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Side Effects"Chemo brain"

Cancer- or cancer-therapy-associated cognitive change."

Last update: 05/05/2016


Intro | Resources | Related Articles 

TOPIC SEARCH: SearchMedica

In the News:

Medscape: Neurofeedback Improves 'Chemo Brain' in Cancer Patients
Fog May Be From Cancer, Not the Chemo http://nyti.ms/9vrOJh

Memory loss, attention deficits, difficulty learning, and mood changes are commonly reported side effects of chemotherapy.

Direct neuro-toxic effects of chemo agents (or the by-products), and hormonal changes induced by the treatment may all play a role. 

The dose, the duration of therapy, genetic factors, and the specific chemo agents may also influence the extent, duration,  and the type of side effects each person will experience.    The experience of cognitive problems can also be influenced or caused by:

bullet The cancer
bullet Other drugs
bullet Cancer or drug-related fatigue, such as low blood counts
bullet Sleep deprivation
bullet Infection
bullet Hormone changes
bullet Other illnesses, such as diabetes or high blood pressure
bullet Nutritional deficiencies
bullet Advancing age
bullet Depression - stress, anxiety, or other emotional pressure

All of these (and the lack of baseline testing) make it challenging to measure the drug-related causes of chemo-brain.

Caregiver comment:  I can see where "chemo brain" could be a very discouraging side effect. I don't think it affects everyone, though, and I only mention this so people contemplating chemo won't become overwhelmed at the thought. One of my sons had Hodgkins lymphoma, chemotherapy and radiation his senior year of college in engineering. It was his best academic year ever, with a grade point average of 3.9. He was accepted to graduate school and is working on his PhD. I attributed part of the increase in grade point average to the decrease in alcohol intake because of the chemo but he disagrees : )  ~ L

"Within one year of treatment, many people find these difficulties greatly improve or no longer exist. However, for some people, "chemo brain" can continue for years following completion of treatment."  cancercare.org pdf

Here we provide resources and links to articles on "chemo brain" - a reported side effect of chemotherapy.  It appears that additional studies will be needed to better measure and understand chemo-induced damage to cognitive and psychological brain function.  

Are there tests to measure damage to the brain from chemo?  

We anticipate that baseline tests (cognitive and imaging) prior to treatment would be required in order to objectively measure injury, and that tests to definitively measure chemotherapy-induced damage do not exist at this time. 

It is also possible that stress, anxiety, and depression - often associated with the diagnosis of a cancer and treatments - plays a role in these effects. 

News Items:

May 2016: 
Study Finds No Association Between Anthracycline-Based Chemo and Cognitive Decline in Women With Breast Cancer - http://bit.ly/1rOU1Rk 
The Fog That [can] Follow [some types of] Chemotherapy nytimes.com


Chemotherapy and Cognitive Function: Maybe It Is All in Their Heads?  Medscape (free login)
Memory Problems Following Chemotherapy  WebMD
Prednisone  PAL
Chemobrain,  ACS Cancer.org
"Chemobrain" fact sheet  cancercare.org PDF 
Doctor, Can We Talk About Chemobrain? Cancercare.org PDF
Depression self-assessment test mayoclinic.com 

Related Articles

Review: Renaming "chemo brain". Cancer Invest. 2007 Sep;25(6):373-7. Review. PMID: 17882646

For some, a fear of this side effect enters into their decision regarding therapy. Our review of the literature reveals that so-called "chemobrain" is complex and that factors other than chemotherapy may affect cognitive function, including the impact of surgery and anesthesia, hormonal therapy, menopause, anxiety, depression, fatigue, supportive care medications, genetic predisposition, comorbid medical conditions, or possibly paraneoplastic phenomenon. Studies to date have differed in their assessment and definition of cognitive impairment, thus, making comparisons between studies difficult.

We propose that the phenomenon commonly referred to as "chemobrain" would be more accurately labeled "cancer- or cancer-therapy-associated cognitive change."
Cognitive function recovers after stem cell transplant  oncolink.org 

To investigate, the researchers initially studied 286 patients who were randomized to be tested pre-transplant and 6 and 12 months, and another 124 were tested at 6 and 12 months. Eighty-three patients who were tested at 12 months only were not included in the analysis.
Neuropsychological changes from pretransplant to one year in patients receiving 
myeloablative allogeneic hematopoietic cell transplant  bloodjournal.org (2006)
ADD Drug Shows Effectiveness Against "Chemobrain"   nci.nih.gov 
Also see Focalin, a refined formulation of Ritalin (d,l-methylphenidate HCl)  centerwatch.com 

TOPIC SEARCH: ClinicalTrials.gov | Outcomes: Web
Mechanisms of chemotherapy-induced cognitive disorders: neuropsychological, pathophysiological, and neuroimaging perspectives. Semin Clin Neuropsychiatry. 2003 Oct;8(4):201-16. PMID: 14613048 or Readable version | Related articles 
Cognitive performance and magnetic resonance imaging findings after high-dose systemic and 
intraventricular chemotherapy for primary central nervous system lymphoma. 
Arch Neurol. 2003 Apr;60(4):563-8. PMID: 12707070 | Related articles

Readable Abstract

Semin Clin Neuropsychiatry. 2003 Oct;8(4):201-16. 

Mechanisms of chemotherapy-induced cognitive disorders: neuropsychological, pathophysiological, and neuroimaging perspectives.

Saykin AJ, Ahles TA, McDonald BC.

Brain Imaging Laboratory, Dartmouth Medical School, Lebanon, NH 03756, USA. [email protected]

Recent studies have indicated the frequent occurrence of neuropsychologic (psychological) deficits and cognitive (thinking) complaints after systemic (not local) cancer chemotherapy. Most early reports were retrospective, but prospective longitudinal studies are underway. 

Although the available evidence suggests a fairly diffuse pattern of changes, memory and executive functions could be preferentially affected. Preliminary data also suggest that some individuals might be more vulnerable than others, leading to investigation of genetic and other risk factors. 

The greatest gap in our knowledge regarding chemotherapy-related cognitive changes is a lack of understanding of the mechanism or mechanisms that account for the observed changes. 

Several pathophysiological candidates include direct neurotoxic effects leading to atrophy (death) of cerebral gray matter (GM) and/or demyelination (Progressive destruction of the myelin sheath that protects the nerves and allows for uninterrupted transmission of nerve impulses) of white matter (WM) fibers, secondary immunologic responses causing inflammatory reactions, and microvascular small blood vessel) injury. Altered neurotransmitter levels and metabolites (compounds produced by the chemotherapy) could constitute an additional mechanism related to neurotoxic (toxic to brain) effects. 

Advanced brain imaging techniques can directly or indirectly assess many of these mechanisms, but to date there has been very limited application of these tools. 

Morphometric magnetic resonance imaging (MRI), functional MRI (fMRI), diffusion tensor imaging (DTI), and MR spectroscopy (MRS) are noninvasive techniques that could yield important complementary data regarding the nature of neural changes after chemotherapy. 

Electrophysiological studies and targeted molecular imaging with positron emission tomography (PET) could also provide unique information. 

We review the minimal imaging data available at present and also note studies of other brain disorders or treatment effects that might serve as a model for imaging chemotherapy-induced changes. 

Large-scale prospective studies are needed to help isolate the pathophysiological mechanisms underlying the cognitive deficits associated with chemotherapy.

PMID: 12707070

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