The last decade has seen a surge in research demonstrating that non–central nervous system cancer and its treatment is associated with cognitive decline in some patients. The decline is typically mild in nature, emerges early or later in the disease and treatment course, and involves primarily memory, executive functioning, and processing speed. Cognitive impairment and brain changes have been observed in cancer patients prior to treatment compared with noncancer control subjects, differentially explained by cancer pathogenesis (1), inflammatory cytokines (2), and fatigue (3). Systemic therapy (mostly chemotherapy [CT] and to a lesser extent endocrine therapy [ET]) has in a dose- (4) and regimen-specific (5–10) manner been associated with cognitive decline, relative to pretreatment cognitive status and in comparison with noncancer control subjects and patients who do not receive systemic treatment (11,12). Neuroimaging has demonstrated reductions in grey matter volume, white matter integrity, and functional connectivity in CT-treated patients compared with noncancer control subjects and with cancer patients not treated with CT (13–15). Preclinical studies show that cytostatic agents can impact neural progenitor cells and oligodendrocytes, upregulate neural activity, and increase synaptic death in cultured neurons (16–18). Importantly, there is evidence that interventions in the lab can reduce or prevent cognitive impairment induced by cytostatic agents (18–20). In summary, there is ample evidence that systemic therapy is associated with cognitive decline, independent of being diagnosed and treated for cancer and the distress that accompanies this.

中文翻译：

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社论：创伤后压力是认知能力下降的主要原因-不是全部，也许根本没有故事

在过去的十年中，研究激增，表明非中枢神经系统癌症及其治疗与某些患者的认知能力下降有关。这种下降通常性质上是轻度的，在疾病和治疗过程中或早或晚出现，主要涉及记忆，执行功能和处理速度。与非癌症对照组相比，在治疗前已观察到癌症患者的认知障碍和脑部变化，这可通过癌症发病机理（1），炎性细胞因子（2）和疲劳（3）进行不同解释。全身性治疗（主要是化学疗法[CT]和较小程度的内分泌治疗[ET]）以剂量（4）和方案特异性（5-10）的方式与认知能力下降相关，相对于治疗前的认知状态，并与非癌症对照组和未接受全身治疗的患者进行比较（11，12）。与非癌症对照组和未接受CT治疗的癌症患者相比，神经影像学已显示CT治疗患者的灰质体积，白质完整性和功能连接性降低（13-15）。临床前研究表明，细胞抑制剂可以影响神经祖细胞和少突胶质细胞，上调神经活动并增加培养的神经元的突触死亡（16-18）。重要的是，有证据表明实验室中的干预措施可以减少或预防细胞抑制剂引起的认知障碍（18-20）。总之，有充分的证据表明全身治疗与认知能力下降有关，