatigue sleep disturbance and pain.[9-13] Moreover poorer cognitive function may be related to medications taken to manage these symptoms (eg analgesics antiemetics hypnotics).[14] Factors that may contribute to poorer pretreatment cognitive function in patients with malignancy include lingering effects of anesthesia after breast malignancy surgery disease-related factors comorbidities (eg diabetes heart failure) and the medications used Rabbit Polyclonal to OR4C6. to manage comorbid conditions.[1 2 Patients who have received malignancy treatment in the past are at increased risk for developing cognitive impairments with current treatment particularly those who experienced cognitive problems with CK-636 recent therapy. [15] Patients receiving higher-dose therapy[16] or a longer duration of therapy particularly with some biologic brokers such as interferon alfa are also at increased risk for cognitive impairments.[17-19] Similarly patients receiving concurrent chemoradiation[20] or therapy delivered directly to CK-636 the central nervous system are at greater risk.[14] Other factors that increase patients’ risk of cognitive impairments include a history of psychiatric illness substance abuse neurological disease or neurotrauma.[4] When a patient with malignancy complains of CK-636 cognitive problems clinicians should keep in mind that these complaints may be associated with mood changes rather than neuropsychological changes. Probing more about depressive symptoms or stress may lead to appropriate management strategies. However when there is concern about clinically significant cognitive impairments referral for a comprehensive neuropsychological assessment may be warranted. Building around the progress researchers have made in characterizing this complex phenomenon and identifying risk factors future research has the potential to improve the identification of patients at different levels of risk for cognitive changes so that targeted interventions may be provided to the patients who need them most. To reach this goal of personalized medicine we must understand the mechanisms underlying cognitive changes. As noted while the multiple main procedures and adjuvant therapies provided to malignancy patients could contribute to these changes at least some of the cognitive changes previously attributed to treatment were obvious before adjuvant therapy.[21-23] Subgroups of patients are likely at variable levels of risk due to pretreatment factors (eg mood changes cognitive reserve physical fitness genomic differences that impact inflammatory processes).[23-26] Moreover these and other unknown factors may influence trajectories of cognitive changes during treatment. A powerful tool for uncovering the CK-636 mechanisms underlying cognitive changes in these subgroups is usually neuroimaging (eg functional MRI). Imaging studies have the.