Dr. Ney is a neuro-oncologist who specializes in the treatment of patients with primary and metastatic brain tumors as well as neurologic complications of cancer. In this interview we discuss the effects of cancer treatment on cognitive ability as well as how patients can cope with them.
Q: What types of cancer treatments cause issues and why?
Ney: The two major types of treatment for cancer include radiation and chemotherapy. When given to the brain, radiation can cause cognitive dysfunction, typically due to direct radiation damage to the normal cells of the brain. Particularly susceptible are the cells of the hippocampus and neural stem cells. The hippocampus is important in memory and memory processing and is one of few structures in the brain that continues to produce new cells in the brain after birth. Similarly neural stem cells or progenitor cells can give rise to new cells in the brain and are particularly susceptible to ionizing radiation.The mechanisms of chemotherapy-induced cognitive dysfunction remain largely unknown. However, proposed mechanisms include direct toxic effects of chemotherapy to neural cells, effect on the blood vessels that supply the brain, increased levels of inflammatory markers or “cytokines” and decreased production of normal transmitters in the brain. Some proposed risk factors include genetic factors, cognitive reserve and education level, and normal aging.
Q: What are some of the signs of loss in cognitive ability?
N: One of the most frequently noted signs is poor memory. This means that a patient may take longer to do routine tasks, have difficulty learning new information and difficulty with “retrieval” or remembering typically well-known things. It may also affect the attention/executive function which is the ability to multi-task and switch between activities. Finally the processing speed may be affected, meaning that performing tasks quickly becomes difficult.
Q: What can patients do about cognitive decline?
N: There have been no proven or well-studied strategies to prevent treatment related cognitive decline. There are a few things we recommend such as cognitive training, for example reading books and newspapers, working on puzzles such as crossword puzzles, learning new languages, regular physical exercise and remaining socially active. Some experts have also recommended high vegetable diets, the Mediterranean diet and diets high in Omega 3-fatty acids.
Q: What can family members of the patients do?
N: One of the most important things that family members can do is support their loved ones, remembering that cognitive changes are not their fault. Helping patients with coping strategies such as making lists, patience and giving them time to recover are the most important things.
Q: Are there any recommendations that you can give patients to help maintain or restore their cognitive ability?
N: I typically recommend to my patients that they stay as physically and mentally active as they can. Staying socially active and engaged is important as well. They should discuss their symptoms openly with their physicians and family so that the appropriate support can be put into place.