Often a patient will come into our office after chemotherapy treatments. One of the first things they will say is “I wish they told me about these side effects so I could be prepared.” One side effect is chemo brain. This is a “brain fog sensation,” a loss of memory and cognitive function. Most research reports that these are temporary conditions caused by chemotherapy treatments and that symptoms should be treated with various methods including memory and brain exercises when needed. Included are certain medications included Alzheimer medications and those for attention-deficit disorder.
Let’s first look at a January 2021 study in the Annals of translational medicine.(1) Here an overview of the problem is given and possible solutions are recommended:
“Cancer-related cognitive impairment refers to a series of cognitive impairment symptoms associated with alternations in brain structure and function, caused by a non-central nervous system malignant tumor and its related treatment.
Cancer-related cognitive impairment may present as memory loss, impaired concentration, difficulty in multitasking and word retrieval, and reduced comprehension speed. Cancer-related cognitive impairment has become one of the prevalent factors that compromise the quality of life for cancer survivors. Different treatments, including surgery, chemotherapy, radiotherapy, endocrine therapy, and targeted drugs, may contribute to Cancer-related cognitive impairment. Meanwhile, patients’ factors, including emotional challenges and genetic makeup, also contribute to the development of Cancer-related cognitive impairment.
The condition can be treated with using stimulants methylphenidate and modafinil, metabolites of nicotine: cotinine, antidepressants of fluoxetine and fluvoxamine, dementia drug of donepezil, and antioxidants ZnSO4, n-acetyl cysteine, propofol, and Chinese herbal of silver leaf medicine. Psychotherapies, including meditation and relaxation, cognitive rehabilitation training, along with physical therapies, including aerobic exercise, resistance training, balance training, yoga, qigong, tai chi electroencephalogram biofeedback, and acupuncture, are also beneficial in alleviating cancer-related cognitive impairment symptoms.”
Chemotherapy associated neurotoxicity and cognitive dysfunction
In a recent study, (2) doctors are exploring the hypothesis that inflammation opens a door for chemotherapy associated neurotoxicity and cognitive dysfunction.
The focus is on cytokines – a small protein that communicates with cells to get them to the site of injury, infection, and inflammation. The thinking is that cytokines are somehow opening a doorway in “blood-brain barrier” the blood filtering mechanism that carries blood to the brain while blocking many harmful substances. It is through this doorway that “unfiltered” chemicals are getting through.
In research from the International Journal of Cancer,(3) doctors looked at neurotoxicity a common side effect of chemotherapy treatment. Clinical studies suggest that the most frequent neurotoxic adverse events affect memory and learning, attention, concentration, processing speeds and executive function.
Emerging preclinical research points toward direct cellular toxicity and induction of neuroinflammation as key drivers of neurotoxicity and subsequent cognitive impairment. (The research suggests that the chemicals used in chemotherapy are somehow bypassing the blood – brain barrier., as we mentioned above.)
Emerging data now show detectable levels of some chemotherapeutic agents within the central nervous system, indicating potential disruption of blood brain barrier integrity.
Blood brain barrier disruption is a key aspect of many neurocognitive disorders, particularly those characterized by a proinflammatory state.
In research from the spring of 2017, (4) researchers reported that cognitive impairment (impairment of memory, attention, or concentration) is documented in 17-75% of patients with various malignancies treated with chemotherapeutic agents that worsen quality of life.
- Changes occur mainly in the ability to learn and remember, in the speed of reactions, and in attention and executive functions.
- Although Chemo-related cognitive impairment’s complexities are not yet fully understood, the involvement of neurotoxicity, such as that induced by treatment, anemia, higher levels of oxidative stress and inflammatory responses, genetic factors, and reduced brain connectivity should be discussed.
“Brain fog,” or “Chermo brain,” can be helped with a customized program of various methods that we offer here.
At the Magaziner Center for Wellness we see a lot of patients post-treatment. These include cancer patients already undergoing conventional treatment by an oncologist or radiotherapist who wish to give themselves the added benefits of nutritional and immune-function support. These patients have reported reduced side effects and better therapeutic results while on our program.
References:
1 Bai L, Yu E. A narrative review of risk factors and interventions for cancer-related cognitive impairment. Annals of Translational Medicine. 2021 Jan;9(1).
2 Damholdt M, Mehlsen M, O’Toole M, Andreasen R, Pedersen A, Zachariae R. Web‐based cognitive training for breast cancer survivors with cognitive complaints—a randomized controlled trial. Psycho-Oncology. 2016;25(11):1293-1300. doi:10.1002/pon.4058.
3. Wardill HR, Mander KA, Van Sebille YZ, Gibson RJ, Logan RM, Bowen JM, Sonis ST. Cytokine-mediated blood brain barrier disruption as a conduit for cancer/chemotherapy-associated neurotoxicity and cognitive dysfunction. Int JCancer. 2016
4. Chemotherapy-related Cognitive Impairment in Patients with Hodgkin Lymphoma – Pathophysiology and Risk Factors. Klin Onkol. 2017 Spring;30(2):93-99. doi: 10.14735/amko201793.
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