• Chemo Brain - Real or Imagined? What You Can Do About It

    by Dr. Susan Sklar
    on Sep 11th, 2017

Hi, it’s Dr. Sklar with another important topic on cognition–one known commonly as chemo brain. It’s a condition where, following chemotherapy treatment for cancer, patients find that they have cognitive difficulties. They don’t remember things as well, they have difficulty concentrating, difficulty getting tasks done, and a struggle to learn new things. Not much is known about it. I had my first patient with chemo brain following breast cancer about 10 years ago. She was very young when she developed her breast cancer. She was in her late 30s, and following her breast cancer she had a lot of memory difficulties and compensated by keeping multiple lists and taking copious notes. Even doing this, it was a struggle for her to do her work as a financial advisor.

Now, 10 years later with another patient who contacted me with likely chemo brain, I searched the literature and found that there’s a little more available than what was available 10 years ago, but still not a lot of information about prevention and treatment of chemo brain.

The first issue is, does it really exist? Certainly for a long time, oncologists felt that it didn’t exist and that difficulties in cognition were due to depression and the stress of going through chemotherapy and cancer treatment. I think this is somewhat a matter of denial. Also, it turns out that women encounter chemo brain considerably more frequently than men, and unfortunately many times for women, when brain and mood issues come into play, it’s assumed that it’s depression or anxiety rather than a physiological process. Now we have studies that show a definite decrease in cognition after people have chemotherapy, and some studies show even a decrease in cognition once cancer has been diagnosed even prior to chemotherapy. So there may be processes going on in the body caused by cancer that impact cognition even before treatment has begun.

While we don’t have studies showing the benefits of treatment specifically for chemo brain, we believe that many of the same approaches pertain as the ones we use in people with Alzheimer’s and other types of cognitive decline. This means addressing inflammation, which can be caused by the chemotherapy and which we know is a huge cause of brain malfunction as well as depression and anxiety. We also know the importance of nerve-growth factors like BDNF, (brain derived neurotrophic factor). These are substances that help the growth of new nerves. And lastly, looking at connectivity, meaning the nerve to nerve transmission in the brain. Good connectivity is essential for good cognition.

We also believe that there are some approaches that can be taken to prevent some of the impact of chemotherapy on the brain, and this involves the use of antioxidants, which frequently are declined by oncologists for fears that it will interfere with chemotherapy.

What we are left with is an approach very similar to the approach that we’re taking to patients who have Alzheimer’s-type dementia in terms of measuring inflammatory chemicals, looking at treatments that increase BDNF (brain derived neurotrophic factor)–certainly exercise is one thing that’s well-known to increase BDNF. And we also look at the connectivity issues. That can be very important. The way that information gets sent around your brain is one nerve connects to another connects to another, and things happen. You either move a limb or a thought goes through your head, but it all depends on one nerve connecting to another, and we believe there are connectivity problems that definitely happen with Alzheimer’s but also with chemo brain. There are substances that we’ve been using to help improve connectivity. Things like citicholine, which helps nerve-to-nerve connection. For inflammation, curcumin is probably one of the best things for reducing brain inflammation, and to raise BDNF one of the most important things is regular aerobic exercise.

Hopefully this will be helpful for those of you that have encountered problems following chemotherapy. Stay posted as we continue to give you information on how to improve your cognition. Talk to you next time.

Author Dr. Susan Sklar

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