Cancer-related neuropsychiatric disorders

Essential cognitive function may be impaired in cancer patients before the initiation of chemotherapy. Cancer decreases cognitive and biological reserves, resulting in accelerated aging. Prefrontal lobe dysfunction is most commonly encountered owing to various mechanisms. Systemic inflammation causes the release of pro-inflammatory cytokines in the brain, with consequent neurotoxic effects on the Kynurenine pathway, local chronic inflammation, and hypothalamus-pituitary-adrenal dysregulation. Exosomes also play a significant role, as genetic and epigenetic changes exert different effects on oxidative stress proteins. Melatonin dysregulation may contribute in cognitive dysfunctions. Neuropsychological impairment has been demonstrated through various neurophysiological (event-related potentials) and neuroimaging (structural and functional MRI) studies. Paraneoplastic syndromes of the central nervous system have been considered, and specific onconeural antibodies may characterize distinctive central nervous system dysfunction patterns. Treatment of tumor-brain is based mainly on non-pharmacological approaches, such as physical activity, cognitive-behavioral therapy, and the mindfulness approach. Some researchers have recommended the prophylactic use of escitalopram in patients with head and neck cancer without depression.