Chemotherapy saves lives, but it may be at the expense of brain function. Previous research has established cancer treatments can impair patients’ cognitive skills, as well as cause chemo-induced seizures and memory loss, a condition known as Chemo Brain.
Chemo brain refers to changes in memory, concentration, and the ability to think clearly. It is also called mild cognitive impairment (MCI). At the moment we don’t know exactly what causes these problems, or how many people are affected by them. Women with breast cancer were the first to report these problems, which they linked to their chemotherapy treatment. So they called the changes chemo brain.
Up to 75% of people with cancer experience cognitive problems during treatment, and up to 35% have issues that continue for months after treatment has finished. These difficulties usually vary in severity and often make it hard to complete daily activities. People who experience serious cognitive problems are encouraged to talk with their doctor, nurse, social worker, or another member of the health care team about ways to manage these issues.
Causes
Although cancer survivors commonly use the term “chemo brain” to describe difficulty thinking clearly after cancer treatment, people who do not receive chemotherapy report similar symptoms. Continuing research into the wide range of cognitive problems experienced by people with cancer has shown they can be caused by a number of factors in addition to chemotherapy, including –
- Radiation treatment to the head and neck, or total body irradiation
- Brain surgery, in which areas of the brain may be damaged or disrupted during a biopsy or the removal of a cancerous tumor
- Hormone therapy, immunotherapy, and other medications (such as anti-nausea medications, antibiotics, pain medications, immunosuppressants, antidepressants, anti-anxiety medications, heart medications, and medications to treat sleep disorders)
- Infections, especially those of the central nervous system (brain and spinal cord), and infections that cause a high fever
- Brain cancer
- Other cancers that have metastasized (spread) to the brain
- Other conditions or symptoms related to cancer or cancer treatments, including anemia, sleep problems, fatigue, hypercalcemia (high blood calcium), and electrolyte (a mineral in your body, such as potassium and sodium) imbalances that can lead to dehydration or organ failure
- Emotional responses, such as stress, anxiety, or depression
- Not having enough of specific vitamins and minerals, such as iron, vitamin B, or folic acid
- Other brain or nervous system disorders unrelated to cancer
Risk Factors
Factors that may increase the risk of memory problems in cancer survivors include –
- Brain cancer
- Chemotherapy given directly to the central nervous system
- Chemotherapy combined with whole-brain radiation
- Higher doses of chemotherapy or radiation
- Radiation therapy to the brain
- Younger age at time of cancer diagnosis and treatment
Symptoms
The symptoms of cognitive impairment can come and go. How much a person notices them seems to depend on what they are doing. For example, if a person needs to juggle a number of things as part of his or her normal day, he may notice it more than someone who doesn’t. People often notice it more when they go back to work. Tiredness usually makes the symptoms worse.
Cognitive problems include difficulties in many areas, these include –
- Trouble concentrating, focusing, or paying attention (short attention span)
- Mental “fog” or disorientation
- Difficulty with spatial orientation
- Memory loss or difficulty remembering things (especially details like names, dates, or phone numbers)
- Problems with comprehension or understanding
- Difficulties with judgment and reasoning
- Impaired arithmetic, organizational, and language skills (such as not being able to organize thoughts, find the right word, or balance a checkbook)
- Problems performing multiple tasks (multitasking)
- Processing information slower
- Behavioral and emotional changes, such as irrational behavior, mood swings, inappropriate anger or crying, and socially inappropriate behavior
- Severe confusion (delirium)
The severity of these symptoms often depends on the person’s age, stress level, history of depression or anxiety, coping abilities, and access to emotional and psychological resources.
Complications
Complications of chemo—such as anemia or hormonal imbalance—can affect cognition. Insomnia, anxiety, and depression could play a role in cog-fog as well.
Treatment
- Medications, including stimulants, cognition-enhancing drugs commonly used to treat Alzheimer’s disease, antidepressants, and opiate antagonists (drugs that block the actions of narcotics, such as morphine)
- Occupational therapy and vocational rehabilitation, to help people with the activities of daily living and job-related skills
- Cognitive rehabilitation (also known as neuropsychological rehabilitation) and cognitive training, to help patients improve their cognitive skills and find ways to cope with cognitive problems
Alternative Treatment
CO-Q10 Enzyme – There is an ever-growing body of scientific data that shows substantial health benefits of CoQ10 supplementation for people suffering from angina, heart attack and hypertension. This nutrient is also recommended to people on statins to off-set the CoQ-depleting effects of the medication. Other studies have reported that CoQ10 may play a role in the prevention or benefit people already suffering from neurodegenerative diseases.
Omega Oils – The healthy fats are essential fatty acids which are obtained from certain fish and plants. These essential oils are omega-3, omega-6 and omega-9. people need to supplement with Omega 3, which is flax oil.) In the body, essential fatty acids are primarily used to produce hormone-like substances that regulate a wide range of functions, including blood pressure, blood clotting, blood lipid levels, the immune response, and the inflammation response to injury or infection.
Vitamin D3 – Studies on the diverse benefits of vitamin D keep pouring in, and one of the latest focuses on cognitive function.
Zinc is important in the synthesis of neuronal membranes. Studies point to the possible association of zinc deficiency and ADHD which is characterised by inabilities to concentrate and pay attention.
Iron is involved in the production of neurotransmitters and also the myelin sheath protecting nerve fibres.
Vitamin D is a steroid hormone vital in calcium and phosphate absorption and in recent studies, several associations between low levels of vitamin D and neurological disorders such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, as well as depression etc have begun to surface and also helps in chemo brain condition.
Vitamin E is essential for normal neurological function.
Choline is essential for the production of neurotransmitters and studies suggest a significant number of adults consume less than recommended.
B12 is essential for neurological function and research suggests deficiency is linked to reduced brain volume and lower cognitive scores.
Glutamine – This is converted to glutamic acid in the brain and promotes the synthesis of GABA, an important brain neurotransmitter. Many believe that L-Glutamine enhances mental function.
Exercise – A study was done to look into the effects of exercise on Alzheimer disease. This study found that exercise improved blood flow and antioxidant pathways. Studies have also shown a clinical reduction in morbidity (disease) and mortality from cardiovascular disease among exercising individuals. A large study indicated a reduction of risk for dementia in individuals who exercised.
Self Help –
- Try relaxation training to help focus your attention.
- Write in a journal or diary to see what influences your memory problems.
- Set a routine or schedule that you follow consistently every day.
- Ride it out—settle in for the day and watch television or funny movies.
- Exercise; aerobic exercise helps your mood and increases alertness.
- Alter your work environment or expectations: simplify.
- Learn what your cognitive strengths are and capitalize on those. (What time of day is best for tackling tasks?)
- Compensate for weaknesses by using external memory aids (daily planner, notes, maps, and reminder phone calls).
- Discuss frustrations about slower moments with friends and family.
Reference –
http://www.cancer.net/navigating-cancer-care/side-effects/attention-thinking-or-memory-problems
http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/chemo-brain
http://www.webmd.com/cancer/what-is-chemo-brain
https://www.fredhutch.org/en/treatment/survivorship/survival-strategies/chemobrain.html
http://www.mayoclinic.org/diseases-conditions/chemo-brain/basics/definition/con-20033864
http://www.cancercare.org/publications/72-cognitive_problems_after_chemotherapy