So, part of the challenge is in identifying the underlying mechanisms and subgroups of patients who are impacted.”. “There is emerging evidence that aerobic exercise supports cognitive recovery,” he said. The analysis was adjusted for HSCT type, age at transplantation, sex, race/ethnicity and cognitive reserve. So, I think for a provider to simply say, ‘yes, this is common among people in your shoes,’ is tremendously therapeutic. A majority of people report cognitive problems during chemo (67% in one study). Ongoing research has been seeking to identify the mechanisms behind cancer-related cognitive decline, as well as ways to manage them. J Clin Oncol. He said conditions such as hypothyroidism, anemia, electrolyte imbalance, sleep apnea, depression or B12 deficiency may account for cognitive issues. This website does not provide, and should not be used for, medical advice, diagnosis, or treatment. Dr. Hara has authored numerous peer-reviewed publications, including articles in PNAS and Journal of Neuroscience. No surprise then, that a study has found that physical exercise helps improve cognition in breast cancer survivors. 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. In many cases, the treatment might need to be tailored to the individual patient. Different types of dementia have different symptoms and warrant different treatment approaches. “It is important to identify potential pharmacological strategies.”. 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. The researchers examined approximately 1,000 single nucleotide polymorphisms in 68 candidate genes among the participants. Cancer-related cognitive impairment can manifest in many ways, but the most common symptoms include lack of focus, issues with verbal or visual memory, shortened attention span, difficulty multitasking and an overall feeling of fogginess. There’s hope and many things you can do Posted November 20, 2019, 10:30 am Jorg Dietrich, MD, PhD Contributor. “Also, comorbid conditions can account for some changes in cognitive function.”. For more about how the brain works and the effects of dementia, see our set of videos below. You should consult with your healthcare providers when making decisions regarding your health. “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.”. Brain Fog vs. Dementia We all forget things. Cancer linked to Alzheimer disease but not vascular dementia. Though I don't know what your grandfather's disease is, but study in breast cancer patients finds that "chemo brain" persists after treatment. “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. Is That Supplement Safe to Take With Your Medications? Researchers found that breast cancer survivors carrying… “However, a portion of survivors, ranging from 20% to 70% depending on the type of treatment, exhibit permanent cognitive deficits.”. Disclosures: Asher, Bhatia, Cole, Sharafeldin and Wagner report no relevant financial disclosures. “Many of these are often habit-forming, as well. Learn about Alzheimer’s vs. dementia and other types here. The patient feels as though their concerns have been heard.” – by Jennifer Byrne. Asher said cancer-related cognitive impairment generally is much less severe than dementia. Additionally, some changes in cognitive function may be associated with the cancer itself. Additionally, Cole said he and his group have been evaluating the possible role of environmental factors, such as poverty, and differences in dietary intake of certain nutrients. This is a mistake. In the 2020 study, the researchers evaluated 277 individuals (58.5% men, 68.6% non-Hispanic white) who underwent HSCT (46.6% allogeneic). “The research community has been trying to answer this question for many years now,” Lynne I. Wagner, PhD, professor of social sciences and health policy at Wake Forest School of Medicine, said in an interview with Healio. Do all patients experience chemobrain, or are some patients more likely to get it? Does having chemo brain increase your risk of developing Alzheimer’s disease? The adverse biological effects of cancer itself can also play a role in Alzheimer’s risk. So I will have pauses in my speech that weren't there before treatment. If your brain is already healthy, you want to make it healthier. Arash Asher, MD, can be reached at arash.asher@cshs.org. Yuko Hara, PhD, is Director of Aging and Alzheimer's Prevention at the Alzheimer's Drug Discovery Foundation. Peter Cole, MD, can be reached at colepd@cinj.rutgers.edu. Healio.com. Null association between tamoxifen use and dementia in Danish breast cancer patients. According to the Dana-Farber Cancer Institute, … For women in their late forties and early fifties, the onset of menopause can bring even more brain fog and memory lapses for many women. He was fine before the cancer and the chemo. Risk of dementia in older breast cancer survivors: a population-based cohort study of the association with adjuvant chemotherapy. Additionally, these patients may be taking medications for comorbid conditions that may compromise their cognitive function. While I was going through cancer treatment and experiencing chemo brain, her dementia made me more self-conscious about chemo brain. 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. “These are things we don’t want to miss,” he said. Particularly with mindfulness, there is reasonable evidence that it really helps with attention, which is an important part of the memory pathway.”. People experiencing chemo brain should notify their doctor and monitor their symptoms, as the impacts vary widely by person and by treatment. The symptoms include lapses in short-term memory, difficulty remembering names and dates and problems concentrating. Wagner said a comprehensive geriatric assessment can also rule out other medical conditions that might be impacting brain function among older patients. 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. 4. “The picture can be fairly complicated for these patients because, in addition to aging, these patients likely have other medical conditions,” Wagner said. The effect of ‘chemo brain’ on your chances of getting other forms of dementia is not clear. Older adults represent another especially challenging group when it comes to cancer-related cognitive impairment. Individuals who have survived treatment for pediatric cancers usually have full, healthy lives ahead of them. In total, 13% of men who had received the therapy went on to develop Alzheimer's disease over eight years of follow-up, compared to 9% who hadn't gotten the treatment, the study found. “These included the blood-brain barrier genes, meaning that they helped or prevented chemotherapies in going into the brain.”. that showed symptoms of loneliness are highly correlated with symptoms of cancer-related cognitive impairment. And as we age, these moments of forgetfulness happen more often. “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? Chemo can cause chemo brain, which can mimic some aspects of dementia. More studies are needed to determine the long-term relationships among cancer, cancer treatments, and cognitive dysfunction. Drugs being investigated include psychostimulants, which have yielded mixed results at best. Learn what might cause it, how long it will last, and what to do about it. Other cancer treatments also can have short- or long-term cognitive implications. Additionally, Bhatia and colleagues identified SNPs on DNA repair genes, as well as on genes related to telomere homeostasis. Asher discussed the use of drugs such as Provigil (modafinil, Cephalon), Ritalin (methylphenidate, Novartis) and Adderall (amphetamine and dextroamphetamine, Shire). “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. “There are also host factors, like differences in genetic makeup, that contribute to the variability,” he said. "Chemo brain is not dementia. Participants underwent neuropsychological testing before HSCT and 6 months, 1 year, 2 years and 3 years after BMT. 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. “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. These treatments can cause short-term, long-term, or delayed mental changes or cognitive problems. Remembering the person. The condition is commonly called “chemo brain” or “chemo fog”, even though chemotherapy is unlikely the sole cause of these cognitive problems. 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. It was assumed that it must all just be anxiety or distress,” he said. The condition is commonly called “chemo brain” or “chemo fog”, even though chemotherapy is unlikely the sole cause of these cognitive problems. 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. 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. 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. Even in our twenties we might lose our keys or forget the name of someone we just met. A number of medical conditions can cause dementia. Chemo brain is a common term used by cancer survivors to describe thinking and memory problems that can occur during and after cancer treatment. What strategies can you incorporate into your day-to-day life that can make up for these changes, so they are less disruptive?”. All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. may be typical for my age- I can’t be sure. If you have been diagnosed with early-stage dementia then you want to slow the rate of dementia. He's had numerous Brain MRIs that all came back clean. They took mice and gave 1 group saline and the other group chemotherapy. Long-term use of tamoxifen reduces the risk of dementia: a nationwide population-based cohort study. 2018;doi:10.1200/JCO.2017.74.2270. 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. Sharafeldin is leading a computer-based cognitive training intervention (cTAG) at UAB. Both conditions may find their cause in similar factors such as gut microbiome imbalance, systemic inflammation, and sleep issues. “Non-myeloablative HSCT recipients showed evidence of delayed decline, [whereas] patients receiving an autologous HSCT were generally spared.”. “We hope to take this forward and apply it to other cancers, and make it into standard of care if it’s working well.”. “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. 2020;doi:10.1016/j.apmr.2020.01.021. J Clin Oncol. Women may be more at risk than men. And many other studies show no significant associations between a history of cancer and dementia risk [3][7-9]. Some of the most common symptoms experienced by cancer patients are memory problems, difficulties with multitasking, and reduced attention and concentration. Radiation doses of … Is Taking Antibiotics Bad For Immune System Expirements By Aden And Cohen … “Cancer-related cognitive impairment is usually mild; it may be distressing to the patient, but you wouldn’t expect to have things like people getting lost or having agnosia or apraxia or things that are associated with more advanced Alzheimer’s or dementia,” he said. It’s been more than 25 years since my chemo so any. Is There a Link Between Aluminum and Alzheimer’s? “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. One of the pieces of this puzzle is that some people appear to be more affected than others. “Insomnia is very common, for example, among [patients with cancer] and cancer survivors,” he said. 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.”. 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. In recent years, there also has been steady increased interest in nonpharmacological interventions. Exercise is a powerful lifestyle component that may have an impact on several mechanisms of cancer-related cognitive impairment. The evidence is mixed. Smita Bhatia, MD, MPH, can be reached at sbhatia@peds.uab.edu. It’s going to be difficult to combat that term,” Asher told Healio. 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. Social factors also may have some effect on cognitive function after cancer treatment. 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). Patterns of dementia diagnosis in surveillance, epidemiology, and end results breast cancer survivors who use chemotherapy. 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.”. “Chemo brain” is a side effect of chemotherapy that affects cognitive function in cancer patients. “These inflammatory cytokines may be produced in response to the cancer, the chemotherapy, or even psychological symptoms such as depression and anxiety. On the 2 nd day, they injected all the mice with a tracer chemical that binds to neurons. I just heard on the radio this morning that pauses in speech can be an early sign of dementia. “We were able to create a prediction tool that could help us identify those at highest and lowest risk of developing cognitive impairment. There doesn't seem to be a gender or age disparity or correlation to the patient's type of cancer. 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. However, depression also causes loss of motivation, irritability, and sadness. 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. 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. Up to 70 percent of cancer patients experience cognitive impairment, including diminished memory, reasoning, and multitasking ability [1] [2]. And there is no evidence that it leads to dementia." 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