Chemotherapy-Induced Cognitive Impairment and Neuroaxonal Damage: Investigating the Role of Serum Neurofilament Light Chain
Bibliographic record
Abstract
Background: Chemotherapy-induced cognitive impairment (CICI), colloquially termed "chemobrain," represents a significant challenge for cancer survivors, potentially affecting up to 85% of patients undergoing treatment. Diagnosis often relies on neuropsychological testing and imaging, which may lack sensitivity for early detection or reflect chronic changes. Neurofilament light chain (NfL), a neuronal structural protein released into biofluids upon neuroaxonal damage, emerges as a promising biomarker. This study investigated the relationship between serum NfL levels and the degree of cognitive impairment in patients receiving chemotherapy. Methods: An observational, cross-sectional study was conducted involving 50 cancer patients undergoing chemotherapy at Dr. M. Djamil General Hospital Padang between October and December 2024. Cognitive function was assessed using the Montreal Cognitive Assessment Indonesian version (MoCA-Ina), and depression was screened using the Patient Health Questionnaire-9 (PHQ-9). Serum NfL levels were quantified using an Enzyme-Linked Immunosorbent Assay (ELISA) method. The Kruskal-Wallis test was employed to analyze the relationship between serum NfL levels and cognitive function status (normal, mild impairment, moderate-severe impairment). Results: Cognitive impairment (MoCA-Ina assessed) was identified in 41 (82%) of the 50 participants, with 30 (60%) exhibiting mild and 11 (22%) exhibiting moderate to severe impairment. The median serum NfL level across all subjects was 23.44 pg/ml (range: 13.81-68.71 pg/ml). A statistically significant relationship was observed between serum NfL levels and the presence and severity of cognitive impairment (p = 0.02). Median NfL levels progressively increased from the cognitively normal group (18.49 pg/ml) to the mild impairment group (23.5 pg/ml) and the moderate-severe impairment group (24.5 pg/ml). Post-hoc analysis revealed significant differences in NfL levels between the normal group and both the mild (p=0.03) and moderate-severe (p=0.01) impairment groups. Conclusion: This study demonstrated a significant positive association between serum NfL levels and the presence and severity of cognitive impairment in cancer patients undergoing chemotherapy. These findings support the potential utility of serum NfL as an accessible biomarker for detecting chemotherapy-associated neuroaxonal damage and concomitant cognitive decline.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".