Radiation-Induced Cognitive Decline: Challenges and Solutions

Parisa Shamsesfandabadi,1 Arpeet Patel,2 Yun Liang,1 Matthew J Shepard,3 Rodney E Wegner1 1Radiation Oncology department, Allegheny Health Network, Pittsburgh, PA, USA; 2Drexel University College of Medicine, Philadelphia, PA, USA; 3Neurosurgery Department, Allegheny Health Network, Pittsburgh, PA, USACorrespondence: Parisa Shamsesfandabadi, Email parisa.shamsesfandabadi@ahn.orgAbstract: Radiation therapy, a common treatment for central nervous system cancers, can negatively impact cognitive function, resulting in radiation-induced cognitive decline (RICD). RICD involves a decline in cognitive abilities such as memory and attention, likely due to damage to brain white matter, inflammation, and oxidative stress. The multifactorial nature of RICD poses challenges including different mechanisms of injury (neurogenesis, oxidative stress and neuroinflammation, dendritic structure alterations and vascular effects) and confounding factors like advanced age, and pre-existing conditions. Despite these challenges, several potential solutions exist. Neuroprotective agents like antioxidants can mitigate radiation damage, while cognitive rehabilitation techniques such as cognitive training and memory strategies improve cognitive function. Advanced imaging techniques like magnetic resonance imaging (MRI) help identify vulnerable brain areas, and proton therapy offers precise targeting of cancer cells, sparing healthy tissue. Multidisciplinary care teams are crucial for managing RICD’s cognitive and psychological effects. Personalized medicine, using genetic and molecular data, can identify high-risk patients and tailor treatments accordingly. Emerging therapies, including stem cell therapy and regenerative medicine, offer hope for repairing or replacing damaged brain tissue. Addressing RICD is vital for cancer survivors, necessitating consideration of cognitive function and provision of appropriate support and resources for those experiencing cognitive decline.Keywords: radiation therapy, radiation-induced cognitive decline, RICD, cognitive decline, cognitive function, central nervous system cancers