Problems

Chemo-brain: prevalence, why it happens, and how to help

  • The largest study to date of chemo-brain shows that 45% of women with breast cancer report it's a substantial problem for months after chemotherapy.
  • A rat study suggests an effect of chemotherapy on dopamine and serotonin may be partly responsible.
  • Better cognitive function, and improved mood, are linked to frequent moderate-to-vigorous physical exercise among breast cancer survivors.
  • A new cognitive-behavioral treatment program has been trialed with positive results.

Chemo-brain common among women with breast cancer

A study involving 581 breast cancer patients and 364 healthy age-matched people (mean age 53) has found that women with breast cancer reported significantly greater cognitive difficulties for up to six months after chemotherapy. Cognitive difficulties were evaluated using FACT-Cog, an assessment that examines a person's own perceived impairment as well as cognitive impairment perceived by others.

Compared to healthy controls, the FACT-Cog scores of women with breast cancer were 45% lower at outset. This difference increased substantially after chemotherapy (see graph). The first assessment after chemotherapy was at 4.8 months, with the second 6 months after that (i.e, nearly a year after chemotherapy). Patients were also much more likely to report significant cognitive decline from diagnosis to the first post-chemotherapy assessment (45.2% vs 10.4% of the controls), and from prechemotherapy to second post-chemotherapy assessment (36.5% v 13.6%).

Having more anxiety and depressive symptoms at the outset, and having lower cognitive reserve (assessed by a reading score), were significantly associated with lower scores.

Those who received hormone therapy and/or radiation treatment after chemotherapy had similar cognitive problems to women who received chemotherapy alone.

Chemobrain a product of dysfunction in dopamine & serotonin release?

A rat study suggests one reason for chemo-brain is an effect of chemotherapy on the neurotransmitters dopamine and serotonin. Both of these are important for both mood and cognition.

After giving carboplatin (commonly used with breast, bladder, colon and other cancers) to rats over four weeks, researchers found that the release and uptake of both dopamine and serotonin in their brains became impaired, although overall levels didn’t change. The rats also showed impaired cognition.

Exercise helps memory for breast cancer survivors

A role for dopamine and serotonin in chemo-brain is consistent with findings that anxiety and depression are risk factors for chemo-brain. No surprise then, that a study has found that physical exercise helps improve cognition in breast cancer survivors.

The study used self-reported data from 1,477 breast cancer survivors, as well as from accelerometers worn by 362 of the women. It found that breast cancer survivors who did more moderate or vigorous physical activity (including brisk walking, biking, jogging, or an exercise class) had fewer subjective memory problems.

Higher levels of physical activity were associated with lower levels of fatigue and distress, and higher levels of physical confidence. The researchers suggest that exercise reduces subjective memory problems via these factors.

Cognitive-behavioral therapy may help

A cognitive-behavioral therapy called "Memory and Attention Adaptation Training" (MAAT), which helps cancer survivors to increase their awareness of situations where memory problems can arise and to develop skills to either prevent memory failure or to compensate for memory dysfunction, has been trialed in a small randomized study involving 47 Caucasian breast cancer survivors. The patients were an average of four years post-chemotherapy.

The participants were either assigned to eight visits of MAAT (30 to 45 minutes each visit) or supportive talk therapy for the same length of time. Both treatments were delivered over a videoconference network between health centers.

MAAT participants reported significantly fewer memory problems as well as improved processing speed two months after treatment. They also reported much less anxiety about cognitive problems.

https://www.eurekalert.org/pub_releases/2017-01/uorm-caw010317.php

http://www.eurekalert.org/pub_releases/2016-05/acs-ih052516.php

http://www.futurity.org/exercise-breast-cancer-memory-1200372-2/

http://www.eurekalert.org/pub_releases/2016-05/w-ctm050216.php

Reference: 

[4253] Janelsins MC, Heckler CE, Peppone LJ, Kamen C, Mustian KM, Mohile SG, Magnuson A, Kleckner IR, Guido JJ, Young KL, et al. Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study. Journal of Clinical Oncology [Internet]. 2016 ;35(5):506 - 514. Available from: http://dx.doi.org/10.1200/JCO.2016.68.5826

[4254] Kaplan SV, Limbocker RA, Gehringer RC, Divis JL, Osterhaus GL, Newby MD, Sofis MJ, Jarmolowicz DP, Newman BD, Mathews TA, et al. Impaired Brain Dopamine and Serotonin Release and Uptake in Wistar Rats Following Treatment with Carboplatin. ACS Chemical Neuroscience [Internet]. 2016 ;7(6):689 - 699. Available from: http://dx.doi.org/10.1021/acschemneuro.5b00029

[4255] Phillips SM, Lloyd GR, Awick EA, McAuley E. Relationship between self-reported and objectively measured physical activity and subjective memory impairment in breast cancer survivors: role of self-efficacy, fatigue and distress. Psycho-Oncology [Internet]. 2016 :n/a - n/a. Available from: http://onlinelibrary.wiley.com/doi/10.1002/pon.4156/abstract

[4256] Ferguson RJ, Sigmon ST, Pritchard AJ, LaBrie SL, Goetze RE, Fink CM, A. Garrett M. A randomized trial of videoconference-delivered cognitive behavioral therapy for survivors of breast cancer with self-reported cognitive dysfunction. Cancer [Internet]. 2016 ;122(11):1782 - 1791. Available from: http://onlinelibrary.wiley.com/doi/10.1002/cncr.29891/abstract

Topics: 

tags problems: 

tags lifestyle: 

tags memworks: 

Concrete thinking may reduce the power of traumatic memories

  • Focusing on concrete details when experiencing a traumatic event may, oddly enough, protect you more from the power of those memories, than if you tried to distance yourself from what you are experiencing.

Can you help protect yourself from the memory of traumatic events? A new study suggests that, by concentrating on concrete details as you live through the event, you can reduce the number of intrusive memories later experienced.

The study, aimed particularly at those who deliberately expose themselves to the risk of PTSD (e.g., emergency workers, military personnel, journalists in conflict zones), involved 50 volunteers who rated their mood before watching several films with traumatic scenes. After the first film, they rated their feelings. For the next four films, half the participants were asked to consider abstract questions, such as why such situations happened. The other half were asked to consider concrete questions, such as what they could see and hear and what needed to be done from that point. Afterward, they gave another rating on their mood. Finally, they were asked to watch a final film in the same way as they had practiced, rating feelings of distress and horror as they had for the first film.

The volunteers were then given a diary to record intrusive memories of anything they had seen in the films for the next week.

Both groups, unsurprisingly, saw their mood decline after the films, but those who had been practicing concrete thinking were less affected, and also experienced less intense feelings of distress and horror when watching the final film. Abstract thinkers experienced nearly twice as many intrusive memories in the following week.

The study follows previous findings that emergency workers who adopted an abstract processing approach showed poorer coping, and that those who processed negative events using abstract thinking experienced a longer period of low mood, compared to those using concrete thinking.

Further study to confirm this finding is of course needed in real-life situations, but this does suggest a strategy that people who regularly experience trauma could try. It is particularly intriguing because, on the face of it, it would seem like quite the wrong strategy. Distancing yourself from the trauma you're experiencing, trying to see it as something less real, seems a more obvious coping strategy. This study suggests it is exactly the wrong thing to do.

It also seems likely that this tendency to use concrete or abstract processing may reflect a more general trait. Self-reported proneness to intrusive memories in everyday life was significantly correlated with intrusive memories of the films. Perhaps we should all think about the way we view the world, and those of us who tend to take a more abstract approach should try paying more attention to concrete details. This is, after all, something I've been recommending in the context of fighting sensory impairment and age-related cognitive decline!

Abstract thinking certainly has its place, but as I've said before, we need flexibility. Effective cognitive management is about tailoring your style of thinking to the task's demands.

http://www.eurekalert.org/pub_releases/2016-05/uoo-tdc050516.php

Reference: 

tags memworks: 

Topics: 

tags problems: 

Diabetes & MCI linked in middle age

September, 2014

A large study has found that mild cognitive impairment occurred twice as often in older adults diagnosed with type 2 diabetes.

A German study involving 1,936 older adults (50+) has found that mild cognitive impairment (MCI) occurred twice as often in those diagnosed with type 2 diabetes.

Analysis of 560 participants with MCI (289 with amnestic MCI and 271 with non-amnestic MCI) and 1,376 cognitively normal participants revealed that this was only observed in middle-aged participants (50-65), not in older participants (65-80). Interestingly, there was a gender difference. Middle-aged women showed a stronger association between diabetes and amnestic MCI, while middle-aged men showed a stronger association with non-amnestic MCI.

http://www.eurekalert.org/pub_releases/2014-09/ip-dma090214.php

Reference: 

Winkler, A., Dlugaj, M., Weimar, C., Jöckel, K.-H., Erbel, R., Dragano, N., & Moebus, S. (2014). Association of diabetes mellitus and mild cognitive impairment in middle-aged men and women. Journal of Alzheimer’s Disease: JAD, 42(4), 1269–1277. http://doi.org/10.3233/JAD-140696

Source: 

tags development: 

tags problems: 

Topics: 

Review shows computerized training can help TBI and stroke victims

  • The first review of computerized training programs to improve attention in those who have suffered a brain injury has reported favorably.

A systematic literature review of computerized training for attention and executive function in adults who suffered a brain injury (TBI or stroke) has concluded that there is encouraging evidence that such programs can help.

The review found 23 of 28 studies reported significant improvements in attention and executive function, with the remaining five showing promising trends. The studies included 11 that focused on TBI, of which 8 reported significant improvement; 5 that focused on stroke, of which all 5 showed significant improvement; 12 mixed-populations, of which 10 showed significant improvement.

Further studies are needed to confirm these results, as various methodological issues, such as a small number of participants, and inadequate controls, need to be addressed. The 28 studies included 9 that were rates as "class I" (the highest standard), 9 class II, and 7 that were class III (no controls). Almost all (26/28) of the studies involved fewer than 50 participants, with some having as few as 1 to 4. Most studies didn't specify how severe the injuries were, something which makes a big difference to treatment and expectations. Over a third of the studies (11) didn't have any control group, and only a few used the best sort of control - a comparable activity (as opposed to, say, no treatment). Only four studies provided any long-term follow-up.

As you can see, a lot of work is needed yet. Moreover, most programs were unique to the study, so we're still some way off producing recommended protocols. Only one program was used on multiple occasions (5): Cogmed QM (originally called RoboMemo).

Still, notwithstanding all these caveats, the review does support the value of specific training for those suffering brain injury.

http://www.eurekalert.org/pub_releases/2016-02/bumc-cra021016.php

Reference: 

tags problems: 

Topics: 

tags strategies: 

Why rest is critical after a concussion

  • A mouse study shows how repeated concussions affect the brain, and confirms the value of having several days of rest after injury.

In the study, mice were repeatedly given extremely mild concussive impacts while anesthetized. The brain's response to a single concussion was compared with an injury received daily for 30 days and one received weekly over 30 weeks.

Mice with a single insult temporarily lost 10-15% of their neuronal connections (dendritic spines), but there was no inflammation or cell death. With three days rest, all neuronal connections were restored.

However, those given daily concussions did not show a loss in dendritic spines, and it's thought that the brain habituates to the repeated shocks. It's further suggested that the loss of synapses is actually a protective effect, allowing the brain to regain normal calcium flow. The long-term effect of this not happening is unknown.

Those given a week of rest between each insult did show the normal dendritic spine loss, however.

Additionally, when a mild concussion occurred each day for a month, there was inflammation and damage to the white matter, and this damage continued for months after the last impact.

These findings are consistent with what has been seen in humans, where white matter inflammation has been found to be a long-lasting consequence of TBI.

On a more positive note, in this model of very mild concussion, there was no increase in tau tangles, suggesting this might be limited to more serious injuries.

http://www.eurekalert.org/pub_releases/2016-02/gumc-fse012816.php

Reference: 

tags problems: 

Topics: 

Tau tangles why TBI increases risk of Alzheimer's

  • Mouse study shows tau tangles may be behind increased Alzheimer's risk for those who have suffered a traumatic brain injury.

We know that traumatic brain injury increases the risk of later developing neurodegenerative disorders such as Alzheimer's disease, but we haven't known why. New mouse studies suggest a reason.

In the research, mice who had a toxic form of tau protein (taken from mice who had suffered TBI) injected into their hippocampus, showed impaired memory and cognition. Moreover, levels of the aggregated tau protein not only increased in the hippocampus, but also in the cerebellum (which is quite some distance away from the hippocampus). This is consistent with other research showing that tau tangles spread from the initial injection site, using mice modeling Alzheimer's disease.

The study followed on from previous research showing that this form of tau protein increases after a traumatic brain injury and may contribute to development of chronic traumatic encephalopathy (a condition experienced by many professional athletes and military personnel).

The findings support the hypothesis that many of the symptoms of TBI may be down to an increase in these tau tangles, and that this may also be responsible for the increased risk for neurodegenerative disease. As an obvious corollary, it also suggests that the tau tangles are an important therapeutic target.

http://www.eurekalert.org/pub_releases/2016-01/uotm-tbi011216.php

Reference: 

tags problems: 

Topics: 

Reduced blood flow in brain after clinical recovery from concussion

  • Some athletes who experience sports-related concussions have reduced blood flow in parts of their brains even after clinical recovery.

Adding to evidence that the standard assessments are inadequate to determine whether concussed athletes are fit to return to action, an advanced MRI technique that detects blood flow in the brain shows that hat brain abnormalities persist beyond the point of clinical recovery after injury.

The study compared 18 concussed players and 19 non-concussed players. For the concussed players, MRI was taken within 24 hours of the injury and eight days afterward. Baselines were taken before the football season.

While clinical assessments showed that the concussed players were back to normal at the eight day mark, the MRI demonstrated a significant blood flow decrease at eight days compared to the first post-injury MRI.

While the significance of this is still not clear, it may be that the brain is more vulnerable to another injury.

The study was presented at the annual meeting of the Radiological Society of North America (RSNA).

http://www.eurekalert.org/pub_releases/2015-11/rson-rbf112315.php

Topics: 

tags problems: 

Brain connectivity changes with working memory after TBI

  • A brain imaging study reveals how working memory is impaired after traumatic brain injury.

Brain imaging while 11 individuals with traumatic brain injury and 15 healthy controls performed a working memory task has revealed that those with TBI showed greater connectivity between the hemispheres in the fronto-parietal regions (involved in working memory) and less organized flow of information from posterior to anterior parts.

The study used a new task, known as CapMan, which allows working memory capacity and the mental manipulation of information in working memory to be distinguished from each other.

The discovery may help in the development of more effective therapies.

http://www.eurekalert.org/pub_releases/2015-10/kf-njs102015.php

Reference: 

tags memworks: 

Topics: 

tags problems: 

Childhood concussions impair brain function two years later

  • A small study found children who had experienced a sports-related concussion two years earlier still showed cognitive impairments, with younger children showing greater deficits.

A study involving 30 children (aged 8-10), of whom 15 had experienced a sports-related concussion two years earlier, and all of whom were athletically active, found that those with a history of concussion performed worse on tests of working memory, attention and impulse control, compared to the controls. This impaired performance was also reflected in differences in brain activity. Additionally, those who were injured at a younger age had the largest cognitive deficits.

All of this points to a need for focused and perhaps prolonged interventions, especially for younger children.

http://www.eurekalert.org/pub_releases/2015-12/uoia-scc121815.php

Reference: 

tags development: 

Topics: 

tags problems: 

Concussion not well understood, but widely feared

  • A survey of US adults suggests worry about concussion goes hand in hand with a lack of understanding.

An online national survey of 2,012 adult Americans (of whom 948 were parents) has found that, while the vast majority (87%) don’t know the definition of a concussion and many don’t know the injury is treatable, there is a high level of concern and even fear across the country.

  • 89% believe concussions are a moderate to severe health concern
  • 32% of parents live in fear that their child will get a concussion
  • 25% of parents do not let their kids play some contact sports because of fear of concussion
  • while 57% have personal experience with concussions, 26% did not see a health care professional when someone in their family had one
  • 37% admit that they are confused about what a concussion truly is
  • headaches, and dizziness/motion sensitivity are recognized as symptoms by 58%, and cognitive difficulty by 55%
  • only 34% recognize fatigue as a symptom, and only 13% recognize changes in mood as a symptom
  • 79% incorrectly believe or are unsure that there is no real way to cure a concussion; the symptoms can only be lessened
  • 81% aren’t comfortable that they would know how to manage or treat a concussion if they sustained one
  • only 49% know that a person doesn't need to stay awake for 24 hours after sustaining a concussion
  • only 25% understand that safety equipment—such as helmets or mouth guards—cannot prevent the majority of all concussions

http://www.futurity.org/concussions-fear-survey-1018432-2/

The full report can be downloaded at http://rethinkconcussions.com/wp-content/uploads/2015/09/harris-poll-report.pdf

Topics: 

tags problems: 

Pages

Subscribe to RSS - Problems