Because my husband was not female undergoing breast cancer treatment,
the DRs in Germany pooh-pooh'd the idea that he had ChemoBrain.  He
was referred to some sort of Psychologist who took one look at his
gray hair and lined face and said Aricept.  Later when this pushy
American refused to consider this, it was finally acknowledge that it
was not Alzheimer's pr Dementia.  Far as we got, as we returned to the
US.  When I told his Oncologist here, he said No way does this man
have Alzheimers.

This today in e-mail from MD Anderson:

Chemobrain Challenges Patient

Many cancer patients treated with chemotherapy experience
forgetfulness, decreased mental stamina and general foggy-headedness
known as "chemobrain." Although the causes of the phenomenon are still
being pinpointed, doctors increasingly have answers to the question,
"What can be done?"

The effects of chemobrain will vary depending on the individual and
the kind of chemotherapy being taken, says Dr. Christina Meyers,
professor of neuropsychology in the M. D. Anderson Department of Neuro-
oncology. Her team uses imaging technology and traditional cognitive
tests to track the mental functioning of hundreds of cancer patients
each year.

Symptoms of chemobrain include:

   * Becoming easily overwhelmed
   * Having trouble multitasking
   * Feeling more forgetful

In dealing with these symptoms, it's helpful to know that the apparent
memory problems actually result from a reduced capacity to process
information, Dr. Meyers says. She knows this because she tests memory
function in patients by asking them to memorize lists of words and
repeat them later. The brain areas responsible for information
retrieval are usually fine. "It's not that you can't remember. You
just didn't process it to begin with," she says.

Dr. Christina MeyersDr. Meyers' patients include people participating
in clinical trials of new drugs used to alleviate chemobrain symptoms.
She also treats cancer patients who are referred to her by other
doctors at M. D. Anderson.

Not all cancer patients undergoing chemotherapy need to seek treatment
for chemobrain; only those experiencing problems. If symptoms exist,
it is important to ask for help as soon as symptoms begin. Cancer
patients not being treated through a cancer center can talk to their
doctor for a referral to a specialist who deals with the effects of
chemotherapy.

What are the Causes?
"Just about every single [chemotherapy] treatment can cause
chemobrain," Dr. Meyers says, including hormonal therapies such as
tamoxifen. Biological therapies such as interferon seem to be the most
severe, with about 50% of those patients experiencing cognitive
problems.

Cancer cells themselves also can contribute to chemobrain. They may
release substances such as cytokines that fight infection but also
cause the brain to slow down. A major result is something Dr. Meyers
calls "brain-mediated" fatigue - a flu-like state characterized by
general malaise and listlessness. Many chemotherapies, in addition to
being toxic to nerve cells, also stimulate production of these same
cytokines. Unlike exertion-related fatigue, brain-mediated fatigue is
not relieved by rest.

Because other medical problems also can influence mental function and
fatigue, Dr. Meyers advises that patients take steps to rule out or
treat problems such as anemia (a side effect of many chemotherapies
and a symptom of some cancers) and thyroid imbalance. Depression,
which can result from a cancer diagnosis, also should be addressed.

How Long do Symptoms Last?
Between one-fourth and one-third of patients have disabling problems
with chemobrain - depending upon the level of activity in their life,
Dr. Meyers says. The effects on a mom with kids and a person with a
demanding job would be greater, for instance, than on a person with
less to do each day.

The good news is most symptoms gradually fade after treatment is
complete. Dr. Meyers cautions that recovery often takes longer than
people expect. Some people take a year before feeling like their old
selves. Others never quite get back to 100%. "It's rare, but it does
happen," Dr. Meyers says. "We're working to figure out why."

Reports from other studies have suggested that chemobrain lasts as
long as 10 years after treatment. Dr. Meyers says these studies are
flawed because they do not compare each patient's abilities before and
after treatment. M. D. Anderson researchers have completed studies
such comparative studies and are finding that a number of patients
experience symptoms before chemotherapy because of the cancer itself.
"Patients with certain cancers such as lung cancer and acute leukemias
have significant problems before treatment," Dr. Meyers says.

What Steps Can Patients Take?
Researchers are continuing their quest for answers to the problem.
Meanwhile, Dr. Meyers suggests several ways to combat chemobrain:

   Stimulant therapy: Drugs such as Ritalin(R), a popular antidote for
attention deficit and hyperactivity disorder, also improves mental
focus, concentration and stamina in cancer patients. Dr. Meyers
suggests discussing this treatment with the patient's physician. Some
patients find it also helps elevate their mood.

   Exercise: Even mild to moderate activity may improve mental
function. Just five minutes on a bicycle can make a difference. Cancer
patients should be careful not to overdo it, though, because they can
fatigue easily. A physical therapist can tailor an exercise program to
support individual levels of strength and stamina.

   Workplace intervention: Employers are required to make reasonable
accommodations for health-related impairments. Cancer patients may
find it helpful to ask for a more soundproof environment, like an
office or a cubicle in a different location, to decrease distractions.
Flexible deadlines can take the pressure off, helping patients feel
less overwhelmed.

   Compensation strategies: Patients can carry a notebook with them
to write things down as they come to mind. They can consider modifying
their current day planners or buy one that better fits their new
needs. Taking a tape recorder to lectures and meetings and taking a
friend or loved one to important personal appointments are also good
ideas. A friend's moral support will help ease a patient's mind, too.

   Recognizing limits: No one wins if someone takes on more than they
can handle. It is important to not be afraid to ask for help.
Delegating tasks or projects can help, and so can giving them up
altogether. In the grand scheme of things, maybe it doesn't matter if
that lawn grows a little wild for a while.

   Keeping up the fun: "People forget that having fun is probably as
therapeutic as anything," Dr. Meyers says. If intense mental
activities gave a person pleasure before, he or she may need to adjust
expectations or think creatively about alternatives. Doing an easier
crossword puzzle could be a compromise. Reading for shorter periods is
a small adjustment. Choosing simple activities like watching a sunset
is also a good idea. "Something like that doesn't take a lot of
effort, but it really fills your heart," Dr. Meyers says.

Meyers' best piece of advice is for patients to be their own
advocates. "If you feel you have this condition, pipe up," she says.
Your doctor or nurse are there to help.
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