| I. Abstract | | | | Broca's area and their corresponding contralateral |
| Chemo brain is a form of cognitive impairment that is | | | | areas in the brain. Interestingly, these areas are |
| found in 25-80% of patients who have received | | | | responsible for memory and concentration. When |
| chemotherapy. Studies show that the syndrome is | | | | patients were given simple memory tests to perform, |
| related to an increase in inflammatory cytokines and | | | | abnormalities in these areas were again demonstrated |
| the problem can last for 10 years or more. No | | | | whereas there were no abnormalities found in people |
| traditional therapies are identified to treat chemo brain. | | | | without cancer. |
| Natural approaches, which are often ignored by | | | | The cause of the metabolic abnormalities in the brain |
| medical experts, have known effects in the prevention | | | | may very well be the same problem that has been |
| and treatment of dementia. These include gingko biloba | | | | implicated in Alzheimer's Dementia, namely |
| which improves circulation and early dementia by | | | | inflammatory cytokines (IC's). Inflammatory cytokines |
| producing anti-inflammatory cytokines and dietary | | | | are substances secreted by the immune system to |
| changes. Diets high in fruits and vegetables are known | | | | help fight infections. When IC's are chronically elevated |
| to decrease the risk of dementia while omega-3 fatty | | | | they lead to a variety of chronic diseases such as |
| acids are known to be anti-inflammatory. These are | | | | heart disease, cancer, strokes, chronic fatigue, |
| the keys to prevention and treatment of chemo brain. | | | | rheumatoid arthritis and dementia. Multiple studies in |
| | | | both animal and human models have demonstrated |
| Loss of memory or dementia is one of the greatest | | | | the correlation of chemo brain with inflammatory |
| fears of aging people. This affliction is by no means | | | | cytokines. Although inflammatory cytokines do not |
| limited to the elderly. Cancer survivors can also | | | | consistently increase with the administration of |
| develop loss of memory. Loss of memory in cancer | | | | chemotherapy, the presence is chemo brain is found |
| patients has different names; dementia, cognitive | | | | when the inflammatory cytokines are elevated. |
| dysfunction, but the most recently coined terms chemo | | | | Curiously, fatigue is also a common chronic complaint in |
| brain and chemo fog suggest chemotherapy may play | | | | cancer patients and inflammatory cytokines are also |
| a major role in its cause. What is chemo brain and | | | | elevated in these patients. |
| how can it be treated? The problem has been | | | | VI. Therapy |
| recognized for a decade but these important | | | | The treatment of chemo brain should target the root |
| questions have only recently been the focus of | | | | causes. Of course, problems such as anemia, |
| experts in the field. Although research into this condition | | | | depression, infection, anxiety must all be addressed |
| is ongoing and unfortunately many questions remain | | | | and treated. Methylphenidate or Ritalin has been |
| unanswered and we will discuss that it is not only | | | | recommended by some experts but it only treats the |
| found in patients who have received chemotherapy. | | | | symptoms of the disease. |
| III. Definition | | | | Since inflammatory cytokines seem to be a major |
| Chemotherapy causes many acute symptoms such | | | | contributing factor to the etiology of the disease, |
| as low blood counts, nausea, hair loss or diarrhea. | | | | therapies aimed at decreasing these should be |
| These often resolve soon after the chemotherapy is | | | | offered. Steroids such as prednisone or |
| stopped. There are however other symptoms that are | | | | dexamethasone are commonly used to treat |
| more chronic. These include fatigue and loss of | | | | inflammatory diseases such as rheumatoid arthritis. |
| memory or chemo brain. Common complaints | | | | There is no proof they are useful in chemo brain and |
| described in studies include not only poor memory but | | | | some researchers have suggested they might cause |
| an inability to concentrate at work or juggle multiple | | | | chemo brain. Additionally, they have too many side |
| tasks. This is very distressing to a patient who has | | | | effects to be useful for long term use. Non-steroidal |
| already had to endure a diagnosis of cancer and the | | | | anti-inflammatory drugs (NSAIDS) such as ibuprofen |
| physical effects of surgery, chemotherapy or radiation | | | | have been found to be helpful in delaying the onset of |
| therapy. Although depression, anxiety, and anemia can | | | | dementia in patients with Parkinson's disease and |
| contribute to these problems, the symptoms of chemo | | | | Alzheimer's disease. This may be a possible therapy |
| brain remain after these other problems have been | | | | for chemo brain but is not likely to be a curative |
| corrected. | | | | modality. |
| Chemo brain is more than a subjective complaint. | | | | There are two therapies that are overlooked by |
| Measurable abnormalities can be found on formal | | | | modern medicine that can effectively treat dementia |
| neuropsychological tests and measures. These tests | | | | and chronic inflammatory cytokines these are gingko |
| can evaluate a variety of parameters including | | | | biloba and diet. |
| attention and concentration, verbal memory, visual | | | | Gingko biloba has been used in traditional Chinese |
| memory, visual-spatial and speed of information | | | | medicine for thousands of years. It has many beneficial |
| processing. Published studies have demonstrated a | | | | effects including improving blood circulation which is |
| broad range of cognitive deficits thus identifying this as | | | | helpful in patients with claudication. It has also been |
| an authentic medical problem. | | | | found to improve function in early dementia due to |
| IV. Incidence | | | | either vascular disease or Alzheimer's disease. Gingko |
| Review articles on chemo brain have demonstrated | | | | improves circulation by increasing anti-inflammatory |
| that this is a common problem. There have been | | | | cytokines. Therefore it seems reasonable to suppose |
| approximately eleven groups that have published | | | | that gingko would be beneficial to patients with chemo |
| reviews on this subject mostly in patients with breast | | | | brain since their form of dementia is caused by |
| cancer but others are also included. Symptoms of | | | | inflammatory cytokines. |
| chemo brain can be found in 25% to 80% after their | | | | Perhaps the most forgotten therapy to prevent and |
| therapy. Interestingly, chemo brain has been found in | | | | treat diseases is diet. Too often patients look for a pill |
| 35% of patients before chemotherapy is ever given | | | | to treat their illness when a change in diet can be very |
| suggesting that there may be a predisposition to the | | | | beneficial. The typical American diet is high in animal |
| illness in addition to effects produced from the cancer | | | | fats, trans-fats, corn oil, refined sugars, and |
| itself and possibly surgery. This appears to be a | | | | carbohydrates and it lacks fruits and vegetables. This |
| problem that is more complex but far reaching. Many | | | | type of diet leads to an increased risk of heart |
| of the 10 million cancer survivors have received | | | | disease, stroke, and cancer. We know that |
| surgery, radiation and chemotherapy and 35% to 80% | | | | inflammatory cytokines play a major role in the etiology |
| may exhibit some cognitive dysfunction. | | | | of these diseases. Multiple studies have shown that a |
| V. Etiology | | | | diet rich in fruits, vegetables, and omega-3 fatty acids |
| The cause of chemo brain is thought to be the result | | | | can prevent theses diseases by their anti-inflammatory |
| of vascular, metabolic, or inflammatory changes in the | | | | and anti-oxidant actions. In many ways, we are |
| brain. Sophisticated radiology scans have found | | | | causing the very chronic diseases that plague us. |
| interesting and provocative changes in the brain. | | | | The treatment or prevention of chemo brain is a |
| Magnetic resonance imaging (MRI) has demonstrated | | | | simple process that focuses on the root cause of the |
| widespread decrease in gray matter of the brain | | | | dementia namely inflammation. We already know that |
| suggesting atrophy of the brain related to a toxic | | | | certain diets and gingko can treat and prevent certain |
| effect of chemotherapy. More recently, researchers | | | | diseases caused by inflammatory cytokines. The most |
| have measured metabolic activity in the brain with | | | | prudent approach to treating or preventing chemo |
| positron emission topography (PET) scanning. Studies | | | | brain is a diet rich in omega-3 fatty acids, fruits, |
| utilizing PET scans have demonstrated decreased | | | | vegetables, and gingko biloba. |
| metabolism in the frontal cortex, prefrontal gyrus, | | | | |