癌症相关认知功能障碍研究进展

The research advance of cancer-related cognitive impairment

癌症和认知功能障碍在中国均具有极高的发病率和致残率,随着癌症诊治水平的提高,癌症患者生存期延长的同时,认知功能障碍等癌症相关并发症亦逐渐显现,严重影响患者的预后和功能独立性。临床上,癌症和记忆力下降等认知障碍同时存在常联想到副肿瘤综合征,尤其是边缘性脑炎。近年的研究发现,部分癌症患者在确诊或接受抗肿瘤治疗后出现明显的认知受损和相关脑区血流灌注下降的客观证据,但无典型的精神症状或癫痫发作以及抗神经元抗体阳性的证据,提示癌症和认知功能的联系远比既往普遍认识的边缘性脑炎要密切。国际上将这种癌症及其治疗引起的认知受损统称为癌症相关认知功能障碍(CRCI),将两者之间联系的阵线前置、重心下移。虽然有一定的研究基础,现阶段国内外关于CRCI的认识仍十分不足,使得迄今为止仍无统一的疾病诊断标准及系统性管理策略。因此,本研究综述国内外CRCI的临床特征、影像学表现以及干预策略的最新研究证据,旨在梳理CRCI的临床研究进展与差距,以提高认识。

In China,cancer and cognitive impairment both have extremely high morbidity and disability rate.As improved diagnostic and therapeutic strategies of cancer significantly increase the patients chance of survival,cognitive impairment and other cancer-related complications gradually emerge in patients later life,which negatively affects prognosis and functional independence of the patients.Clinically,the coexistence of cancer and cognitive impairment reminds scientists of paraneoplastic syndrome,especially limbic encephalitis.Recent studies present objective evidence of obvious cognitive impairment and decreased blood perfusion in relevant cerebral regions after some patients cancer diagnosis and antitumor treatment,but no evidence points to typical psychiatric symptoms,epileptic seizures,or positive antineuronal antibodies,suggesting that cancer and cognitive function are more closely linked than previously believed.Internationally,this cognitive system impairment caused by this cancer and its treatment is collectively referred to as cancer-related cognitive impairment(CRCI).Despite the former researches,understanding of CRCI nowadays is still far from sufficient,and optimal diagnostic criteria and systematic management strategies for CRCI are yet to be established.Therefore,this review summarizes the latest research evidence on clinical features,neuroimaging manifestations,and intervention strategies of CRCI patients,aiming to investigate the progresses and gaps in clinical work of CRCI in order to raise awareness.