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article imageHow brain training is effective against 'chemobrain': Interview Special

By Tim Sandle     Dec 10, 2017 in Science
A specific type of brain training is effective against "chemobrain", the common cognitive deficits caused by cancer or its treatments. Up to 90 percent of cancer survivors report cognitive issues, and there is no widely-accepted treatment.
The new brain training research is cutting edge and it has recently been reported to a peer reviewed journal (“Speed of processing training in middle‑aged and older breast cancer survivors (SOAR): results of a randomized controlled pilot”). These are exercises based around BrainHQ, developed by Posit Science. The exercises are designed to address dementia prevention, bipolar disorder and, now, chemobrain. Digital Journal earlier ran an exclusive interview with the developers behind BrainHQ's application for bi-polar disorder (see: "Computerized brain training tackles bipolar disorder").
To find out more about chemobrain and the BrainHQ approach, Digital Journal spoke with Dr. Henry Mahncke, Posit Science's CEO. The first part of the article focuses on chemobrain. A follow-up article - "BrainHQ - cognitive training to battle 'chemobrain'" - looks at the new approach to treatment.
Dr. Henry Mahncke is the CEO of Posit Science.
Dr. Henry Mahncke is the CEO of Posit Science.
Digital Journal: Thanks for the interview Dr. Manhcke. How would you define ‘chemobrain’?
Dr. Manhcke: In the 1980s, breast cancer survivor support groups began to draw attention to different types of cognitive impairment, as an adverse effect of chemotherapy, which persisted even after the cancer treatment ended.
Initially, this condition was called “chemobrain” or “chemofog.” At first, there was widespread doubt in the medical community about whether this was a real condition; however, in the 1990s, serious studies were undertaken and it is now widely acknowledged that cognitive deficits are a common symptom of cancer and its treatment. There is disagreement among experts as to its cause (or causes), which have been said to include, the cancer itself, the treatment of the cancer, stress related to the patient’s condition and hormonal change.
The condition is now often also referred to as “cancer-related cognitive impairment” or “cancer-induced cognitive decline” to reflect that it is associated with both the disease and its treatment. While somewhat less accurate, we use the term “chemobrain” because of its widespread usage.
DJ: How extensive are cognitive issues with cancer patients?
Dr. Manhcke: Our new study notes that estimates range from 21 to 90 percent of patients treated for cancer. Other research indicates that symptoms can persist for 10 or more years. Effects (as with other forms of cognitive impairment) can interfere with maintaining employment, relationships, and day-to-day independence.
There are more than 35 million people with greater than five years of cancer survivorship, globally. This suggests 7 million to 31 million people globally may be grappling with these issues. There are no broadly accepted (or FDA-approved) interventions for what is commonly called chemobrain.
Metastatic breast cancer in pleural fluid
Metastatic breast cancer in pleural fluid
DJ: How are these cognitive issues assessed?
Dr. Manhcke: As with other subjective symptoms, such as pain, cognitive impairment is generally diagnosed and measured among cancer patients by using various standardized self-report assessments. Objective cognitive assessments – what you might think of as “cognitive tests” – can also be used, but can only objectively capture cognitive decline (or improvement) if such a test had been used for prior measurement of the patient to establish a baseline for comparison.
DJ: How can cognitive exercises help?
Dr. Manhcke: The right kind of cognitive exercises can help by improving foundational brain function – the speed and accuracy of brain information processing – which improves specific symptoms of cognitive decline, including, for example, declines in speed of processing, attention, memory and executive function.
What’s exciting about this study (and prior studies of populations with cancer-related cognitive impairments) is the direct demonstration in a clinical trial that this approach has a significant impact on chemobrain.
DJ: And this fits in with your new research?
Dr. Manhcke: This new pilot study is independent research conducted by a team at the University of Alabama at Birmingham, and was published in the peer-reviewed journal Breast Cancer Research and Treatment (Ed: "Speed of processing training in middle aged and older breast cancer survivors (SOAR): results of a randomized controlled pilot").
The study was funded by the National Institutes of Health, American Cancer Society and Susan G. Komen Foundation.
DJ: What did the study involve?
Dr. Manhcke: This study enrolled 60 breast cancer survivors, who were randomized into a brain training intervention group and a no-training control. The intervention group was asked to complete a total of 10 hours of training (at the rate of about two hours per week) in the visual speed of processing exercise “Double Decision” from the BrainHQ web app. Participants were measured at study entry, six weeks later, and six months later.
The researchers reported significant improvements in standard measures of processing speed and executive function at the six-month follow-up. They also noted significant improvements at six weeks in standard measures of processing speed and episodic memory. Other subtests from the NIH toolbox did not show significance.
As noted by the investigators, these results are largely consistent with prior research. In a 2012 study of 82 cancer survivors at Indiana University (using a set of five BrainHQ visual speed of processing exercises in classes for 10 hours against a memory training control), researchers found significant gains in processing speed and working memory in at a two-month follow-up.
In addition, in a 2016 study of 242 cancer survivors in Australia (using a set of five BrainHQ visual speed of processing exercises on their own at home for 40 hours against a no-training control), researchers found significant improvements in the primary assessment, the Perceived Cognitive Impairment measure, after training and at a six-month follow-up.
DJ: The findings seem significant
Dr. Manhcke: This new study contributes to the literature by focusing on the persistence of effects (at six months) of just a single exercise, with a relatively small amount of training (10 hours). In addition, it is the first study of its kind conducted among a population with a majority of African-American women.
Posit Science is working with regulators to find the most efficient path to market for making brain training that addresses clinical conditions broadly available.
Dr. Henry Mahncke is the CEO of Posit Science, the maker of the BrainHQ web and app brain exercise platform. In a follow-up article Dr. Mahncke discusses how his specific cognitive training platform works.
More about Cancer, chemobrain, Chemotherapy, Brain training
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