Chemotherapy

Introduction
Improvements in cancer therapy have helped a growing number of
patients to survive. Impairment of cognitive function is one of the most
frequently reported side effects of Chemotherapy with profound impact
on the quality of life of affected individuals (1). Finally the increased
awareness of chemotherapy-related cognitive impairments is reflected
by a growing number of recent review papers focusing on the structural
and functional concomitants of chemotherapy in the human brain.
Focused their overview on functional magnetic resonance imaging
(fMRI), while ignoring structural imaging and other methods of
functional analysis
like EEG (2).
Pulsed chemotherapy
The repeated application of drugs for a short time is a typical protocol
for chemotherapy, called pulsed chemotherapy (3). For example, in this
protocol, one may use the drug doxorubicin combined with other drugs
to treat some types of cancer. The chemotherapy with these drugs is
given through cycles of treatment according to the type of cancer (4).
Challenges and limitations of neurocognitive
studies in cancer patients
Despite the apparent consistency of findings across a large number of
studies, the robustness or even the existence of the chemobrain
syndrome is still a matter of debate. In most cases effect sizes were only
small to moderate (5).
Some studies found chemotherapy-related deficits restricted to specific
functions such as visual memory or working memory, arguing against a
general cognitive impairment (6). Moreover, some investigations even
failed to find chemotherapy-related deficits at all (7).
Interestingly, correlations between subjective and objective impairment
were found to be weak (8) or even absent (9). Correlations were often
restricted to memory tests; only one study reported a correlation with a
neuropsychological test battery (10) these observations suggest that the
relationship between subjective complaints and neuropsychological test
performance may be specific to particular cognitive domains. Emotional
distress may lead to a negative perception of cognitive abilities even if
no objective neuropsychological deficits are detectable (11).

Cognitive deficits after chemotherapy

Chemotherapy has long been recognized to have a potential negative
impact on cognitive function (12). More recent data suggest that about
15e45% of patients complain about memory and attention problems,
lack of concentration, and deficits in multitasking or decision making
following chemotherapy (13) . This so-called chemobrain or chemo
fog syndrome is experienced by patients as highly disturbing.
A meta analysis of studies investigating neuropsychological effects of
systemic cancer treatments found the largest effects of treatment on
executive functions, verbal memory, and motor function (14). Memory
loss and lack of attention and concentration were also identified as
common findings in a review of 10 studies in breast cancer patients (15).

References:-
1. Hutchinson, Hosking, Kichenadasse, Mattiske, & Wilson, 2012
2. Reuter-Lorenz and Cimprich (2013)
3. De Pillis and Radunskaya (2003)
4. Shulman et al.,2012

5. Falleti, Sanfilippo, Maruff, Weih, & Phillips, 2005; Hutchinson
et al.,2012; Jansen, Miaskowski, Dodd, Dowling, & Kramer,
2005;Stewart, Bielajew, Collins, Parkinson, & Tomiak, 2006
6. Bender et al.,2006; Jansen et al., 2005
7. Jenkinset al., 2006; Juergens et al., 2010; Mehlsen, Pedersen,
Jensen,& Zachariae, 2009
8. Taillibert, Voillery, & Bernard-Marty, 2007
9. Castellon et al., 2004; Hermelink et al., 2010; Schagen et
al.,1999; Vardy & Tannock, 2007
10. Fliessbach et al., 2005
11. Hermelink et al., 2010
12. Silberfarb, 1983; Weiss, Walker, &Wiernik, 1974
13. Hermelink et al., 2010; Matsuda et al., 2005; Schagen1999;
14. Anderson-Hanley, Sherman, Riggs, Agocha, & Compas,
15. Matsuda et al., 2005