Chemo brain

Subject: Chemo brain Thu Jan 20, 2011 12:41 pm

Chemo brain
Filed under: Cancer & Chemo
Chemo brain is a common term used by cancer survivors to describe
thinking and memory problems that can occur after cancer treatment.
Chemo brain can also be called chemo fog, cognitive changes or cognitive
dysfunction.

Though chemo brain is a widely used term, it's misleading. It's not yet
clear that chemotherapy is the cause of concentration and memory
problems in cancer survivors. And many cancer survivors with memory
problems still score well on cognitive tests, leaving doctors wondering
whether chemo brain really exists.

Despite the many questions, it's clear that the memory problems commonly
called chemo brain can be a frustrating and debilitating side effect of
cancer and its treatment. More study is needed to understand this
condition.

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Symptoms

Signs and symptoms of chemo brain may include:

* Being unusually disorganized
* Confusion
* Difficulty concentrating
* Difficulty finding the right word
* Difficulty learning new skills
* Difficulty multitasking
* Fatigue
* Feeling of mental fogginess
* Short attention span
* Short-term memory problems
* Taking longer than usual to complete routine tasks
* Trouble with verbal memory, such as remembering a conversation
* Trouble with visual memory, such as recalling an image or list of words

Signs and symptoms of cognitive or memory problems vary from person to
person and are typically temporary, often subsiding within two years of
completion of cancer treatment.

When to see a doctor
If you experience troubling memory or thinking problems, make an
appointment with your doctor. Keep a journal of your signs and symptoms
so that your doctor can better understand how your memory problems are
affecting your everyday life.

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Causes

It's not clear what causes signs and symptoms of memory problems in cancer survivors. Cancer-related causes could include:

Cancer treatments

* Chemotherapy
* Hormone therapy
* Immunotherapy
* Radiation therapy
* Stem cell transplant
* Surgery

Complications of cancer treatment

* Anemia
* Fatigue
* Infection
* Menopause (associated with hormone therapy)
* Nutritional deficiencies
* Sleep problems, such as insomnia

Emotional reactions to cancer diagnosis and treatment

* Anxiety
* Depression

Other causes

* Inherited susceptibility to chemo brain
* Medications for other cancer-related signs and symptoms, such as pain medications

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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

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Complications

The severity and duration of the symptoms sometimes described as chemo
brain differ from person to person. Some cancer survivors may return to
work, but find tasks take extra concentration or time. Others will be
unable to return to work.

If you experience severe memory or concentration problems that make it
difficult to do your job, tell your doctor. You may be referred to an
occupational therapist, who can help you adjust to your current job or
identify your strengths so that you may find a new job.

In rare cases, people with memory and concentration problems are unable
to work and must file for disability benefits. Ask your health care team
for a referral to an oncology social worker or a similar professional
who can help you understand your options.

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Preparing for your appointment

If you're currently undergoing cancer treatment, talk to your oncologist
about your signs and symptoms. If you've completed treatment, you might
start by making an appointment with your family doctor or a general
practitioner. In some cases, you may be referred to a professional who
specializes in helping people cope with memory difficulties
(neuropsychologist).

Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be well prepared. Here's some
information to help you get ready and what to expect from your doctor.

What you can do

* Keep a journal of your memory lapses. Describe the situations in
which you experience memory problems. Note what you were doing and what
type of difficulty you experienced.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Take a family member or friend along or bring a recorder.
Sometimes it can be difficult to absorb all the information provided
during an appointment. Someone who accompanies you may remember
something that you missed or forgot. Record the conversation with your
doctor so you can listen to it later.
* Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions
can help you make the most of your visit. List your questions from most
important to least important in case time runs out. For chemo brain,
some basic questions to ask your doctor include:

* What is likely causing my symptoms?
* How long do symptoms typically last?
* What kinds of tests can help determine whether the symptoms I'm experiencing are caused by cancer treatment?
* Should I see a neuropsychologist? What will that cost, and will my insurance cover it?
* What is the best treatment for my symptoms?
* Are there things I can do on my own, in addition to the treatment you're suggesting, to help improve my memory problems?
* Are there any brochures or other printed material that I can take home? What websites do you recommend?
* Should I plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment any time you
don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may allow more time later to cover points you want to
address. Your doctor may ask:

* When did you first begin experiencing these symptoms?
* Have your symptoms been continuous or occasional?
* How do your symptoms affect your everyday life?
* What, if anything, seems to improve your symptoms?
* What, if anything, appears to worsen your symptoms?

What you can do in the meantime
Track your symptoms in a journal. Note the time of day and the
situations when memory problems occur. Patterns in your symptoms may
help your doctor better understand what could be causing your symptoms
and the best way to help you cope.

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Tests and diagnosis

There's no clear definition of chemo brain, so no tests exist to
diagnose this condition. Cancer survivors who experience these symptoms
often score in normal ranges on memory tests.

Your doctor may recommend blood tests, brain scans or other tests to
rule out other causes of memory problems. But if no apparent cause can
be found for your symptoms, your doctor may refer you to a specialist
who can help you cope with memory changes.

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Treatments and drugs

It's not clear what causes chemo brain, and no cure has been identified.
In most cases, cancer-related memory problems are temporary, so
treatment focuses on coping with symptoms until they eventually subside.

No standard treatment has been developed for cancer-related memory
problems. Because symptoms and severity differ from person to person,
your doctor can work with you to develop an individualized approach to
coping.

Controlling other causes of memory problems
Cancer and cancer treatment can lead to other conditions, such as
anemia, depression, sleep problems and early menopause, which can
contribute to memory problems. Controlling these other factors may make
it easier to cope with these symptoms.

Learning to adapt and cope with memory changes
A neuropsychologist, who specializes in diagnosing and treating
conditions that affect memory and thinking, can create a plan to help
you cope with chemo brain symptoms. Doctors sometimes refer to this as
cognitive rehabilitation or cognitive remediation.

Learning to adapt and cope with memory changes may involve:

* Repetitive exercises to train your brain. Memory and thinking
exercises may help your brain repair broken circuits that may contribute
to chemo brain.
* Tracking and understanding what influences memory problems.
Carefully tracking your memory problems may reveal ways to cope. For
instance, if you become more easily distracted when you're hungry or
tired, you could schedule difficult tasks that require extra
concentration for the time of day when you feel your best.
* Learning coping strategies. You may learn new ways of doing
everyday tasks to help you concentrate. For instance, you may learn to
take notes or make an outline of written material as you read. Or a
therapist may help you learn ways of speaking that help you commit
conversations to memory and then retrieve those memories later.
* Stress-relief techniques. Stressful situations can make memory
problems more likely. And having memory problems can be stressful. To
end the cycle, you may learn relaxation techniques. These techniques,
such as progressive muscle relaxation, may help you identify stress and
help you cope.

Medications
No medications have been approved to treat chemo brain. But medications
approved for other conditions may be available if you and your doctor
agree they may offer some benefit.

Medications that are sometimes used in people with these symptoms include:

* Methylphenidate (Concerta, Ritalin, others), a drug approved for attention-deficit/hyperactivity disorder (ADHD)
* Donepezil (Aricept), a drug used in people with Alzheimer's disease
* Modafinil (Provigil), a drug used in people with certain sleep disorders

More study is needed to understand how or if these drugs may be helpful for people with these types of memory problems.

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Lifestyle and home remedies

You can take steps to ease chemo brain symptoms on your own. For instance, try to:

* Control what you can about your working environment. If noise and
commotion are contributing to your distraction, try to find a quiet
corner where you can concentrate. Soft music may help drown out other
noises.
* Prepare yourself for success. Before tackling a complicated task
that requires concentration, take steps to ensure that you will have the
best chance for success. Eat so you won't be distracted by hunger. Pick
a time of day when you'll be the most alert. Get a good night's sleep.
Have a plan so you know exactly what you'll need to do in order to
complete your task.
* Stay organized. Use calendars or planners to keep on task. That
way you won't spend time wondering if you're forgetting an appointment
or an item on your to-do list. Write everything down in your planner.
Make organization a priority at home and at work, too. Having an
organized work space means you can spend more time on tasks that you
need to accomplish.
* Clear your mind of distractions. When distracting thoughts pop up,
write them down in your planner. Recording your thoughts will help to
quickly clear them and ensure that you remember them later.
* Take frequent breaks. Divide your tasks into manageable portions
and take a break each time you complete one part. Give yourself a short
rest so that you'll be able to continue later.
* Exercise your brain. Try crossword puzzles or number games to
exercise your brain. Take up a new hobby or master a new skill, such as
learning to play a musical instrument or learning a language.
* Exercise your body. Moderate exercise, such as brisk walking, can
help you cope with stress, fatigue and depression. All can contribute to
memory problems. If you haven't been active lately, get the OK from
your doctor first. Start slowly and work up to at least 30 minutes of
activity most days of the week.

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Alternative medicine

No alternative treatments have been found to cure chemo brain. If you're
interested in trying alternative treatments for your symptoms, discuss
the risks and benefits with your doctor. Alternative treatments for
other types of memory problems are also touted as helpful for chemo
brain, such as:

* Ginkgo. Supplements containing ginkgo leaves have shown some
promise in treating age-related memory changes in older adults, but more
study is needed. Ginkgo supplements are generally safe, but they can
interfere with some common medications, including blood thinners. Talk
to your doctor before beginning ginkgo supplements.
* Vitamin E. Vitamin E may be beneficial for brain cells, but more
study is needed. Vitamin E supplements are generally safe when taken in
recommended doses, but they can interfere with common medications,
including blood thinners and chemotherapy drugs. It may be easier and
safer to choose foods that are high in vitamin E, such as vegetable oils
and eggs.

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Coping and support

Chemo brain symptoms can be frustrating and debilitating. With time,
you'll find ways to adapt so that concentration will become easier and
memory problems may fade. For most cancer survivors, memory problems
subside within two years of treatment. Until then, there are ways to
cope. Try to:

* Understand that memory problems happen to everyone. Despite your
best strategies for dealing with your memory changes, you'll still have
the occasional lapse. It happens to everyone. While you may have little
control over the cancer-treatment-related memory changes, you can
control other causes of memory lapses that are common to everyone, such
as being overly tired, distracted or disorganized.
* Take time each day to relax. Stress can contribute to memory and
concentration problems. Devote time each day to stress-relief
activities, such as exercise, listening to music, meditation or writing
in a journal.
* Be honest with others about your symptoms. Be open and honest with
the people who are close to you about your chemo brain symptoms.
Explain your symptoms and also suggest ways friends and family can help.
For instance, you might ask a friend to remind you of plans by both
phone and email.

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