more evidence of "chemobrain" (and maybe hope)

[Lani]

they can now see the changes on scans--and most improves a year after chemo

but since we don't really know how the brain works, nor how MRI images of the brain really correspond to cognitive function, this research is truly in its infancy


Indiana University School of Medicine
IU researchers: Chemotherapy alters brain tissue in breast cancer patients





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INDIANAPOLIS -- Researchers at the Indiana University Melvin and Bren Simon Cancer Center have published the first report using imaging to show that changes in brain tissue can occur in breast cancer patients undergoing chemotherapy.

The cognitive effects of chemotherapy, often referred to as "chemobrain," have been known for years. However, the IU research is the first to use brain imaging to study women with breast cancer before and after treatment, showing that chemotherapy can affect gray matter. The researchers reported their findings in the October 2010 edition of Breast Cancer Research and Treatment.

"This is the first prospective study," said Andrew Saykin, Psy.D., director of the Indiana University Center for Neuroimaging and a researcher at the IU Simon Cancer Center. "These analyses, led by Brenna McDonald, suggest an anatomic basis for the cognitive complaints and performance changes seen in patients. Memory and executive functions like multi-tasking and processing speed are the most typically affected functions and these are handled by the brain regions where we detected gray matter changes."

Dr. Saykin, who is Raymond C. Beeler Professor of Radiology at the IU School of Medicine, and colleagues studied structural MRI scans of the brain obtained on breast cancer patients and healthy controls. The scans were taken after surgery, but before radiation or chemotherapy, to give the researchers a baseline. Scans were then repeated one month and one year after chemotherapy was completed.

The researchers found gray matter changes were most prominent in the areas of the brain that are consistent with cognitive dysfunction during and shortly after chemotherapy. Gray matter density in most women improved a year after chemotherapy ended.

For many patients, Dr. Saykin said, the effects are subtle. However, they can be more pronounced for others. Although relatively rare, some patients -- often middle-aged women -- are so affected that they are never able to return to work. More commonly, women will still be able to work and multi-task, but it may be more difficult to do so.

The study focused on 17 breast cancer patients treated with chemotherapy after surgery, 12 women with breast cancer who did not undergo chemotherapy after surgery, and 18 women without breast cancer.

"We hope there will be more prospective studies to follow so that the cause of these changes in cancer patients can be better understood," Dr. Saykin said.

Dr. Saykin and his colleagues started their research at Dartmouth Medical School before finishing the data analyses at IU. A new, independent sample is now being studied at the IU Simon Cancer Center to replicate and further investigate this problem affecting
many cancer patients.

[karen z]

Thanks for posting.
kz

[imdavidson]

Lani,

Scientists have been using PET scans and functional MRI to study changes in brain function for a few years. Generally though, the patients who participated in these studies had already been through chemotherapy and/or hormonal therapy. What's different about this study is that Dr. Saykin and his team did a "before" and "after." They scanned patients prior to undergoing chemo or radiation and then at two points after going through chemo. So they had some good data comparing the changes in their brain tissue.

This is just one more study in a growing body of scientific evidence that connects the dots between chemotherapy and cognitive dysfunction.

All the best,
Idelle

[AlaskaAngel]

This article was both encouraging and discouraging to me... The exciting thing is, like Idelle says, this time they didn't just wait until chemo was over and then examine patients.

The discouraging thing is knowing that even though the examination technology has existed for years and years, until now they haven't considered possible brain damage with treatment worth making the effort to image the brain before giving the therapy. Why gather proof of damage if it just might show that treatment in low-risk for recurrence groups doesn't make good sense?

AlaskaAngel

[bejuce]

I've been wondering if I'm a victim of chemo brain. Because of my work as a lawyer, I need to pay attention to lots of details. The other day I finished a project, proofread it a couple of times, and still missed a word that should not have been there.

This is happening more often than before for me, and when it does, I have no recollection of making the mistake. Could this be chemo brain? Is it possible that my brain function has been affected to the point that I can't pay attention to details as much as before?

[Jackie07]

Here's my doctor's statement on my neurophsychological report for the testing done on 6-30-2008, 1 year after my bi-lateral mastectomy and 18 weeks of chemotheray (TCH) and 4 weekly Herceptin:

1. Decline in overall intellectual functionin compared to previous results.

2. Cognitive decline likely attributable to post-chemotherapy encephalopathy and the effects of frontal neoplasm and gammaknife treatment.

3. Rule-out possible incipient dementing process.

4. Probable limitation to maintaining gainful employment.

Notice the term she used was (post-chemotherapy) 'encephalopathy'[= brain damage?].

My guess is that there are now many tiny little gaps existing in our brain due to chemotherapy. The mishaps of our memory most likely happen when the electric impulses carrying the message hit the [black] hole and cause the glitch. It's very similar to what many senior citizens experience in their daily lives. The difference is that most of them are retired due to natural aging process...

Still, our brain is very 'fluid' and capable of self-repair. Exercise (both mental and pysical) and good nutrition are the keys. The brain will create new pathway if we work on it.

[imdavidson]

Hi Bejuce,

Neuropsychological testing can screen for "chemo brain" symptoms (as can brain scans as reported above). And several studies include patient questionnaires and interviews to help make that diagnosis.

In our book we have one entire chapter devoted to the role of neuropsychologists. Contributing to the chapter were experts from UCLA, Sloan-Kettering and MD Anderson. They actually talked about the type of paper-and-pencil testing they use, how they screen out for depression, and their criteria for making a diagnosis.

One key question they ask is: Have your cognitive abilities changed since treatment? If so, that is one of the indicators. Also, keep in mind that people who need to function at the top of their games (such as lawyers or parents who run households!) may feel the difference far more keenly than others who are retired or have few responsibilities.

I would give it some time though. You've been through a lot. It may be that by this time next year the fog will have lifted and you'll be as sharp as ever.

Best wishes,
Idelle

[Jackie07]

Glad there's more and more attention on the subject. Below is a similar thread started less than a year ago:

http://her2support.org/vbulletin/showthread.php?t=42946

[Jackie07]

Another interesting link that shows why and how:

http://www.fi.edu/learn/brain/exercise.html#top

And more writings by Idelle found on the Web:

http://s332621331.onlinehome.us/Disc...elle-davidson/

[michka]

This is an interesting thread. I am happy doctors are now really trying to assess potential damage induced by chemotherapy and not only putting cognitive problems on menopause or depression. I am however concerned about our future if large studies come out saying we might have brain damage from chemotherapy. Many of us face employment problems after treatments. This might really make it worse to find a job. However, to choose, I still prefer an in depth study that could lead to a more selective use of chemotherapy and maybe some kind of prevention. Michka