Cognitive function (IQ) decline, anyone else?

[Jackie07]

Just learned that my IQ had dropped 21 points since my last test in 2003 - based on the 19 neuropsychological batteries I took on the last day of June.

"Cognitive decline likely attributable to post-chemotherapy encephalopathy and the effects of frontal neoplasm and gammaknife treatment" is the 2nd heading of the 2-page report.

Were we depressed about the result? No. Actually both me and my poor hubbie were elated. He no longer suspects that I purposely try to irritate him. I no longer feel bad about losing my teaching jobs.

The neuropsychologist recommends a one year follow-up to "identify a possible concomitant dementia, such as Alzheimer's disease."

Just thought I would share with everyone here. Just think how much smarter we would be acting (looking) here if we had not gone through chemo...

[Terri B]

Well said Jackie, and good for you!

Is it too soon for me to have Chemo-brain? I swear, I have a pretty quick propensity to turn into a blithering idiot. I have to call a "time out" anytime it happens so I can gather my thoughts!

[Jackie07]

Terri,

It will be a long time and much more treatments before you experience anything like mine. Remember that I have had 3 shots of Gamma knife treatment 7 years ago and back to back surgeries and chemo the past four years.

I do want to remind everyone to stay active both physically and mentally. And stay 'happy' - the best medicine for our health!

[Terri B]

Oh Jackie,

I didn't mean to imply that my situation is ANYTHING like yours!

[Jackie07]

Sorry. I was just trying to show off my cognitive deficit...

[R.B.]

Hi,

The usual cry in case it is not on anybody's radar - The long chain Omega 3s DHA and EPA are essential to brain function and structure, and trials suggest they protect against neurological decline including alzheimers.

Oestrogen allows women to make more long chain fats from the mother fats (assuming they are in the diet).

Women arguably need higher Omega 3s for lots of reasons.

Trials suggest that higher Omega 3s reduce the risk of BC.

http://her2support.org/vbulletin/sho...ght=greek+diet

[Merridith]

Hi there:

I was just a part of an anecdotal fact-finding study for chemobrain. According to the researcher, it seems that the effects of chemobrain is largely reversable, after 1.5 -2 years. However the timelines seem to vary depending how old you were when you started your chemo. Younger = faster recovery time.

Regards,
Merridith

[Jackie07]

That's good to hear. Thanks for the encouraging info. I am exactly your age. Do you know if we are still young enough to recover?

According to the PBS program about the brain elasticity, we all have great hopes to accomplish the 'impossible' because the way our brain is structured. I am pretty determined to 'show' the doctor that I will be one of the exceptional cases. She did not see how 'brain damaged' (yes, that's what encephalopathy means) I was back in 1990 just after my 25-hour brain surgery.

I will try to live long enough to prove her wrong...

[MJo]

What a coincidence. I am going for testing from a neurologist next week. My Internist wants me to go because of my cognitive trouble. I have started using a sleep mask and I am sleeping better, so that should help. I wake up a lot at night. Since my brain scan and echocardiagram turned out ok, I've stopped worrying. If my IQ is down, so be it.

[Believe51]

I am going to have Mighty Oak read this particular thread because it highly pertains to him also. Along this journey this has been a big issue for him to deal with. Seeing all of your posts will not only lighten him up but allow him to follow up with testing if he deems it important enough.>>Believe51

[Jackie07]

Glad you find the thread of value. Thanks for posting. Let's hope there will be more feedbacks from our members on the board.

[SoCalGal]

Hey - I have an idea - maybe we can start a class action lawsuit against all the drug mfgs who forgot to list cognitive problems as a side effect of the chemo. NOW who's the stupid one?
Chemo brain - let it rain...money that is
As far as recovering after treatment ends - what if treatment never ends? When is my brain supposed to recover? I'm going to take an online IQ test right now.

[StephN]

Flori -
Give us the web address of that online IQ test.

I am sure mine has fluctuated over the years, and not only due to being postmeno and over 50!

I was a long time in the Gamma Knife radiosurgery. 56 minutes for the large 3cm tumor and 20 mins for the smaller tumor. I am positive there was some effect at least for a while. And not only from the d*&^%*&^ decadron I had to take. That stuff messes a person up for a long time!

[Jackie07]

Sorry I am cutting in.

I have used the test on IQquest.com over the years and my IQ is still way high according to that test. It is a fun test and the good score comforted me - until I saw the doctor and got the comprehensive tests (19 of them) result. Watch out when they ask you to fill out detailed personal information online because it could well be used by third parties and identity theft is a big concern.

The neuropsychologist advised my husband to start testing in between 55 - 60 (yr-old) to establish a baseline because we were worried about him getting Alzheimer's disease. His Mom has been in the nursing home for several years now because of that. And my husband is the only one among the three siblings to have high blood pressure and heart disease like her. And his cadiovascular problems developed way earlier than hers, despite him having been an avid athlete.

It might be good to talk to our doctors about getting tested to establish a baseline. Later testing may tell us if we are affected by the treatment or if we have come out of the 'chemobrain'.

[Jackie07]

The association between neuropsychological impairment, self-perceived cognitive deficits, fatigue and health related quality of life in breast cancer survivors following standard adjuvant versus high-dose chemotherapy.
Mehnert A, Scherwath A, Schirmer L, Schleimer B, Petersen C, Schulz-Kindermann F, Zander AR, Koch U.
Institute of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52-S35, 20246 Hamburg, Germany. mehnert@uke.uni-hanburg.de
OBJECTIVE: The possible association between neuropsychological impairment, self-perceived cognitive deficits, fatigue and health related quality of life has been studied in high-risk breast cancer survivors 5 years following standard adjuvant (n=23) versus high-dose chemotherapy (n=24) and in early-stage breast cancer patients (n=29) (comparison group) following radiation therapy. METHODS: A neuropsychological assessment covering attention, memory and executive functions was used together with the questionnaire for self-perceived deficits in attention (FEDA), the multidimensional fatigue inventory (MFI-20) and the EORTC-QLQ-C30. RESULTS: Findings have shown that neuropsychological impairment is not directly associated with self-perceived cognitive deficits, fatigue and HRQOL. However, 46% of patients reported self-perceived cognitive deficits and 82% of the patients complained about cancer related fatigue. Except for reduced activity we did not find significant group differences, even though patients who received standard-dose chemotherapy had consistently higher levels of self-perceived cognitive deficits and fatigue, and the lowest HRQOL. CONCLUSION: Results emphasize the need for psychosocial counseling and support during treatment phase and follow up care as well. Sensitive cancer-specific measures for the assessment of self-perceived cognitive deficits in different cognitive domains according to neuropsychological measurements are required. PRACTICE IMPLICATIONS: The role of self-perceived cognitive deficits and fatigue should be considered in educational interventions and counseling. Specific rehabilitation measures should be developed, implemented and evaluated in order to meet the needs of these patients and to decrease the frequency of cognitive deficits following cancer treatment.
PMID: 17320337 [PubMed - indexed for MEDLINE]

[Jackie07]

Adjuvant chemotherapy for breast cancer: effects on cerebral white matter seen in diffusion tensor imaging.
Abraham J, Haut MW, Moran MT, Filburn S, Lemiuex S, Kuwabara H.
Department of Medicine, Section of Hematology and Oncology, Johns Hopkins University, Baltimore, MD, USA. jabraham@hsc.wvu.edu
PURPOSE: The purpose of this study was to examine the effect of adjuvant chemotherapy on normal-appearing white matter in women with breast cancer. PATIENTS AND METHODS: Ten patients with early-stage breast cancer who were treated with adjuvant chemotherapy and 9 age-, education-, and IQ-matched healthy controls were studied with magnetic resonance imaging. Diffusion tensor imaging was used to calculate fractional anisotropy (FA), a measure of white matter integrity. Measurements were made in the genu and splenium of the corpus callosum. Participants also completed measures of processing speed, depression, and anxiety. RESULTS: Relative to controls, patients had slower processing speed and lower FA in the genu. Processing speed was positively correlated with FA in the genu. CONCLUSION: The results of this pilot study suggest that adjuvant chemotherapy affects normal-appearing white matter in the genu of the corpus callosum and that this is related to the cognitive deficits experienced by patients.
PMID: 18501063 [PubMed - indexed for MEDLINE]

[Jackie07]

Chemotherapy and cognitive deficits: mechanisms, findings, and potential interventions.
Nelson CJ, Nandy N, Roth AJ.
Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA. nelsonc@mskcc.org
"Chemobrain" is the phenomenon of cognitive decline some patients may experience after chemotherapy. Current research indicates the cognitive domains that may be most impacted by chemotherapeutic agents are visual and verbal memory, attention, and psychomotor functioning. These cognitive deficits can have an effect on a patient's ability to make informed treatment decisions, pursue occupational or academic pursuits, and his or her overall quality of life. The potential mechanisms that cause this disruption remain largely unknown, although contributing factors could be vascular injury and oxidative damage, inflammation, direct injury to neurons, autoimmune responses, chemotherapy-induced anemia, and the presence of the apolipoprotein E epsilon4 (APOE epsilon 4) gene. Interventions to help alleviate the symptoms of chemobrain could include nonpharmacologic treatment such as antioxidants and cognitive-behavioral therapy. In addition, patients may benefit from pharmacologic treatment such as recombinant human erythropoietin and psychostimulant drugs such as methylphenidate. It is important to note that the proposed therapeutics treat the symptoms of chemobrain based on the hypothesized mechanisms. Therefore, a detailed understanding of the mechanisms that cause chemobrain, as well as a comprehension of what specific cognitive domains are impacted, is crucial in developing more specific treatments to improve patients' cognitive functioning and overall quality of life.

[Jean]

Jackie,
You are sounding pretty darn smart to me!
Maybe you are coming from a level of genius!

Tell your husband he is a lucky man.

Hugs,
jean

[Jackie07]

Thank you, Jean. That is very kind of you. My poor hubbie has been taking anti-depressant for over a year now. Think about living with a wife like me - he's constantly worried whenever I am left alone in the house (or anywhere else.)

The deficits are real and dangerous sometimes - during my worse times I had a history of incidents including locking our dog outside in the hot summer afternoon(it was a toy poodle - she appeared at our doorstep in 1993, and I firmly believed that God had sent her to me); leaving the car running in the driveway (possibly over 4 hours) after I got home from work; leaving the toast burning and caused the fire alarm to go off - the fire engines came...
For a while we were worried that I'd be like the girl depicted in "50 First Dates" in which Drew Barrymore was having problems with her 'short-term' memory (she's not able to retain and lock the newly aquired information in her long-term memory.)

If any of my past employers would have kept me, I could have done a much better job after that first year because I would be familiar with the environment. (But then again, I could have burned down the building - another one of our favorite movies is 'Pure Luck' in which Martin Short set out to look for his boss'es missing daughter - an 'accident-prone' girl - who was kidnapped in South America. She caused disasters everywhere she went, including burning down the whole village where the natives had rescued and sheltered her. The kidnappers eventually begged her to leave them.) I have the hardest time in retaining names and procedures (and oftentimes, 'following rules' .

The neuropcychologist thought being a math teacher (what I thought I would pursue since my math ability is still in the superior range) would be too demanding. She thinks being a math tutor will be a more obtainable goal.

[Joe]

A paper was presented at the 2007 ASCO meeting about cognitive function being treated with Provigil.

There have also been clinical trials involving the drug Aracept.

Both studies had promising resukts.

Regards
Joe