Tuesday, November 15, 2011

BACK TO THE BUSINESS OF CHEMOBRAIN

Halle-friggen-lullia!


My google page, the one that distracts me from doing actual work no matter HOW HARD I try?


Let's get back to business.


The reason for the existence of this very blog.


My need for personal vindication and the absolute certainty I had that chemobrain is causing far greater issues for many more people than anyone can estimate.


And, I got the moves like Jagger and it goes like this:


According to this newly published study, breast cancer itself may be the cause of "measurable brain injury."  In other words, my chemobrain or my twitter @chemobrainfog may need to be adjusted to properly reflect that a breast cancer diagnosis in and of itself may be causing brain issues. 


@chemobrainfogboob?  As it is, I'm using far too many characters in the tweet world......


From Stanford University..... In case the link doesn't work...... Nah... this is worthy of a blog entry.  Any emphasis is MINE.  At the bottom of the page are links to every article in EVERY journal where I could locate the story until I got ummmm, distracted...... by Dancing With The Stars.


I AM a medical news junkie.  I got my fix last night.  Now, how to FIX it?





A neuroimaging study from the Stanford University School of Medicine has found that when asked to perform certain tasks, women who have undergone chemotherapy for breast cancer had significantly less activation of a part of the brain known to play a critical role in planning, attention and memory than did breast cancer patients without such treatment, as well as healthy women.

The research, published Nov. 14 in the Archives of Neurology, advances previous findings about the effects of chemotherapy and breast cancer on brain function. It provides “further evidence that primary breast cancer may cause measurable brain injury,” the study authors wrote, adding that women treated with chemotherapy experience additional brain abnormalities and cognitive difficulties.


The study also shows an association between breast cancer patients’ self-reported cognitive impairment and abnormalities in brain function. Among patients who received chemotherapy, complaints about their cognitive ability significantly correlated with lower activation of these parts of the brain, the study found.
“This shows that when a patient reports she’s struggling with these types of problems, there’s a good chance there has been a brain change,” said lead author Shelli Kesler, PhD, assistant professor of psychiatry and behavioral sciences. “Yet these women are often dismissed as imagining or exaggerating the problems.”


Kesler, whose research focuses on ways to predict which cancer patients might experience impairments, said it was important for patients and physicians to have an increased awareness of the issue — “not only to validate the patients’ experience, but to also increase the likelihood that they’ll receive proper, supportive services and treatments for their cognitive difficulties.”


The study involved 25 female breast cancer patients who underwent chemotherapy and surgery, 19 breast cancer patients who had surgery only and 18 healthy females who served as controls. Participants were screened to ensure they had no neurological, psychiatric or medical conditions known to affect cognitive function.


The researchers used functional magnetic resonance imaging to determine which parts of the women’s brains activated when they performed a card-sorting task that measures problem-solving skills. The researchers also used a questionnaire to assess patients’ perception of their cognitive abilities.


Kesler and her colleagues replicated previous findings by showing that cancer patients demonstrated significantly reduced activation in two parts of the prefrontal cortex, including one that is responsible for working memory, cognitive control and monitoring. In new findings, they showed that women in the chemotherapy group demonstrated significantly reduced activation of an additional region of the prefrontal cortex, which Kesler and colleagues describe as “potential neurotoxic brain injury,” and that decreased levels of activation significantly correlated with increases of the patients’ self-reported executive dysfunction.
“When women are reporting cognitive problems, there is a biological change that corresponds,” Kesler said.


Women in the chemotherapy group were also found to make more errors on the card-sorting task and take longer to complete it than healthy women and cancer patients who hadn’t had chemotherapy. “Cancer patients may have brain changes, but the changes don’t necessarily impact them functionally,” Kesler said. “But when you add chemotherapy to that, the changes are so severe that the patients can’t compensate for it anymore.”



Kesler’s next step is to conduct a longitudinal study of cancer patients during which researchers would target this region in pre-treatment brain scans and predict which women might be most vulnerable to cognitive problems.
Co-authors of the paper include Jamie Kent, PhD, postdoctoral scholar in psychiatry and behavioral sciences, and senior author Ruth O’Hara, PhD, associate professor of psychiatry and behavioral sciences. The work was supported by the National Institutes of Health.


Information about the Department of Psychiatry and Behavioral Sciences, which also supported this research, is available at http://psychiatry.stanford.edu/.




From Health Day

US News and World Report

Med Page Today

Abstract from publication

My Health News Daily

   

5 comments:

  1. Awesome, AM. Thanks for pointing out this study. I *knew* my brain was different... at first I was blaming the Tamoxifen. (That is definitely an added culprit.) But my memory issues began after diagnosis — 3 months before I started the Tammy. (And I didn't even have chemo!) There are black holes in my memory. My husband will mention a restaurant we went to and I have absolutely no memory of it. ZIP. It's not foggy memory — it's NO memory.

    I don't know that much that can be done about it... but not beating ourselves up for not remembering things is a start. And letting other people know that they will experience these problems may help them cope better down the line.

    Interesting stuff. Thanks again!

    Renn

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  2. Hey Renn,

    I have been on top of the research since I had my "issues" validated by the doctor at Sloan who "altered" the study criteria so I could participate with the CogMed software. I am by no means an expert, but I do recall Tim Ahles (who IS an expert) talking about the "black holes" you describe. The working memory-the issues with numbers-the ADD-the multi-tasking.... yes, but when he talked about dropping entire conversations, I was stunned!

    There are so many parts of this research that I find fascinating. The replication of old findings and the "new findings" along with a biological change that corresponds to some of this stuff.

    You are right. As of now, there isn't much that can be done. Work around "solutions" (pill cases to remember to take the tammy), me and my iPhone with every appt AND alarms set......

    NOT Beating ourselves up is the biggest start... and not letting others tell us we are exaggerating. It's difficult enough to deal with when you have a frame of reference. I could juggle a dozen tasks and get them all done properly. The fact that I can't, at least not now and I have to accept it may not change? Frustrating.

    I love that they are taking the next logical step. Do testing BEFORE the treatment begins.

    Meantime, mostly, I will continue to joke my way through..... because laughter IS the best medicine! Laughing with friends, EVEN better!!

    xoxo
    AnneMarie

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  3. Wow! So many things can cause "cognitive issues." Since chemo I've strongly identified with my mother, who has dementia. She's always telling me how she doesn't remember things, and when I say, "I know, Mom. I have the same problem," she sometimes says, "Do you have dementia, too?" When I tell her mine is caused by the chemo I took for breast cancer, she says, "Did you have cancer?"

    Laughter... That is totally the best medicine, especially when we can laugh at ourselves. Like yesterday, I swear the guy on the radio said a man had been "eaten to death," but it was "beaten to death." In addition to my brain, I guess my hearing is going as well.

    XOXOXO,
    Brenda

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  4. Hi Brainfoggy, thanks for this article, just freshly published. Now we are getting somewhere in the world of respectability for having chemobrain. Thank goodness, because my ex-friends really can't stand me saying that I can't do this and that. You know, like, read a book. That is just totally unacceptable to them, since I was known for being so literate before. So I spend all my time alone now. Also because of the fatigue and depression and losing my beloved career.

    I posted the link to the scholarly journal you cited on my bloggy just now. I mean the abstract. I read it, and it is difficult to understand. However, I did not come away with the same impression that you did, to quote your post above:

    "According to this newly published study, breast cancer itself may be the cause of "measurable brain injury." In other words, my chemobrain or my twitter @chemobrainfog may need to be adjusted to properly reflect that a breast cancer diagnosis in and of itself may be causing brain issues."

    Instead, I got a much stronger conclusion that the patients without chemo were slightly less sharp by having breast cancer (but causes of that were not mentioned, like anxiety or whatever), and that patients who had chemo got slammed with toxins so damaging to brain that it actually showed on their MRIs. That is a big deal. It's astounding. It's physical evidence of toxic damage, not just troublesome complaining on the part of women.

    Now they better figure out how long it lasts, whether it's permanent, and how we can be rehabilitated like Congresswoman what's-her-name was with her brain injury.

    Instead of just being kicked to the curb when breast cancer treatment is finished, like we are now.

    boo hoo, I'm so sad,

    Love, Evelyn

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  5. Evelyn,
    Yes precisely! This was the line in that thing that got me:

    "But when you add chemotherapy to that, the changes are so severe that the patients can’t compensate for it anymore"

    I can't read a book anymore either...... unless it has some basis in facts that are already well rooted in my brain. A novel? NO way. I can't keep the characters straight.

    There are so many aspects of this study that are troubling. Observations like being dismissed for exaggerating what we are experiencing....

    Brain damage, as in toxins killing cells, yes, very scary....

    Bottom line, ANYONE who is dealing with a disability claim should be printing this thing out and shoving it down the throats of the review people. Ya hear me, E....

    I know you're sad..... your entire life was yanked from you..... This is "chemobrain's dirty little secret" ..... I can attempt to laugh my way out of it but my (former) career was NOT my passion. In your case, you lost the ability to do what you love to do..... that's a reason for sadness.

    Love to you,
    AnneMarie
    xoxox

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