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Lifting the Fog of Chemo Brain

When Idelle Davidson was diagnosed with breast cancer in 2005, the furthest thing from her mind was safeguarding her memory. Radiation and chemotherapy took her energy, and most of her time. But months later, she began to forget things and become more and more disoriented — losing her car at the mall, forgetting friends’ phone numbers. She became concerned something was wrong.
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October 7, 2009

When Idelle Davidson was diagnosed with breast cancer in 2005, the furthest thing from her mind was safeguarding her memory. Radiation and chemotherapy took her energy, and most of her time. But months later, she began to forget things and become more and more disoriented — losing her car at the mall, forgetting friends’ phone numbers. She became concerned something was wrong.

“I didn’t understand what was happening to me,” said Davidson, a health and science journalist.

It wasn’t until she began attending support groups for cancer patients that she discovered something called “chemo brain.”

“People started describing their symptoms, and I said, ‘That’s happening to me, too,’” she said.

After doing some research, Davidson discovered that as many as 80 percent of chemotherapy patients experienced similar symptoms. And yet, little has been written about the phenomenon. Wanting to normalize the condition and provide a source of comfort and information for people like herself, Davidson reached out to Dr. Dan Silverman, head of neuronuclear imaging in the Ahmanson Biological Imaging Division at Ronald Reagan UCLA Medical Center. Together, they wrote the recently released book, “Your Brain After Chemo: A Practical Guide to Lifting the Fog and Getting Back Your Focus” (Da Capo Lifelong Books, $25).

While lacking a clear-cut medical definition, chemo brain can be described as the cognitive impairment that some people experience during and after chemotherapy. Research into the condition is relatively new, but it’s beginning to offer hope. And a study that recently began at UCLA will seek to help patients manage their symptoms, by focusing on rehabilitation and coping strategies. 

In addition to memory loss — a leading symptom of chemo brain — patients also describe a mental fog and trouble with daily activities. Many, including Davidson, report that the condition heavily impairs the quality of their work.

“I write for a living,” Davidson said. “Everything took a little bit longer, because you’re much slower cognitively. I think my writing suffered quite a bit.”

Clinical evidence supports patients’ claims. Based on his research, Silverman says that “the most common problems are with what they call executive function.” Controlled by an area in the front of the brain called the prefrontal cortex, executive functioning refers to the ability to maintain focus, multitask and concentrate, among other things.

A 2004 study by Jeffrey S. Wefel published in the journal Cancer provides further confirmation. In it, researchers tracked 18 women who underwent chemotherapy for breast cancer. Participants took neuropsychological tests before treatment, after treatment and then again one year later. The tests showed that cognitive ability had declined in 61 percent of the women.

While the data uphold a link between cognitive impairment and cancer treatment, experts remain perplexed as to how, exactly, chemotherapy could affect the brain. One of the most puzzling aspects has to do with the blood-brain barrier, a separation between the brain’s blood vessel branches and its cells, which is responsible for preventing anything harmful from entering the brain — including, in theory, chemotherapy agents.

Some researchers wonder if chemotherapy alone is to blame for patients’ symptoms. A leading theory that suggests otherwise, according to Silverman, is that chemotherapy causes the immune system to release molecules called cytokines. Produced during times of illness, cytokines often result in feeling tired or nauseous.

“Cytokines can more readily get into the brain than the chemo can,” Silverman said, “but they can also damage the brain.”

Another potential culprit is endocrine therapy, including the commonly used drug Tamoxifen. Endocrine therapy’s effect on cognitive functioning has yet to be studied thoroughly.

“Part of what we suspect,” said Dr. Steven Castellon, a neuropsychologist who has done extensive research on chemo brain, “is that there’s something about chemo and endocrine therapy, that [people who get both] seem to have more cognitive difficulties.”

As the search for a cause continues, medical professionals still must find appropriate treatments for patients who are suffering. Castellon suggests starting with lifestyle changes, such as using a PDA and consciously building structure into every day. Mental exercises can also be beneficial, including “crossword puzzles, sudokus, anything that’s cognitively stimulating,” he said. Some patients also see improvement from practicing yoga or meditating.

Following the implementation of these techniques, if a patient is still exhibiting symptoms, medication may be the next step. “Stimulants work very well for those executive problems,” Silverman said. Ritalin, which is commonly used to treat attention-deficit disorder, is one such option to fight fatigue and promote concentration.

Cognitive impairment can be devastating, but the good news is that recovery is likely. In the results of the Wefel study, 50 percent of sufferers were found to have recovered within one year of finishing chemotherapy treatment. And in her book, Davidson reports that 75 percent of patients recovered after two years.

In the future, experts may be able to use positron emission tomography (PET) and magnetic resonance imaging (MRI) scans to flag patients who are at a greater risk for developing chemo brain prior to treatment, and monitor them throughout.

Davidson, who is now four years out from her initial diagnosis and fully recovered, hopes that her book will help define chemo brain for those seeking answers, and forward research in the field.

“By understanding the cause,” she said, “scientists can find out how to fight chemo brain, or find ways so that people don’t experience it at all.”

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