Depressive symptoms and cognitive deficits in a cancer patient submitted to chemotherapy with 5-Fluoracil: A case report

Bottino, Sara Mota Borges; Garcia, Célia Petrossi Gallo; Viana, Bernardo de Mattos; Bottino, Cássio Machado de Campos

doi:10.1590/S1980-57642013DN70300013

ABSTRACT

Cognitive deficits in cancer patients can be related to depression, anxiety, and the side effects of treatments such as fatigue. In this case report, we described an elderly patient with rectal adenocarcinoma, which presented depressive symptoms and memory complaints after treatment with 5-Fluoracil and Leucovorin. Depressive symptoms improved after two months but cognitive and functional impairment worsened suggesting the diagnosis of mild dementia. Structural and functional brain changes were seen on neuroimaging exams. Rivastigmine was introduced up to 12 mg/day, and after a one-year follow up the patient remained stable. Cognitive deficits can be a consequence of cancer therapies and a protocol to investigate deficits cognitive could be useful to the diferential diagnosis and management of elderly cancer patients submitted to chemotherapy.

Key words:
cognitive deficits; dementia; cancer; chemotherapy; 5-Fluoracil.

RESUMO

Déficits cognitivos em pacientes com câncer podem estar relacionados à depressão, ansiedade e aos efeitos colaterais dos tratamentos, como fadiga. Neste relato de caso, descrevemos um paciente idoso com adenocarcinoma do reto, que apresentou sintomas depressivos e queixas de memória, após o tratamento com 5-Fluoracil e Leucovorin. Os sintomas depressivos melhoraram após dois meses, mas o comprometimento cognitivo e functional pioraram, sugerindo o diagnóstico de demência leve. Mudanças cerebrais estruturais e funcionais foram vistos em exames de neuroimagem.Rivastigmina foi introduzida até 12 mg/dia, e após um ano de seguimento o paciente permanecia estável. Déficits cognitivos podem ser consequência das terapias anti-neoplásicas e um protocolo para investigar déficits cognitivos pode ser útil para o diagnóstico diferencial e manejo de pacientes idosos com câncer submetidos à quimioterapia.

Palavras-chave:
déficits cognitivos; demência; câncer; quimioterapia; 5-Fluoracil.

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REFERENCES

Jansen CE, Miaskowski C, Dodd M, Dowling G, Kramer J. A meta-analysis of studies of the effects of cancer chemotherapy on various domains of cognitive function. Cancer 2005;104:2222-2233.
Bottino SMB, Fráguas R, Gattaz WF. Depressão e câncer. Rev Psiquiatr Clin 2009;36(Suppl.3):109-115.
Ahles TA, Root JC, Ryan EL. Cancerand CancerTreatment Associated Cognitive Change: An Update on the State of the Science. J Clin Oncol 2012;30:3675-3686.
Ahles TA, Saykin AJ. Candidate mechanisms for chemotherapy induced cognitive changes. Nat Rev Cancer2007;7:192-201.
Falleti MG, Sanfilippo A, Maruff P, Weih L, Phillips KA. The nature and severity of cognitive impairment associated with adjuvant chemotherapy in women with breast cancer: a meta-analysis of the current literature. Brain Cogn 2005;59:60-70.
Bottino CMC, Pádua AC, Smid J, Areza-Feg, Novaretti T, Bahia VS. Differential diagnosis between dementia and psychiatric disorders. Dement Neuropsychol 2011;5:288-296.
Tannock IF, Ahles TA, Ganz PA, van Dam FS. Cognitive Impairment associated with chemotherapy for cancer: Report of a workshop. J Clin Oncol2012;22:2233-2239.
Simó M, Rifà-Ros X, Rodriguez-Fornells A, Bruna J. Chemobrain: A systematic review of structural and functional neuroimaging studies. Neurosci Biobehav Rev 2013;37:1311-1321.
Ahles T. Brain vulnerability to chemotherapy toxicities. Psychooncology 2012;21:1141-1148.
Deprez S, Amant F, Smeets A, et al. Longitudinal assessment of chemotherapy-induced structural changes in cerebral white matter and its correlation with impaired cognitive functioning. J Clin Oncol2012; 30:274-281.
Baehring JM, Fulbright RK. Delayed leukoencephalopathy with stroke-like presentation in chemotherapy recipients. J Neurol Neurosurg Psychiatry 2008;79: 535-539.
Wefel JS, Saleeba AK, Buzdar AU, et al: Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer. Cancer2010;116:3348-3356.
Winocur G, Binns MA, Tannock I. Donepezil reduces cognitive impairment associated with anti-cancer drugs in a mouse model. Neuropharmacology 2011;61:1222-1228.

Publication Dates

Publication in this collection
Jul-Sep 2013

History

Received
08 June 2013
Accepted
20 Aug 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Jansen CE, Miaskowski C, Dodd M, Dowling G, Kramer J. A meta-analysis of studies of the effects of cancer chemotherapy on various domains of cognitive function. Cancer 2005;104:2222-2233.

[2] Bottino SMB, Fráguas R, Gattaz WF. Depressão e câncer. Rev Psiquiatr Clin 2009;36(Suppl.3):109-115.

[3] Ahles TA, Root JC, Ryan EL. Cancerand CancerTreatment Associated Cognitive Change: An Update on the State of the Science. J Clin Oncol 2012;30:3675-3686.

[4] Ahles TA, Saykin AJ. Candidate mechanisms for chemotherapy induced cognitive changes. Nat Rev Cancer2007;7:192-201.

[5] Falleti MG, Sanfilippo A, Maruff P, Weih L, Phillips KA. The nature and severity of cognitive impairment associated with adjuvant chemotherapy in women with breast cancer: a meta-analysis of the current literature. Brain Cogn 2005;59:60-70.

[6] Bottino CMC, Pádua AC, Smid J, Areza-Feg, Novaretti T, Bahia VS. Differential diagnosis between dementia and psychiatric disorders. Dement Neuropsychol 2011;5:288-296.

[7] Tannock IF, Ahles TA, Ganz PA, van Dam FS. Cognitive Impairment associated with chemotherapy for cancer: Report of a workshop. J Clin Oncol2012;22:2233-2239.

[8] Simó M, Rifà-Ros X, Rodriguez-Fornells A, Bruna J. Chemobrain: A systematic review of structural and functional neuroimaging studies. Neurosci Biobehav Rev 2013;37:1311-1321.

[9] Ahles T. Brain vulnerability to chemotherapy toxicities. Psychooncology 2012;21:1141-1148.

[10] Deprez S, Amant F, Smeets A, et al. Longitudinal assessment of chemotherapy-induced structural changes in cerebral white matter and its correlation with impaired cognitive functioning. J Clin Oncol2012; 30:274-281.

[11] Baehring JM, Fulbright RK. Delayed leukoencephalopathy with stroke-like presentation in chemotherapy recipients. J Neurol Neurosurg Psychiatry 2008;79: 535-539.

[12] Wefel JS, Saleeba AK, Buzdar AU, et al: Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer. Cancer2010;116:3348-3356.

[13] Winocur G, Binns MA, Tannock I. Donepezil reduces cognitive impairment associated with anti-cancer drugs in a mouse model. Neuropharmacology 2011;61:1222-1228.

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