Chemotherapy linked to memory loss

When Dessolena Bottiglieri, a 41-year-old artist in New York, was on chemotherapy, the train route she’d taken for years no longer looked familiar. Her once-sharp memory skills had faded, and she spent a lot of time looking: for her keys, her drawing pens, “things I always had a place for.”

She and other former cancer patients say they went into chemotherapy unaware that they could wind up enveloped by a mental fog.

Similarly, heart bypass patients are at greater risk for memory loss and other cognitive problems as well as depression. And people with diabetes are realizing that they are prone to memory and attention problems beyond the normal wear and tear of a hectic life.

Scientists have begun to try to decipher why such mental problems are arising, which ones are due to diseases, and which are byproducts of medications or procedures, and to determine what, if anything, can prevent them.

In diabetes, for instance, researchers reported recently that maintaining normal blood sugar levels in adults with type 2 diabetes can improve memory and attention problems. They said people with this common form of diabetes can experience severe problems with working memory, the ability to keep a lot of information on line and be able to organize it. Problems in working memory make it hard to complete everyday tasks.

“When most people think about the complications of diabetes, they tend to think about the development of blindness or painful neuropathies or cardiovascular problems,” said the study’s co-author, Christopher Ryan, a professor of psychiatry at the University of Pittsburgh School of Medicine. “Few health professionals are even aware of the cognitive complications of diabetes.”

The findings were reported at the American Diabetes Association meeting last month.

Cancer doctors have long acknowledged “chemo” brain but believed it was a result of unshakable fatigue.

“We are still very early in the research on chemotherapy and its effects on the brain,” said Dr. Joyce O’Shaughnessy of Baylor Cancer Center in Dallas, during a conference sponsored by the organization Living Beyond Breast Cancer. “We know it’s real, but we are still trying to figure out how common it is.”

A few years ago, researchers at the Netherlands Cancer Institute in Amsterdam began asking cancer patients about problems remembering, thinking and organizing. They compared the answers from women on high-dose chemotherapy, standard-dose chemotherapy and those in early stages who did not receive any medicines.

There were sharp differences: 32 percent of those in the high-chemotherapy group had cognitive complaints compared with 16 percent of the standard-dose patients. Among those not on medicines, 9 percent complained of such mental changes.

Two years after treatment ended, the problems were still present. After a second two-year interval, scientists noted improvements in half of the women.

O’Shaughnessy recently tested whether erythropoietin, a substance that occurs naturally in the body to increase red blood cell production, would help organize the brain’s section known as executive secretary — the frontal cortex. The number of EPO receptors on brain cells are known to increase on the heels of brain trauma, suggesting that the substance may be attempting to protect the brain. In the study, half the women received weekly injections of Procrit, a medication form of EPO, and all participants were given cognitive tests before the study and six months later.

O’Shaughnessy said there was “a hint that these women (taking Procrit) didn’t have as many cognitive complaints.” A second, larger study has been launched.

Researchers at the University of Texas M.D. Anderson Cancer Center also have found evidence of cognitive decline in women with nonmetastatic breast cancer before chemotherapy, something they say probably stems from the disease process itself. The study was published in the latest issue of Cancer.

O’Shaughnessy recommends that patients on chemotherapy medicines stay as active as possible with walking, aerobics, swimming or cycling three times a week for at least 20 minutes. She also is looking at the benefit of mental exercises, which are now used in physical therapy for stroke patients.

“The brain is a muscle,” she said. “There may be ways to retrain the brain.”