Exploring the Possible Link Between Chemotherapy and Dementia
In the realm of cancer treatment, chemotherapy plays a vital role in combating the disease. However, its impact on cognitive health, particularly in relation to dementia, remains a topic of ongoing research and debate.
A 2017 study revealed a potential concern for female breast cancer survivors who underwent chemotherapy, as they may face a higher risk of developing Alzheimer's later in life [1]. Conversely, a 2021 study found a link between chemotherapy and a lower risk of Alzheimer's and dementia in individuals over 65 with a colorectal cancer diagnosis [2].
The current scientific consensus acknowledges the recognised concern about cognitive impairment associated with chemotherapy, often referred to as "chemo brain." However, the direct causal link between chemotherapy and long-term dementia remains unclear and under active investigation [1].
Chemotherapy can cause acute and sometimes persistent cognitive changes, particularly in older adults. These symptoms do not always progress to diagnosed dementia and may be reversible or mitigated with tailored clinical care [1]. As a result, there is a growing emphasis on comprehensive geriatric assessment (CGA) in oncology to stratify patient risk, including cognitive vulnerability, to guide chemotherapy decisions and reduce toxicity without compromising survival [1].
Despite ongoing research, no recent large prospective trials definitively establish chemotherapy as a direct cause of dementia. The focus of research remains on identifying risk factors, predictive biomarkers, and the mechanisms behind cognitive decline post-chemotherapy [1].
It is important to note that chemotherapy can affect healthy cells, leading to side effects such as fatigue, hair loss, infection, bruising or bleeding easily, anemia, mood changes, and problems with concentration or focus, colloquially known as "chemo brain." However, the link between chemotherapy and dementia is currently unclear [3].
In the management of dementia, strategies such as physical activity, healthy eating, avoiding alcohol and smoking, regular doctor checkups, writing down daily tasks and appointments, maintaining hobbies, keeping the mind active, engaging with friends, family, and the local community, and planning for the future can be beneficial [4]. Medications such as donepezil, N-methyl-D-aspartate (NMDA) receptor antagonists, cholesterol and blood pressure drugs, and selective serotonin reuptake inhibitors (SSRIs) can also help manage dementia symptoms [4].
In conclusion, while the clinical community acknowledges chemotherapy-related cognitive impairment, a definitive scientific consensus confirming chemotherapy as a cause of dementia does not yet exist. Further well-designed longitudinal studies are needed to clarify this relationship. Current practice emphasizes careful assessment of older patients’ cognitive and physical status to tailor chemotherapy regimens accordingly [1]. It is crucial to remember that, while there is no cure for dementia, it is possible to manage symptoms effectively.
[1] American Society of Clinical Oncology. (2021). Geriatric Oncology. Retrieved from https://www.cancer.net/sites/patient/files/styles/web_content_width/public/2021-04/geriatric_oncology_brochure.pdf
[2] National Institute on Aging. (2021). Alzheimer's Disease and Related Dementias. Retrieved from https://www.nia.nih.gov/health/alzheimers-disease-related-dementias
[3] Mayo Clinic. (2021). Chemo brain. Retrieved from https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/chemo-brain/art-20047694
[4] Alzheimer's Society. (2021). Dementia: Living well with dementia. Retrieved from https://www.alzheimers.org.uk/about-dementia/living-with-dementia
- The scientific community continues to investigate the potential link between chemotherapy and a higher risk of Alzheimer's in breast cancer survivors, as suggested by a 2017 study.
- In contrast, a 2021 study found a possible protective effect of chemotherapy on the development of Alzheimer's and dementia in older adults with colorectal cancer.
- While chemotherapy's impact on cognitive health is a focus of ongoing research, a clear direct causal link between chemotherapy and long-term dementia has not been established.
- In the management of dementia, strategies that prioritize health-and-wellness, mental-health, and personal care such as exercise, therapy, and social engagement can improve quality of life alongside medical treatments like donepezil, NMDA receptor antagonists, cholesterol and blood pressure drugs, and selective serotonin reuptake inhibitors (SSRIs).
