What is post cancer cognitive deterioration or chemobrain?
It is a condition of deterioration in cognitive functioning that may be found during and after the tumor treatments.
It is not limited to those who have received chemotherapy, but it is more frequent in those who did it. Despite the difficulties and variability in the results of research, in literature there is a general consensus on the fact that at least half of the people who cross cancer and necessary treatments can experience some form of deterioration in memory and attention.
What are the symptoms?
- Difficulty concentration and attention, distractability
- Difficulty following what people are saying
- Slowness in processing information
- Difficulty learning and retention of new information
- Difficulty in recalling words
- Difficulty in recalling names and faces of people recently encountered
- Memory difficulties and in remembering appointments
- Decrease in mental flexibility
- Feeling of mental fatigue and clowning (chemofog)
Patients report a difficult experience of not recognize themselves more than they were used to workingespecially in that “multitasking” mode that often characterizes our frenetic days.
What more frequently patients complain are problems with “short -term” memory and with working memory. For example, they describe difficulties in studying, reading a book or in remembering what they were looking for in a room.
Often they complain of forgetting events taken or even checking the agenda (Kaelin cm, 2005).
When are the symptoms appear?
For some patients the symptoms they appear during the period of treatments doctors. For many others they present themselves e increase between 9 and 12 months after the end of the therapies. For 10-20% of patients, long-term effects may remain.
For the minority of people who show long -term effectsthese effects can also be found after ten years, but remained stablely, without worsening.
Post cancer cognitive deterioration differs from Alzheimer’s and other types of mental disorders
Often patients frighten themselves, believing they are developing mental problems such as Alzheimer’s or other types of dementia.
In reality they are different conditions and that are not related.
Patients with Chemobrain describe in the self -report tests sometimes an important deterioration in their functionality and quality of life. However, they usually do not have objective feedback on neuropsychological tests and instead tend to correlate in a stronger way with the measures of emotional distress (anxiety and depression).
What are the causes?
Which type of cancer or which type of treatment leads to this condition is still important subject to study. As early as 2007, factors that were then supported by subsequent research were highlighted, first of all chemotherapy but not only.
Other factors such as the functioning of the immune system, the inflammatory response of the body to cancer itself, damage to the cerebral microvascular system, the effects of radiotherapy, hormonal changes, stem cell transplantation and new immunotherapies can affect cognitive functioning.
To complicate everything, today we also know that genetic vulnerability can modulate the measure in which chemotherapy can cross the brain barrier and thus impact on cognitive functions.
The term “Chemobrain” (“chemotherapy brain”) or chemofog (“clowning from chemo”) have therefore been used to describe the patient cognitive deterioration of the patients, even if today we know that chemotherapy is not the only culprit.
What can be done to reduce symptoms?
At the moment there are no effective prevention methods or pharmacological therapies that can treat this form of cognitive deterioration.
Studies have been made on some drugs but without evidence of efficacy and many patients prefer a non -pharmacological approach precisely because they are already subjected to important pharmacological therapies often with important side effects.
For this reason, it seems fundamental to approach the problem with a treatment that is short, well usable and non -pharmacological that goes to work on the specific aspects of this problem.
The Memory and Attention Adaptation Training – Maat
The Memory and attention Adaptation Training uses cognitive – behavioral therapy methods Taken from research on stress, anxiety, symptoms management in behavioral medicine and various treatment approaches in cognitive rehabilitation (Ferguson and Gillock, 2021).
The Maat is designed to help people use intact skills to develop new compensatory ways to deal with all those tasks that require the use of attention and memory every day.
A complex system
Attention and memory are influenced by multiple and interactive neurocognitive systems. Affective states, physiological activation, sensory acuteness and environment affect orientation, on the speed of processing of information, on recognition, coding and recovery of information from memory.
In routine conditions, a low “request” condition, these interacting cognitive systems work well easily. When the conditions are more complex and therefore more requesting for systems, cognitive failures become more frequent and produce negative consequences.
It is here that patients perceive a disparity between what is asked of them (who becomes a sort of “threat”) and the resources they feel they actually have available to respond to these requests. This leads to an increase in physiological activation and distress and a further decrease in cognitive performance.
The main purpose of the memory and attention adaptation training
The Maat aims to help patients, through cognitive-behavioral strategies, exercise and make a strong and efficient use of the cognitive skills present.
This in order to learn to apply new skills in order to feel more effective and capable of control compared to daily requests.
By reducing the disparity between the perception of their resources and the requests is reduced by distress.
Your performances are thus attributed to more controllable factors and the motivation to continue the re -adaptation path is strengthened.
The 4 members of the Maat
- Education and re -ractum: it is underlined what is known and what is not compared to cognitive deterioration in oncological patients; The foundations of the function of memory and attention and those who are the “normal” cognitive failures that all people are experienced are explained.
- Self -awareness training: works on the awareness of the numerous factors that affect memory and attention, such as expectations compared to symptoms, environmental requests, stress, chemo therapy, etc.
- Self -regulation: works on emotional regulation and the stress frontal capacity
- Compensatory strategies: training of internal and external skills to the person to facilitate optimal functioning despite cognitive dysfunctions.
Cerebral stimulation strategies: neurofeedback
There are some studies that suggest that the systems of neurofeedback They can be useful, but this area also needs research.
In particular Alvarez and Al. (2013) have published an important study on supplementary Cancer Therapies on the use of Non-linear dynamic neurofeedback (neuropthimal).
Cognitive deterioration, fatigue, sleep and emotional discomfort (in particular anxiety and depression) in women who had had a diagnosis of breast cancer with symptoms of cognitive cognitive deterioration has been measured.
In Baseline measurements, the participants showed serious dysfunctions on all measures compared to the normal population.
After 20 brain training sessions, the measurements of the patients had returned to the norm on the stairs of sleep, fatigue, emotions and on most of the cognitive evaluation stairs.
Bibliography
- Alvarez et al. (2013). The effect of Eeg Biofeedback on Reducing Post Cancer Cognitive Impairement. Integrative Cancer Therapies 12 (6) 475-487.
- Ferguson R. & Karen Lee Gillock. 2021 Memory and Attention Adaptation Training. A BIRF Cognitive Behavoral Therapy for Cancer Survivors. Oxford University Press
- Kaelin cm Living Through Breast Cancer. MC GRW HILL
