Oštećenje kognitivnih funkcija nakon kemoterapije

master's thesis

• Title (english): Cognitive impairment associated with chemotherapy
• Author: Neva Purgar
• Mentor: Nikola Đaković (mentor)
• Committee member: Lidija Beketić-Orešković (predsjednik povjerenstva)
• Committee member: Fedor Šantek (član povjerenstva)
• Committee member: Nikola Đaković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2014-03-19, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Oncology

Abstract

Rak dojke je najčešći zloćudni tumor u žena, a svaka deseta žena će ga dobiti
tijekom svog života. “Post-chemotherapy cognitive impairment (PCCI)” ili
„Chemotherapy related cognitive impairment (CRCI)“ je pojava kognitivnog deficita
koji se javlja u otprilike trećine pacijenata nakon provedene kemoterapije. Neki od
simptoma uključuju: nemogućnost obavljanja više stvari istovremeno (eng.
multitasking), zbunjenost, zaboravljivost, slabo prisjećanje, iscrpljenost itd. U
posljednjih 20 godina istraživanja na ovom području su ustvrdila povezanost između
sistemske adjuvantne kemoterapije i kognitivnih promjena, što je potvrđeno i s
nekoliko meta-analiza. Oštećenja su najčešće bila vezana uz pamćenje, izvršne
funkcije, brzinu obrade informacija, orijentaciju u prostoru i verbalne sposobnosti.
Iako promjene u pacijenata prema neuropsihološkim testovima mogu biti vrlo blage,
one svejedno imaju snažan utjecaj na kvalitetu života. Strukturne studije su uz pomoć
MR-a otkrile smanjenje gustoće sive tvari i volumena, DTI-em su otkrivene promjene
cjelovitosti bijele tvari i volumena. Prozor u rad mozga su otvorile funkcionalne studije
korištenjem fMR-a, koji je pokazao post-terapijske promjene u mozgu, prilikom
rješavanja zadataka koji su ispitivali sjećanje i izvršne funkcije, te obrazac
povezanosti mozga u odmoru. U većini slučajeva problemi s pamćenjem su
privremeni, stoga je terapija usmjerena na pomaganje pacijentima da se nauče nositi
sa simptomima. Razvijanje standardne terapije je otežano, obzirom da simptomi
nerijetko variraju među pacijentima. Neki od pokušaja liječenja farmakoterapijskim
pripravcima uključuju: metilfenidat, modafinil i donepezil.

Abstract (english)

Breast cancer is the most common invasive cancer in women and one in ten women
will be diagnosed during her life time. “Post – chemotherapy cognitive impairment
(PCCI)” or „Chemotherapy related cognitive impairment (CRCI)“ is a phenomenon of
cognitive decline that occurs approximately in one third of patients over the course of
their chemotherapy. Some of the symptoms are: inability to multitask, confusion,
forgetfulness, poor recall, exhaustion etc. Two decades of research, primarily in the
breast cancer patient population, has confirmed an association between cognitive
changes and systemic adjuvant chemotherapy as confirmed by several metaanalyses.
Across cognitive studies, the specific domains affected have been relatively
consistent, and include memory, executive function, processing speed, and verbal
and spatial abilities. Although the changes may be relatively mild as measured by
current psychometric methods, such mild cognitive dysfunction may have a very
significant impact on quality of life. Structural changes detected include decreased
gray matter density and volume on anatomic MRI and alteration in white matter
integrity and volume on diffusion tensor imaging (DTI). fMRI studies have
demonstrated post-treatment changes in brain activation during memory and
executive tasks and in resting brain connectivity pattern. Developing standard therapy
is difficult, given that symptoms often vary among patients. In most cases, memory
problems are temporary, so the therapy is focused on helping patients to learn to
cope with the symptoms. Attempts using medications include: methylphenidate,
modafinil and donepezil.

• Keywords: Rak dojke; oštećenje kognitivnih funkcija; kemoterapija; post-chemotherapy cognitive impairment (PCCI); Chemotherapy related cognitive impairment-CRCI; MR; fMR; neuropsihološki testovi
• Keywords (english): Breast cancer; cognitive impairment; chemotherapy; Post-chemotherapy cognitive impairment (PCCI); Chemotherapy related cognitive impairment-(CRCI); MRI; fMRI; neuropsychological tests
• Language: croatian
• URN:NBN: urn:nbn:hr:105:562796
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Access restricted to students and staff of home institution
• Created on: 2015-12-16 10:15:33