Navigating the aging brain: The interplay between brain malignancy and the aging microenvironment

Abstract

The rising incidence of age-related brain pathologies, including brain malignancy, underscores an urgent need to understand the mechanistic interplay between aging and tumorigenesis. Historically viewed as distinct entities, brain tumors and neurodegenerative disorders are now recognized to share key biological processes, such as cellular senescence, chronic inflammation, and metabolic dysregulation. In this review, we deconstruct the existing knowledge at the intersection of cancer neuroscience and aging biology, and propose that age-related alterations in neuronal function, such as the accumulation of senescent cells, ion channel dysregulation, and neurotransmitter imbalance, are not inert background features but as active mediators of tumor progression and treatment resistance. We summarize the aged neural microenvironment, marked by a proinflammatory senescence-associated secretory phenotype (SASP) and blood-brain barrier dysfunction, underlies a permissive soil for malignancy. Moreover, we highlight the emerging concept that tumors can induce a pathological aging phenotype in surrounding neurons, which in turn potentiates the observed cognitive deterioration. By framing brain tumors as products of a dysfunctional aging ecosystem, we propose therapeutic strategies that target convergent aging mechanisms through senolysis, metabolic reprogramming, and neurotransmitter modulation may simultaneously achieve tumor control and preserve cognitive function. This integrated perspective opens new avenues for repurposing neuroactive drugs and designing interventions that address the sophisticated biology of the aging brain and malignancy.