Can Chemotherapy Make Dementia Worse

Can Chemo Cause Cognitive Decline In Older Patients

– November 28, 2018

Chemobrain the foggy feeling that clouds thinking for some cancer patients is real. A new study that included Moffitt breast cancer patients over age 60 shows it may be more of a risk for those who carry a gene associated with Alzheimers disease. But overall, the number of study participants who experienced cancer-related cognitive challenges was reassuringly small.

The research, published recently in the Journal of Clinical Oncology, is part of the Thinking and Living with Cancer Study, a multi-center prospective study to evaluate cognitive changes in older cancer patients. Normal aging increases risks for cognitive declines regardless of cancer status. While they are not at higher risk of Alzheimers or other forms of dementia than the general population, many cancer patients are concerned about the much more subtle cognitive impacts associated with chemobrain. Yet prior to the TLC Study, little research existed on how cancer treatment impacts those risks for older patients.

Researchers compared cognitive skills testing results of 603 individuals over the age of 60 for a two-year period. Roughly half had been diagnosed with non-metastatic breast cancer. Participating cancer patients were divided into two groups: those treated with chemotherapy with or without hormonal therapy, and those treated with hormonal therapy alone.

Relationship Between Chemotherapy And Alzheimers

Patients treated for cancer may develop cognitive issues, such as memory loss. They may also lack the ability to multitask. Symptoms typically fade several months after the patient completes treatment. Individuals with the APOE4 gene, however, may experience long-term cognitive issues. It has been established that the APOE4 gene increases the risk of developing Alzheimers. Individuals who receive chemotherapy and have this gene are more likely to face long-term issues. It isnt clear that this gene causes the symptoms these individuals have, but researchers have observed that individuals who have this gene are more likely to experience memory and multitasking issues after they have completed chemotherapy. Research is ongoing, and individuals who have this gene will want to consult with their physician about their specific risks and alternatives for treatment.

Ways To Cope With Attention Thinking And Memory Problems

Here are some ways to cope.

At home

• Keep a checklist of daily reminders. Put it where you can see it often. Keep a copy at work if you need to.

• Get ready for the next day by setting out the things you will need the night before.

• Color code or label certain cabinets or drawers where you store things at home.

• Put things, such as car keys, back in the same place every time. This helps you find them easily.

• Get rid of clutter, such as extra papers, books, and other items around your home.

• Store important phone numbers in your cell phone. Or put a list next to your home phone. You can carry an address book in case you forget to bring your cell phone when you go out.

At work

Talk with your employer if you are having problems at work. Discuss ways your employer could help, such as changing your workload or deadlines. Read more about going back to work after cancer.

At the doctor

Dont be afraid to ask your doctor questions, even if you feel like you are repeating yourself. Use a notebook, voice recorder, the Cancer.Net mobile app, or an ASCO Answers guide to record the answers. You may ask a friend or family member to go to the appointment with you. He or she can help take notes and review them later.

General tips

Do not be afraid to ask for help. Talk with your health care team about counseling and other resources and ask family and friends to help when you need it.

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Cognitive Problems In Patients With Noncns Cancer

The number of cancer survivors is growing due to ageing populations, earlier detection of cancer and advances in cancer treatments.21 This results in a large number of persons confronted with longterm side effects of cancer and cancer treatment, such as premature menopause, congestive heart failure and cognitive problems.

The prevalence of cognitive problems during and after cancer treatment ranges between 17% and 75%, with a subgroup of nonCNS cancer survivors having longterm cognitive problems lasting up to more than 20 years after cessation of treatment.22, 23 For many years, research was primarily directed to chemotherapy as the driving force behind disturbances in the normal functioning of the brain dubbed by some cancer survivors as chemobrain. Different mechanisms for chemotherapyinduced cognitive problems have been revealed and suggested, including toxicity to neural progenitor cells, DNA damage in postmitotic neurons and telomere shortening, deregulation of cytokines and hormonal changes.24 However, studies examining the consequences of chemotherapy on brain functioning often were crosssectional and therefore provided no information about the baseline cognitive function of cancer patients.25

Signs Of Attention Thinking And Memory Problems

Signs of attention, thinking, and memory problems can include the following.

• Trouble concentrating, focusing, or paying attention.

• Difficulty remembering things, such as names, dates, or phone numbers.

• Feeling disoriented, like you are in a “mental fog.” You might have difficulty finding your way around.

• Feeling very confused, taking longer to deal with new information, or having difficulty understanding things.

• Difficulty making decisions or thinking things through.

• Difficulty organizing your thoughts or doing mental tasks, such as finding the right word or balancing your checkbook.

• Problems doing more than one thing at a time.

You might also notice changes in your emotions and behavior. You may act in ways you never did before. You might have mood swings, get angry or cry at unusual times, or act differently in social situations.

How severe these problems are depends on many factors, including:

• Your age

• Your type of cancer, where it is, and your treatment

• If you had depression or anxiety in the past

• How much help you have access to for mental and emotional problems

Talk with your doctor if you or your loved one develop these symptoms. Managing symptoms is an important part of cancer care and treatment. It is called palliative care or supportive care. Attention, thinking, and memory problems are just as important as other symptoms during treatment.

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Could Medications Contribute To Dementia

• By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Alzheimers disease and other illnesses that cause dementia are devastating, not only for those affected but also for their friends and family. For most forms of dementia, there is no highly effective treatment. For example, available treatments for Alzheimers disease may slow the deterioration a bit, but they dont reverse the condition. In fact, for most people taking medications for dementia, it may be difficult to know if the treatment is working at all.

Experts predict that dementia will become much more common in the coming years. We badly need a better understanding of the cause of these conditions, as this could lead to better treatments and even preventive measures.

Strategies To Deal With Surveillance And Survival Bias

Few studies investigated the relation of cancer with other diseases including stroke, automobile injuries, osteoarthritis and macular degeneration, which were used as negative control diseases.7, 8, 9 In case of survival bias, cancer patients would also have a decreased risk of these diseases. The risk of stroke, osteoarthritis and macular degeneration after cancer was found to be increased, while there was no relation with automobile injuries. Interestingly, the risk of cancer following automobile injuries was decreased. For this reason, the authors suggested that the ascertainment of cancer after serious medical conditions is limited. However, it is questionable whether these diseases are suitable negative controls. Stroke and automobile injuries are characterised by acute symptoms, making the association with cancer less sensitive to surveillance bias. Moreover, there seems to be a biological mechanism underlying the frequently found positive relation between cancer and stroke.67, 68 Lastly, cancer shares risk factors with osteoarthritis and macular degeneration such as obesity and inflammation.69, 70 Therefore, the results of the association of cancer with these negative control diseases should be interpreted carefully.

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What Causes Chemo Brain

Chemo brain is most commonly connected with chemotherapy, but other treatments, such as hormone therapy, radiation, and surgery may be associated with it also. These treatments can cause short-term, long-term, or delayed mental changes or cognitive problems. Beyond the chemo brain symptoms that start during and just after treatment, there are some cases where chemo brain symptoms start and continue after treatment is over. Some people with cancer have very real brain problems even though they havent had chemo.

Certain things can increase the risk of developing chemo brain or worsening brain function problems. These include:

• The cancer itself, for example brain tumors
• Other drugs used as part of treatment, such as steroids, anti-nausea, or pain medicines
• Other conditions or illnesses, such as diabetes or high blood pressure
• Having other symptoms like tiredness, pain, or sleep problems
• Emotional distress such as depression or anxiety
• Older age
• Nutritional deficiencies
• Using alcohol or other substances that can change your mental state

Most of these cause short-term problems, and get better as the underlying problem is treated or goes away. Others can lead to long-lasting brain problems unless the cause is treated.

Questions To Ask About Chemo Brain

These are just some of the questions you may want to ask your doctor:

• Based on my treatment, am I at increased risk for brain changes?
• When might these changes happen and how long will they last?
• Are there other medical problems that could be causing my symptoms?
• Is there treatment for my symptoms?
• What can I do to manage chemo brain?
• Is there anything I can do to help prevent or decrease chemo brain symptoms?
• Should I see a specialist? Can you recommend one?

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Chemotherapy May Improve Survival For Older Colon Cancer Patients With Dementia

Cancer and dementia are both diseases associated with aging and as a result, it is not uncommon for elderly men and women to have both conditions. And because chemotherapy can be challenging for older cancer patients with dementia, some patients and families choose to forego treatment.

A study recently published in the American Association for Cancer Research journal Cancer Epidemiology, Biomarkers & Prevention showed that foregoing chemotherapy was linked to worse survival in older patients with colorectal cancer who also had dementia.

In general, dementia patients with advanced colon cancer are being undertreated. There are many good reasons why physicians, patients, and families may decide to forego chemotherapy, including toxicity, functional limitations of the patient, or if patients are diagnosed with colon cancer at later stages, said Yingjia Chen, PhD, a postdoctoral fellow in the Memory and Aging Center in the Department of Neurology at University of California, San Francisco.

However, our findings suggest that chemotherapy may increase survival and should be considered for advanced colon cancer patients with dementia in a similar fashion as for those without dementia, Chen added.

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When Do Cognitive Changes Occur

Cognitive changes can occur at any point during your experience with cancer. Sometimes they are the first sign of a brain tumor. These changes may also happen after completing cancer treatment or after taking certain medications.

• Chemo brain can occur during or after chemotherapy treatment.
• Delirium may occur suddenly during treatment. Delirium usually happens after an identified cause, such as chemotherapy, and it is often reversible.
• Dementia due to cancer treatment comes on gradually over time and usually after treatment is completed. It may be harder to identify than delirium, and it may not have one identifiable cause. Dementia can develop as early as three months after radiotherapy to the brain. It can also occur 48 months or longer after completion of radiation therapy.
• Symptoms of dementia can also occur after surgery to remove a brain tumor.

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About Symptoms And Side Effects

A person with cancer and dementia may have symptoms or side effects caused by cancer or cancer treatment. These can usually be prevented or well-controlled.

Symptoms or side effects will depend on the type of cancer or treatment. We have more information about the most common side effects.

The person you care for may not be able to tell you if they have symptoms or side effects. You may have to ask them regularly. If they have problems communicating, it can help to look for signs in their body language or facial expressions.

Some symptoms or side effects of cancer may be like the ones caused by dementia. If the person you care for has symptoms you are worried about, talk to the doctor or nurse.

How Long Does It Last

Often, the fogginess will fade when your chemo ends. But for some people, the fuzzy feelings will linger for several months or sometimes a year or more.

For those with lasting symptoms, researchers are looking at medicines for diseases like depression, ADHD, Alzheimerâs, and other types of dementia. But more testing needs to be done.

If you have chemo brain that persists and youâve tried all the self-help tips, talk with a neuropsychologist. This is a doctor who specializes in the brain and can help with attention span and memory. They will find areas where you need help and tell you if other treatable problems like depression, anxiety, and fatigue are to blame.

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Tell Others What Is Happening

Another thing you can do to better manage chemo brain is tell family, friends, and your cancer care team about it. Finding and getting support is important. Let them know what youre going through. You may feel relieved once you tell people about the problems you sometimes have with your memory or thinking.

Chemo brain is a side effect you can learn to manage. Even though this might be a change thats not easy to see, like other changes such as hair loss or skin changes, your family and friends might have noticed some things and may even have some helpful suggestions. For instance, your partner might notice that when youre rushed, you have more trouble finding things.

Tell your friends and family members what they can do to help. Their support and understanding can help you relax and make it easier for you to focus and process information.

Dementia Patients: Increased Mortality Los Less Likely To Discharge Home

A total of 164,551 patients with dementia and 2,320,668 patients without underwent surgery at 804 different hospitals. Dementia patients, compared to those without, tended to be older and were more likely to be women or African American or have undergone an emergent operation . A similar rate of patients with versus without dementia underwent surgery at teaching hospitals and urban hospitals . Overall, 6.4% of surgical procedures were performed in dementia patients. In the dementia group, the most common surgical procedure was hip or femur repair among patients without, it was knee arthroplasty .

In adjusted analyses, dementia patients, compared to those without undergoing the same procedure, had a higher in-hospital mortality rate , lower home discharge rate , and longer LOS . When looking at specific procedures, for dementia patients being treated for fracture or dislocation of the hip and femur, compared to patients without dementia, the OR for in-hospital mortality was 1.16 and for home discharge was 0.66 the mean difference in hospital LOS was 0.24 days . For total or partial hip replacement, the ORs for in-hospital mortality and home discharge for dementia patients versus those without dementia were 1.41 and 0.19 , respectively the mean difference in LOS was 1.21 days .

The study was published in JAMA Network Open.

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Exploring The Concept Of A Positive Association Between Cancer And Dementia

The association between cancer and dementia remains complicated, since a substantial amount of bias may influence the direction of the association. Based on the high prevalence of cognitive problems among cancer patients, shared genetic traits and the increased risk of cancer in persons with MCI, the existence of a true inverse link between cancer and dementia can be questioned in fact, it is reasonable to explore the existence of a positive association which may be more plausible from a mechanistic point of view.

DNA damage caused by oxidative stress and deficient DNA repair mechanisms are also important in the pathogenesis of cancer and dementia. Genetic polymorphisms associated with a decreased capacity to repair damaged DNA can be related to an increased risk of cancer and cognitive impairment. Furthermore, syndromes such as xeroderma pigmentosum and ataxia telangiectasia are caused by genetic defects in DNA damage repair mechanisms and are characterised by an increased risk of cancer and cognitive problems, indicating a shared pathology.24

Chemotherapy’s Damage To The Brain Detailed

Date:

University of Rochester Medical Center

Summary:

A commonly used chemotherapy drug causes healthy brain cells to die off long after treatment has ended and may be one of the underlying biological causes of the cognitive side effects — or “chemo brain” — that many cancer patients experience.

A commonly used chemotherapy drug causes healthy brain cells to die off long after treatment has ended and may be one of the underlying biological causes of the cognitive side effects — or “chemo brain” — that many cancer patients experience. That is the conclusion of a study published recently in the Journal of Biology.

A team of researchers at the University of Rochester Medical Center and Harvard Medical School have linked the widely used chemotherapy drug 5-fluorouracil to a progressing collapse of populations of stem cells and their progeny in the central nervous system.

“This study is the first model of a delayed degeneration syndrome that involves a global disruption of the myelin-forming cells that are essential for normal neuronal function,” said Mark Noble, Ph.D., director of the University of Rochester Stem Cell and Regenerative Medicine Institute and senior author of the study. “Because of our growing knowledge of stem cells and their biology, we can now begin to understand and define the molecular mechanisms behind the cognitive difficulties that linger and worsen in a significant number of cancer patients.”

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