Home Health and Fitness Cognitive behavioral therapy may help ease ‘chemo brain’

Cognitive behavioral therapy may help ease ‘chemo brain’

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Shannon Correary said she felt dizzy by the end of her second round of chemotherapy for breast cancer.

“I had absolutely no short-term memory,” said Corry, 57, a screenwriter in Los Angeles who finished treatment in October 2021. …Who is this person who said hello earlier? Where did she know her?’ In that case, I pretended to know the person, but often her interactions still left me uncertain who the person was. . ”

Justin Schuster, 19, of Liveruck, New York, has described his brain as “empty” since finishing treatment for Hodgkin’s lymphoma in April. “I can’t get my thoughts together,” says Schuster. He dropped out of Lehigh University last December after discovering a swollen lymph node just above his collarbone. “I can’t find the words and I forget what I was trying to say.”

What both Coralie and Schuster describe is often called the “chemical brain,” an abbreviation for a debilitating medical condition characterized by loss of word retrieval, memory, executive function, and inability to concentrate. be.doctors call it cancer-related cognitive impairment (CRCI), Studies have shown that it affects about 75 percent of cancer patients During treatment, 35% reported that symptoms persisted after treatment ended.

It remains a mystery why some people get the disease and others don’t, and why some people have symptoms for years while others go away in months.

But Aram Kim, director of the Supportive Oncology Program at NYU Langon University Perlmutter Cancer Center, encourages people to communicate with their health care team about cognitive changes.

“Very good and calm communication with the oncology team is important because knowing that, we can do something,” she says.

What Causes “Chemobrain”?

Jeanne Mandelblat, the first director of the Georgetown Lombardi Institute for Cancer and Aging, thinks inflammation plays a role.

“Cancer treatments kill cancer cells, but they can also damage cells, accelerate aging, and increase inflammation, such as inflammation in the brain. It can affect cognition.” said leader Mandelblat. Think about cancer, live with cancera 15-year longitudinal study focusing on aging breast cancer patients and cognitive impairment.

But the term “chemobrain” is a misnomer, she added, because patients experience cognitive impairment not only from chemotherapy, but also from immunotherapy and hormone therapy. “It’s not all one thing, but it’s a real phenomenon and people have cognitive problems that are disabling in their lives,” she says.

The chemical brain is probably also activated simply because of the cancer itself.

“As people go through cancer and recover, they experience many other problems that may affect function but not necessarily the brain. Insomnia in this population.” High rates of anxiety and depression can occur, and lifestyle changes can be significant, and they may be less effective than they used to be. says Nicolette Gabel, director of the Division of Rehabilitation Psychology and Neuropsychology at the University of Michigan Rogel Cancer Center.

Coralie says the severe depression she experienced during treatment was even worse than her short-term memory loss.

“I could clearly see that the chemotherapy drugs had killed all the positive hormones in my brain,” she says. “There were no dopamine, no serotonin, no oxytocin, no endorphins. It’s too dangerous, lonely, and sad. ”

Neuropsychologists such as Gabel and Eric Zhou, an assistant professor at Harvard Medical School who specializes in disease recovery, say treating chemotherapy brains requires a multifaceted approach.

“This is a combination of cognitive retraining and mindfulness practices to reduce stress.” [and] It improves things like sleep and relaxation, and reduces the high levels of cortisol stress that persist when people are going through these changes,” Gabel said.

Zhou encourages patients to talk to their doctors about dementia symptoms as soon as possible.a Recent research showed that the following interventions improved patient symptoms:

exercise: and A study of over 500 breast cancer patientsThose who exercised for 150 minutes a week maintained cognitive function similar to cancer-free controls, said study author Michelle C. Janelsins-Benton, associate professor at the University of Rochester Medical Center.

“People who were physically active at diagnosis had better cognitive function retention than those who were physically inactive before treatment, even if it was not maintained during treatment. says Janel Sins-Benton.

She speculates that exercise reduces inflammation in the body, which may be a contributing factor. In another study, Janelsins-Benton found that moderate exercise also helped patients maintain their attention span. “This requires more research, but I think it’s a very promising benefit of exercise,” she says.

Cognitive behavioral therapy (CBT): Resetting thought patterns and behaviors can improve symptoms and make life easier, says Zhou.

“If you are forgetful, having a very organized home environment that allows you to have specific places to put things can be very helpful,” says Zhou. “Using a calendar, especially one on your phone or smartwatch that can sound an alarm, can be a call to action.”

Yorktown Heights, N.Y., nurse Diana Pernicano, 29, has been writing everything down since she was treated for Hodgkin’s lymphoma at age 19. Her absent-mindedness was once so severe that she was asked to leave her first nursing position because she often forgot important information.

“I was so embarrassed,” she says. “Fortunately, I was able to refocus and return to my favorite nursing job, which I have had for nine years.”

A type of CBT called Adaptive training for memory and attention Gabel says it’s particularly effective and something patients can easily practice at home.

sleepy: Lack of sleep “amplifies the physiological changes that occur in people with chemical brains,” says Zhou. If you’re having trouble sleeping at night, talk to your doctor about trying CBT. The best way to deal with insomnia. Techniques, according to Zhou, include adjusting your bedtime, making your bedroom a more restful space, and limiting your time in bed to sleep only, watching TV, reading or playing games on your smartphone. It is said that it may include “sleep restriction” that does not occur.

Mindfulness: Meditation, deep breathing and yoga may improve dementia. small study of breast cancer patients. “I don’t know why this helps, whether it’s the mind-body connection or whether these things are good for us in general,” Zhou said.

Psychostimulants: Although there is no clinical evidence yet for its efficacy, drugs Adderall and others may help. “People with significant cognitive fatigue and attention problems can benefit greatly from these drugs,” Gabel said.

Fear of cognitive impairment may cause cancer patients to stop treatment, but it shouldn’t, Gabel said.

“All of this may sound very frightening to people, and I’m afraid people will refuse treatment that could be curative,” she says. “There are cancer survival rates today that were unthinkable 20 years ago.

No FDA-approved solution yet

There are no Food and Drug Administration-approved drugs available for chemobrain, but Mandelblat predicts it won’t be long before doctors can offer patients a drug solution.

“We’re making some progress and hopefully we’ll see the repurposing of already approved drugs into chemobrains,” Mandelblat said. the study It shows promise in mice.

something like that study Cisplatin, a widely used chemotherapy drug, Sphingolipid Daniela Salvemini, author of the study and director of the Institute for Translational Neuroscience, St. Louis University School of Medicine, said that metabolism in the hippocampus (where memories are stored) in the mouse brain plays an important role in the chemical brain. says there is.

Salvemini’s team then administered fingolimod and Zeposia, already FDA-approved drugs for multiple sclerosis, and found that they could block chemical brain development in mice.

Clinical trials in humans are needed, Salvemini said. “This could be a revolutionary approach to treating cancer patients and cancer survivors. It doesn’t give much, but it has a huge impact on the lives of those affected.”

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