Dementia post-radiotherapy: improvement with acetylcholinesterase inhibitor A case report

Demência pós-radioterapia: melhora com inibidor da acetilcolinesterase. Um relato de caso

Abstract

Cognitive decline associated with radiotherapy is a progressive complication that affects many patients submitted to this form of treatment. The lack of an effective treatment drives research for new treatment options to improve the quality of life of patients with this disorder. We report the case of a 64 year-old man who developed a severe dementia of the frontal subcortical type, which was associated with subcortical frontal lesions and appeared as a late complication of radiotherapy used to treat a pituitary tumor. After many pharmacological attempts to improve his cognitive and behavioral problems, the patient showed a significant improvement in the cognitive, functional and behavioral impairments after treatment with an acetylcholinesterase inhibitor. This report discusses hypotheses for the positive effect of this treatment.

Key words:
dementia; therapeutics; radiotherapy; cholinesterase inhibitors.

Resumo

A demência associada à radioterapia é uma complicação grave e tardia que acomete muitos pacientes submetidos à RT. A falta de um tratamento efetivo faz com que novas opções de tratamento sejam pesquisadas, no intuito de melhorar a qualidade de vida dos pacientes que apresentam esta complicação. Apresentamos o caso de um homem de 64 anos que anos depois de radioterapia utilizada para tratamento de um tumor de hipófise evoluiu com uma síndrome demencial frontal grave com lesões subcorticais frontais. Depois de muitas tentativas farmacológicas para melhorar seus transtornos cognitivos e comportamentais houve importante melhora cognitiva, funcional e comportamental com o uso de inibidor da acetilcolinesterase. Hipóteses para explicar este efeito positivo do tratamento são discutidas.

Palavras-chave:
demência; terapêutica; radioterapia; inibidores da colinesterase.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

• ¹
  Petrovich Z, Yu C, Giannotta SL, O'Day S, Apuzzo MJ. Survival and pattern of failure in brain metastases treated with stereotactic gamma knife radiosurgery. J Neurosurg 2002;97(suppl l5):499-506.
• ²
  Moretti R, Torre P, Antonello RM, et al. Neuropsychological evaluation of late-onset post-radiotherapy encephalopathy: a comparison with vascular dementia. J Neurol Sci 2005; 230:195-200.
• ³
  Soffietti R, Sciolla R, Giordana MT, Vasario E, Schiffer D. Delayed adverse effects after irradiation of gliomas: clinicopathological analysis. J Neuro-Oncol 1985;3:187-192.
• ⁴
  Glass JP, Hwang TL, Leavens ME, Libshitz HI. Cerebral radiation necrosis following treatment of extracranial malignancies. Cancer 1984;54:1966-1972.
• ⁵
  Burger PC, Mahaley MS, Dudka L, Vogel FS. The morphologic effects of radiation administered therapeutically for intracranial gliomas. Cancer 1979;44:1256-1272.
• ⁶
  Al-Mefty O, Kersh JE, Routh A, Smith RR. The long-term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg 1990;73:502-512.
• ⁷
  Shaw PJ, Bates D. Conservative treatment of delayed cerebral radiation necrosis . J Neurol Neurosurg Psychiatr 1984;47:1338-1341.
• ⁸
  Glantz MJ, Burger PC, Friedman AH, et al. Treatment of radiation-induced nervous system injury with heparin and warfarin. Neurology 1994;44:2020-2027.
• ⁹
  Chuba PJ, Aronin P, Bhambhani K, et al. Hyperbaric oxygen therapy for radiation-induced brain injury in children. Cancer 1997;80:2005-2012.
• ¹⁰
  Murros KE, Toole JF. The effect of radiation on carotid arteries: a review article. Arch Neurol 1989;46:449-455.
• ¹¹
  Dorresteijn LDA, Kapelle AC, Boogerd W, et al. Increased Risk of Ischemic Stroke After Radiotherapy on the Neck in Patients Younger Than 60 Years . J Clin Oncology 2002 ;20: 282-288.
• ¹²
  Werner MH, Burger PC, Heinz ER, et al. Intracranial atherosclerosis following radiotherapy. Neurology 1988;38:1158-1160.
• ¹³
  Shaw EG, Rosdhal R, D'Agostino Jr RB, et al. Phase II study of donepezil in irradiated brain tumor patients: Effect on cognitive function, mood, and quality of life. J clin oncol 2006; 24:1415-1420.
• ¹⁴
  Boelaert K, Gittoes NJL. Radiotherapy for non-functioning pituitary adenomas. Eur J Endocrinology 2001;144:569-575
• ¹⁵
  Engelhardt E, Moreira DM, Laks J. Vascular dementia and cholinergic pathways. Dement Neuropsychol 2007;1:2-9.

Publication Dates

• Publication in this collection
  Jan-Mar 2009

History

• Received
  20 Oct 2008
• Accepted
  21 Dec 2008