Neuroimaging studies of cognitive dysfunction following cancer and treatment

Survival rates for non-central nervous system cancers (CNS) have markedly improved in recent decades due to advancements in early detection and treatment; however, this progress has also led to a rise in survivors living with long-term side effects, including cancer-related cognitive impairment (CRCI). Neuroimaging has been vital in understanding the impact of cancer and its treatments on brain functioning, revealing changes in brain activity, structure, and connectivity associated with cognitive decline. This review summarizes current neuroimaging research on adults with non-CNS cancers, focusing on alterations in gray and white matter and functional, metabolic, and vascular changes. Consistent findings of alterations in the prefrontal cortex have been observed, with both structural and functional changes observed in patients with CRCI, and limbic and temporal structures also appear to be impacted. These brain changes have been shown to correlate with functioning on objective and self-reported measures of executive functioning and memory. Future research should further explore novel complementary techniques and analytic approaches, to provide more in-depth knowledge on various potential mechanisms contributing to CRCI. Multimodal investigations of biomarkers including genomic interactions, neuroinflammatory processes, oxidative stress, blood-brain barrier disruption, and gut-brain axis effects could yield new insights. Neuroimaging will remain essential in elucidating these mechanisms and their roles in CRCI.