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Sunday, June 17, 2018

Deficits in the Healing Arts

"We need an infusion of new ideas. Cognitive neuroscience would help us characterize the deficits people have and allow us to connect them to particular brain systems."
"Patients and their families want to know what to expect during and after treatment [chemotherapy following cancer surgery]."
"Cancer-related cognitive impairment is real. And those of us in the field are intent on figuring it out."
Todd S. Horowitz, cognitive psychologist, program director, Division of Cancer Control and Population Sciences, National Cancer Institute, U.S.
[Woman undergoing chemotherapy]
Chemotherapy is known to interfere with cognitive abilities, but for how long? MedicalNewsToday
For every action there is a corresponding reaction. Pharmaceutical and medical science has allowed us to live longer and ostensibly better. When we have the misfortune to acquire a chronic illness, or when any untoward medical condition of however long a duration assails us, there is a formulaic therapy, a specific drug that will minimize symptoms, or 'cure' the illness, or enable us to live with the inconvenience to our daily health outcomes. Far from ideal, however, since even though the medication addresses the illness itself, the prescription will invariably impact not only on the condition it is engineered to target, but create another condition in the process, minor or major.

Dr. Horowitz and two other researchers at the institute they all represent produced a paper published in the journal Trends in Neurosciences, last week addressing a puzzling and important issue with the hope that they can influence an outcome where specialists in brain science can put their expertise to work to figure out why it is that so many cancer patients suffer from a condition known officially as cancer-related cognitive impairment, and which people who suffer from the condition and their doctors more familiarly term "chemobrain".

The estimates are that between 17 to 75 percent of cancer patients suffer from this condition where sufferers mention a range of impairments. And then to make it even more complicated patients with various types of cancers or those who have been put through a different set of therapeutic protocols speak of a wide range of disabilities in a malfunctioning brain. Researchers, to date, are stumped. There are theories but nothing has been proven. Some believe that chemobrain owes its presence to treatment for cancer destabilizing the immune system, so a toxic flood of inflammatory agents is unleashed on the central nervous system.

The condition is more commonly compared to living with a mental fog. Long after the recovery period from surgery and chemotherapy has passed and medical check-ups post-surgery have been lifted patients are exposed to a "new normal" situation that includes concentration difficulties, inability to recall words, short-term memory, and the end of multi-tasking. The onset of these symptoms lumped together as foggy brain syndrome or chemobrain is as mysterious as its presence. No one knows if it will eventuate, how long it will last, and what precisely is involved, let alone whether it can be treated, or, best case scenario, avoided altogether.

Not much is known about the mechanics involved in the phenomenon which experts attempt to use standard neuropsychological tests for, to determine the extent of cognitive impairment in various "domains", inclusive of attention, processing speed, visuospatial skill and various types of memory with clinical measures devised for the purpose of diagnosing or assessing injury caused through severe brain diseases like Alzheimer's, traumatic brain injury, or stroke. What works for those conditions seems unhelpful in the detection, measurement or explanation of the subtle impairment that stalls the return to normalcy for many cancer survivors.

Return to a normal lifestyle is stalled, temporarily or permanently. That mentally demanding work role for an employee suffering the after effects of cancer treatment becomes an impossibility. Some people are unable to resume driving, much less plan for their future. Experts speak of the possibility that chemotherapy may be responsible for brain inflammation, and DNA scrambling in the brain, or that chemotherapy promotes an acceleration of the aging process, or disables the brain's normal repair mechanisms. A simpler explanation might be that chemotherapy designed to eliminate certain cells, manages to breach the blood-brain barrier, attacking neurons directly.

Confoundedly MRI scans capable of capturing portions of the brain's more elusive structures have shown before patients undergo treatment, breast cancer patients, as an example are seen with reduced volumes of white matter, the brain's vital connective tissue. The scans reveal that paying attention exacts more of an effort on the part of the patient with chemobrain, that their cortical structures show both early- and long-term brain volume losses.

And then, MRI studies capturing activation in particular brain regions have shown a reduction in connectivity in a neural circuit named the default mode network with its central role in diseases of aging, along with those involving inflammation and cell stress. The hope is to be able to achieve a more accurate, dependable understanding of the aspects of chemobrain to give hope to cancer patients, to enable their brain to work as well as their medical-protocol-healed body. The hope is to be able to select specific treatments as strategies in the hopes of reducing the effects of chemobrain, or eliminating it entirely.
Signs and symptoms of chemo brain may include the following:
  • 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
Mayo Clinic

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