Bhatia and Sharafeldin are now conducting studies in which patients identified through the tool as being at high risk receive remediation therapy. Post-chemotherapy cognitive impairment (PCCI) (also known in the scientific community as "CRCIs or Chemotherapy-Related Cognitive Impairments" and in lay terms as chemotherapy-induced cognitive dysfunction or impairment, chemo brain, or chemo fog) describes the cognitive impairment that can result from chemotherapy treatment. “These are things we don’t want to miss,” he said. The website and apps are well-designed, user-friendly, and pleasing to the eye. Brain HQ . In the pro-inflammatory state that occurs with cancer, inflammatory cytokines, which upregulate inflammation, can cross the blood brain barrier and directly alter neuronal function. They took mice and gave 1 group saline and the other group chemotherapy. According to Asher, the concept of “chemo brain” historically has been dismissed because many chemotherapy drugs do not readily cross the blood-brain barrier. (2010), Ording AG, Jensen AB, Cronin-Fenton D et al. “We and others have identified common genes that make some more susceptible to this side effect of therapy.”. Long-term use of tamoxifen reduces the risk of dementia: a nationwide population-based cohort study. Also, when patients continue to struggle with significant cognitive concerns and functional re-integration after 6 to 12 months have passed, it may also be time to think about getting neuropsychological testing.”. 2020;doi:10.1200/JCO.19.01866. But, another study showed an association between a history of cancer and a reduced risk of Alzheimer’s disease [6]. Disclosures: Asher, Bhatia, Cole, Sharafeldin and Wagner report no relevant financial disclosures. 2020;doi:10.1016/j.apmr.2020.01.021. Learn what might cause it, how long it will last, and what to do about it. “We’re identifying a subgroup of patients who are at the highest risk and having these patients participate in computer games in order to improve their cognition,” she said. Patients who undergo HSCT often are exposed to conditioning regimens that include total-body irradiation and high-dose chemotherapy. Personal Health columnist Jane Brody recently wrote about chemo brain, ... then the answer is a definite “yes,” particularly for the world’s most common cause of dementia, Alzheimer’s disease. “We found that allogeneic [HSCT] recipients treated with full-intensity conditioning were the most compromised group when compared with healthy controls,” Sharafeldin, who co-authored a 2018 study of cognitive impairment after HSCT, told Healio. So I will have pauses in my speech that weren't there before treatment. “The evidence is rather limited for using these stimulant-type medications,” he said. “Chemo brain” is a side effect of chemotherapy that affects cognitive function in cancer patients. These treatments can cause short-term, long-term, or delayed mental changes or cognitive problems. The study used self-reported data from 1,477 breast cancer survivors, as well as from accelerometers worn by 362 of the women. Asher, who helped develop a psychoeducational intervention called “Emerging from the Haze,” said he believes addressing some of these lifestyle factors can bring about improvements in cognitive functioning for cancer survivors. Also, visceral fat is associated with producing more inflammatory cytokines, and so that might also be a mechanism contributing to this.”. Some are reversible while others can lead to more permanent states of dementia. Particularly with mindfulness, there is reasonable evidence that it really helps with attention, which is an important part of the memory pathway.”. To Prevent Development of Cognitive Dysfunction Due to Chemotherapy. As researchers continue to search for evidence-based approaches to cancer-related cognitive decline, clinicians can make a difference for patients through one simple step: acknowledging the problem. "Chemo brain is not dementia. “However, a subset will note he said, problems with attention span, short-term memory and/or executive functions, like impulse control or flexibility in switching from one task to another.”. Smita Bhatia, MD, MPH, can be reached at sbhatia@peds.uab.edu. Radiation doses of … Nicotinic Treatment of Post-Chemotherapy Subjective Cognitive Impairment: A Pilot Study. Inflammatory cytokines are thought to be one potential driver of cancer-related cognitive impairment, Asher said. Experts with whom Healio spoke said that because the causes of “chemo brain” are so varied and extensive, effective treatment likely will combine pharmacologic, behavioral and rehabilitative approaches. The evidence is mixed. Wagner said PCPs also should be receptive to any concerns a patient might express regarding cognitive impairment, even when it occurs years after cancer treatment. No surprise then, that a study has found that physical exercise helps improve cognition in breast cancer survivors. Your use of this site constitutes your agreement to the Terms & Conditions. may be typical for my age- I can’t be sure. “The good news is that most survivors of childhood cancers are fine, with no symptoms of cognitive impairment,” Cole, who deals frequently with pediatric cancer survivors, said. If you have been diagnosed with early-stage dementia then you want to slow the rate of dementia. “In addition, cancer treatments, including both chemotherapy and radiation, can directly cause damage to the brain through a multitude of mechanisms, including induction of neuroinflammation, oxidative stress and perturbation of normal cellular processes.”. “There are also many conditions — like anemia, for example — that may result from cancer treatment and are associated with reduced cognitive function,” Wagner said. Noha Sharafeldin, MD, PhD, MSc, can be reached at nsharafeldin@peds.uab.edu. Raffa RB (2013) Cancer 'survivor-care': II. There doesn't seem to be a gender or age disparity or correlation to the patient's type of cancer. Cole said he and his colleagues are investigating why some survivors of pediatric cancer seem to be disproportionately affected by cancer-related cognitive impairment. Even patients treated with surgery may experience their own version of “chemo brain.” According to Wagner, general anesthesia has been associated with cognitive effects lasting between 4 and 6 weeks. “Also, comorbid conditions can account for some changes in cognitive function.”. Arash Asher, MD, can be reached at arash.asher@cshs.org. “This may be the basis of the foggy feeling many patients with cancer describe, even when they’re not getting chemotherapy or radiation,” Cole said. Chemo brain is a common term used by cancer survivors to describe thinking and memory problems that can occur during and after cancer treatment. The duration of chemo brain can vary from a few weeks to several years [3]. “I think simply recognizing that these cognitive changes are real can be tremendously beneficial,” Wagner said. “Patients undergoing allogeneic HSCT receive 12 weeks of online cognitive training, and their cognitive function is measured prior to and after training to evaluate efficacy of the intervention,” Sharafeldin said. Peter Cole, MD, can be reached at colepd@cinj.rutgers.edu. These recommendations and other information regarding chemo brain can be found at the American Cancer Society. 2018;doi:10.1200/JCO.2017.74.2270. Sharafeldin N, et al. Cognitive impairments can occur after patients with hematologic cancers undergo hematopoietic stem cell transplantation, as shown in a study co-led by Noha Sharafeldin, MD, PhD, MSc, assistant professor in the division of hematology and oncology and member of the Institute for Cancer Outcomes and Survivorship (ICOS) at University of Alabama at Birmingham (UAB) School of Medicine, and Smita Bhatia, MD, MPH, director of the ICOS at UAB. To the best of our knowledge, people who have been affected by ‘chemo brain’ are no more likely than anybody else to get Alzheimer dementia in later life. Some strategies to manage chemo brain include getting enough rest, exercising regularly, and using a daily planner or smart phone to keep track of your schedule. He's had numerous Brain MRIs that all came back clean. Older adults represent another especially challenging group when it comes to cancer-related cognitive impairment. His oncologist started him on the same medicine they give to Alzheimer patients, but stressed that Dad does not have Alzheimer's disease. The patient feels as though their concerns have been heard.” – by Jennifer Byrne. Risk of dementia in older breast cancer survivors: a population-based cohort study of the association with adjuvant chemotherapy. The various cognitive impairments collectively known as “chemo brain” can cause anxiety, frustration and difficulty with everyday tasks for cancer survivors. “The thought was that ‘chemo brain’ couldn’t be real because many drugs don’t readily get into the brain, so how could that be causing cognitive issues? Women may be more at risk than men. Sharafeldin added that some patients who undergo HSCT seem to be more vulnerable to cognitive impairment and its persistence than others. J Clin Oncol. “If you have a patient do a clock draw and they are completely disoriented, that is unlikely to be cancer-related cognitive impairment.”. Genetics also could play a role in predicting which patients will be most affected by cognitive symptoms after HSCT, as shown by research led by Sharafeldin and Bhatia. WEDNESDAY, Oct. 3, 2018 (HealthDay News) -- Many older breast cancer patients might worry that they will be struck by "chemo brain" after their treatments, but a new study suggests that only those who carry a gene linked to Alzheimer's face that risk. Chemo brain vs dementia Dementia vs encephalopathy Dementia vs psychosis Schizophrenia vs dementia Download Here Free HealthCareMagic App to Ask a Doctor. Chemo brain is not dementia. J Clin Oncol. “We were able to create a prediction tool that could help us identify those at highest and lowest risk of developing cognitive impairment. For more about how the brain works and the effects of dementia, see our set of videos below. Even in our twenties we might lose our keys or forget the name of someone we just met. Exercise is a powerful lifestyle component that may have an impact on several mechanisms of cancer-related cognitive impairment. Cole also cited possible genetic predispositions to treatment-related cognitive impairment. (2005), Heck JE, Albert SM, Franco R et al. A second reason I did not want to talk about chemo brain was my job. “‘Chemo brain’ was popularized initially in breast cancer survivors, and it’s what our patients use. He was fine before the cancer and the chemo. Accordingly, memory issues may be linked to certain chemotherapy drugs prescribed. “Other approaches include pharmacotherapies for comorbid depression and/or fatigue,” she said. “There are also host factors, like differences in genetic makeup, that contribute to the variability,” he said. In this study (published in early 2011) researchers wanted to see if the chemo drugs that cross the BBB were more likely to interfere with growth of neurons than the chemo drugs that don ’t cross the BBB. “Certain demographic characteristics place some individuals at higher risk [for] impairment,” she said. “Neuropsychological assessment and neuroimaging may identify whether there are other medical conditions, such as vascular conditions, that may be affecting the vasculature of the brain,” she said. Was mine foreshadowing? “There are many different factors that may contribute to cognitive changes in the cancer setting, and so I don’t think there is going to be a singular mechanism for everyone,” Asher said. It’s going to be difficult to combat that term,” Asher told Healio. Though I don't know what your grandfather's disease is, but study in breast cancer patients finds that "chemo brain" persists after treatment. Other cancer treatments also can have short- or long-term cognitive implications. However, these survivors often are at crucial stages in their educational and intellectual development and therefore may be especially impacted by cancer-related cognitive impairments. ‘Chemo brain’ vs. dementia. “These included the blood-brain barrier genes, meaning that they helped or prevented chemotherapies in going into the brain.”. The symptoms include lapses in short-term memory, difficulty remembering names and dates and problems concentrating. Additionally, Bhatia and colleagues identified SNPs on DNA repair genes, as well as on genes related to telomere homeostasis. For some patients, cognitive impairment may emerge before cancer treatment begins. “We identified certain genes that were associated with post-transplant cognitive impairment,” Bhatia told Healio. One of the pieces of this puzzle is that some people appear to be more affected than others. My 75 year old Dad suffers from chemo-induced dementia. Because cognitive impairment among cancer survivors has also been noted in patients treated with hormone therapy, radiation, bone marrow transplantation and surgery, the term “chemo brain” is misleading, according to Arash Asher, MD, director of cancer rehabilitation and survivorship and assistant professor of physical medicine and rehabilitation at Cedars-Sinai Medical Center. “I would argue that, depending on which group you look at, the rate is at least 50%. Learning systems of adaptation and behavior modification may be an effective way for some patients to overcome cancer-related cognitive decline. Primary care physicians and other clinicians who treat cancer survivors should be aware of each patient’s case and be watchful for signs of cancer-related cognitive decline. And as we age, these moments of forgetfulness happen more often. “These inflammatory cytokines may be produced in response to the cancer, the chemotherapy, or even psychological symptoms such as depression and anxiety. “Sometimes, it’s confusing,” he said, “In cases where both processes might be going on, I usually consider imaging and/or neuropsychological testing whenever there is a concern for dementia. Suffering from “chemo brain”? Up to 70 percent of cancer patients experience cognitive impairment, including diminished memory, reasoning, and multitasking ability [1] [2]. This is a mistake. Clinical trials are underway to test whether docosahexaenoic acid (DHA) [10] or nicotine patches [11] may prevent or reduce cognitive dysfunction in patients receiving chemotherapy. “We’ve defined ourselves based on our cognition, our ability to remember things — it’s part of what makes us uniquely human. This benefit may be related to reduced inflammatory cytokines from exercise or other factors such as improving depression or self-efficacy — all of which are important for cognitive function.”. Chemo can cause chemo brain, which can mimic some aspects of dementia. Social factors also may have some effect on cognitive function after cancer treatment. Healio.com. “Studies show that up to a third of people have cognitive symptoms before they get any cancer treatment, so there’s belief that maybe the inflammatory response to the cancer might be contributing to the cognitive symptoms,” Asher said. The condition is commonly called “chemo brain” or “chemo fog”, even though chemotherapy is unlikely the sole cause of these cognitive problems. Heflin LH, Meyerowitz BE, Hall P et al. Posit Science's Brain HQ brain training program has been proven effective in over 60 peer-reviewed studies, including research involving their software and chemobrain patients. He said conditions such as hypothyroidism, anemia, electrolyte imbalance, sleep apnea, depression or B12 deficiency may account for cognitive issues. A number of medical conditions can cause dementia. She earned a doctorate in neurology and neuroscience at Weill Graduate School of Medical Sciences of Cornell University and a bachelor's degree in biology from Cornell University, with additional study at Keio University in Japan. Also known as cancer treatmentâ related cognitive impairment, it is often described as a decrease in mental “sharpness” before, during, and after cancer treatment, according to the American Cancer Society (ACS). When managing these patients, it may be difficult for clinicians to differentiate cognitive decline linked to cancer from early dementia or age-related memory loss. He noted that factors such as obesity, insomnia and even loneliness have been found to be associated with cognitive impairment among patients who have survived cancer. Cancer as a risk factor for long-term cognitive deficits and dementia. It’s been more than 25 years since my chemo so any. So, part of the challenge is in identifying the underlying mechanisms and subgroups of patients who are impacted.”. Both conditions may find their cause in similar factors such as gut microbiome imbalance, systemic inflammation, and sleep issues. “It is important to identify potential pharmacological strategies.”. Arch Phys Med Rehab. “Anecdotally, I’ve certainly seen this in my own practice. Introduction. “There is a need to look at this broadly, to see what factors are playing a role for each person, and to target interventions to that person.”. And there is no evidence that it leads to dementia." Wagner said a comprehensive geriatric assessment can also rule out other medical conditions that might be impacting brain function among older patients. Neuroepidemiology of cancer and treatment-related neurocognitive dysfunction in adult-onset cancer patients and survivors, Disruption of prefrontal brain activation top-down control of working memory capacity as possible mechanism for chemo-fog/brain (chemotherapy-associated cognitive impairment). Ongoing research has been seeking to identify the mechanisms behind cancer-related cognitive decline, as well as ways to manage them. Chemo brain can also be called chemo fog, cancer-related cognitive impairment or cognitive dysfunction.Though chemo brain is a widely used term, the causes of concentration and memory problems aren't well-understood. “However, a portion of survivors, ranging from 20% to 70% depending on the type of treatment, exhibit permanent cognitive deficits.”. “High doses of radiation to the brain are particularly damaging, for example,” he said. Chemo brain is a common chemotherapy side effect that affects thinking & mood. Not to be overlooked, Meyer adds, is the impact of moving the body: “We are finding that physical exercise might be better than cognitive exercise in preventing new dementias and helping with chemo brain.” Tako says her experience is proof that long-term problems with chemo brain exist. However, depression also causes loss of motivation, irritability, and sadness. Some of the most common symptoms experienced by cancer patients are memory problems, difficulties with multitasking, and reduced attention and concentration. One study of twins found that cancer survivors were more likely than their twins without cancer to have cognitive dysfunction [4]. What strategies can you incorporate into your day-to-day life that can make up for these changes, so they are less disruptive?”. “What was interesting is that when participants went through our group rehabilitation program, the improvements in loneliness these patients achieved paralleled improvements in cognitive symptoms,” he said. “We found older age, male gender, low education, low income levels and — most importantly — an individual’s cognitive reserve to be important predictors of cognitive outcomes [after] transplant.”. Researchers have discovered so much about how the brain works that it can be tempting to think of the person just in terms of their brain, and that changes in a person's behaviour are caused wholly by damage to their brain. Because many of these symptoms may be attributable to other causes, Asher said it is important to rule out other possible explanations for cognitive issues. Chemo brain is most commonly connected with chemotherapy, but other treatments, such as hormone therapy, radiation, and surgery may be associated with it also. While I was going through cancer treatment and experiencing chemo brain, her dementia made me more self-conscious about chemo brain. As part of the TAILORx breast cancer treatment trial, Wagner and colleagues found that at 12, 24 and 36 months, women treated with hormone therapy reported similar loss of cognitive function as those treated with chemotherapy. Reasonable lifestyle changes, which most patients can safely make, are another way to potentially combat cancer-related cognitive decline, according to Asher. Cancer linked to Alzheimer disease but not vascular dementia. (2009). The researchers examined approximately 1,000 single nucleotide polymorphisms in 68 candidate genes among the participants. Participants underwent neuropsychological testing before HSCT and 6 months, 1 year, 2 years and 3 years after BMT. Brain With Dementia More You don't need to be a brain specialist to notice certain differences in images of a healthy older person's brain compared to that of someone with dementia. In the 2020 study, the researchers evaluated 277 individuals (58.5% men, 68.6% non-Hispanic white) who underwent HSCT (46.6% allogeneic). Null association between tamoxifen use and dementia in Danish breast cancer patients. (2008), Roe CM, Fitzpatrick AL, Xiong C et al. She added that physicians should not overlook patients who have undergone endocrine therapy as part of their cancer treatment. In that study, Brown and colleagues conducted a randomized, double blind assessment of memantine vs. placebo in 508 patients who received WBRT for brain metastases. Is That Supplement Safe to Take With Your Medications? Sharafeldin N, et al. “If these are the cards you’ve been dealt, what can you do? “These approaches are mainly restorative, and the premise is that they will subsequently promote improvements in everyday activities.”. Up to 70 percent of cancer patients experience cognitive impairment, including diminished memory, reasoning, and multitasking ability [1][2]. So, I think for a provider to simply say, ‘yes, this is common among people in your shoes,’ is tremendously therapeutic. “What the research has shown over the past 10 years is that although the drugs may not readily cross the blood-brain barrier, the inflammatory cytokines that our body produces in response to the chemotherapy — interleukin-1, interleukin-6, tumor necrosis factor-alpha and others — can cross the blood-brain barrier, and we know they can be neurotoxic.”. Remembering the person. Drugs being investigated include psychostimulants, which have yielded mixed results at best. “There is emerging evidence that aerobic exercise supports cognitive recovery,” he said. Lynne I. Wagner, PhD, can be reached at lywagner@wakehealth.edu. To some extent, he said, the variability among patients is related to the type of treatment used. These may all be synergizing.”. “The strategy here is for patients to identify and adapt to their problem areas,” she said. Sharafeldin said agents such as erythropoietin or hormonal treatment have been used, but these may carry increased risk for adverse events among patients with cancer. Cancer survivors who experience these symptoms often score within normal ranges on memory tests.Your doctor may recommend blood tests, brain scans or other tests to rule out other causes of memory problems. Wagner emphasized that although the cognitive deficits patients mention may be mild, providers should take them seriously. Older adults represent another especially challenging group when it comes to cancer-related cognitive impairment. Adding these genetic variants helped us tremendously.”. “There are pilot studies of things like qigong and other mind/body interventions. And many other studies show no significant associations between a history of cancer and dementia risk [3][7-9]. Although research is being conducted in hopes of identifying an effective treatment for cancer-related cognitive impairment, no intervention for these symptoms has been established. Wagner discussed REMEMBER, an ongoing trial conducted by the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base at Wake Forest Baptist Comprehensive Cancer Center that is evaluating the use of Aricept (donepezil, Eisai) among breast cancer survivors with cancer-related cognitive impairment. Are medicines used to treat ‘chemo brain’? When managing these patients, it … Learn about Alzheimer’s vs. dementia and other types here. Asher said cancer-related cognitive impairment generally is much less severe than dementia. A study of breast cancer patients reported that in the long-run, dementia diagnoses were more common in women who had chemotherapy treatment than those who had not [5]. Chemo Brain vs. Depression. In many cases, the treatment might need to be tailored to the individual patient. He does some really crazy things sometimes. Is Cancer a Risk Factor for Cognitive Decline in Late Life? that showed symptoms of loneliness are highly correlated with symptoms of cancer-related cognitive impairment. But then again, it is not smooth sailing. The adverse biological effects of cancer itself can also play a role in Alzheimer’s risk. So, I think primary care providers should keep an ear out about changes in cognitive function, even if it’s a few years after starting treatment.”. Individuals who have survived treatment for pediatric cancers usually have full, healthy lives ahead of them. Animal studies have shown that chemotherapy may cause temporary reductions in cell growth in brain areas (such as the hippocampus) that control learning and memory. Does having ‘chemo brain’ mean I’ll get dementia? “We combined the information from these genes, as well as the patient’s clinical characteristics,” Bhatia said. I usually use these when someone has metastatic cancer and they are going to be in some sort of treatment indefinitely, or when we’ve tried all nonpharmacologic options and nothing has helped.”. There’s hope and many things you can do Posted November 20, 2019, 10:30 am Jorg Dietrich, MD, PhD Contributor. The effect of ‘chemo brain’ on your chances of getting other forms of dementia is not clear. “It really is multifactorial. It was assumed that it must all just be anxiety or distress,” he said. I just heard on the radio this morning that pauses in speech can be an early sign of dementia. More studies are needed to determine the long-term relationships among cancer, cancer treatments, and cognitive dysfunction. Dr. Hara was previously an Assistant Professor in Neuroscience at the Icahn School of Medicine at Mount Sinai, where she remains an adjunct faculty member. In the United States, the Food and Drug Administration has cleared five medications (four of them still in common use) for Alzheimer’s. 4. Is There a Link Between Aluminum and Alzheimer’s? There are no tests to diagnose chemo brain. “They are evaluating whether donepezil, which is approved for Alzheimer’s dementia, might help women with breast cancer to preserve their cognitive function,” she said. Mild cognitive impairment and 'chemo brain' should be differentiated from progressive neurodegeneration. “In these cases, a comprehensive geriatric assessment would be required, ideally by a geriatric oncologist. If your brain is already healthy, you want to make it healthier. 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