Lo0se your mind…loose your life Dr. Michael Wald/Dr. Nilay Shah

Lo0se your mind…loose your life
Dr. Michael Wald/Dr. Nilay Shah
Integrative Medicine & Nutrition Clinic
914-242-8844
The information presented herein is meant for educational purposes only and
is not meant to replace sound medical or nutritional advice. This material is
copyright, 2010 (Dr. Michael Wald)
Depression
Concentration
difficulties
Problem with multitasking
Memory
Moodiness
Fatigue
Brain-fog-awareness
Sleep difficulties
Other associated problems:
Chemo-neuropathy
Surgical/physical
Hormonal problems
Nutritional imbalances
Increased future risk of
cancer due to immune
suppression
Increased risk of infection
Neurotoxic effects and
other organs
The authors examined the long-term cognitive implications
of cancer treatment among breast cancer survivors over 65
years old who received treatment during midlife.
30 women survivors were matched with 30 non-cancer,
healthy older adults in terms of age, education, and IQ.
Cancer survivors scored significantly lower in the cognitive
domains of executive functioning, working memory, and
divided attention, (frontal-subcortical brain regions).
Findings suggest that among breast cancer survivors who
remain disease-free for more than a decade, the previous
cancer treatment may further augment cognitive
dysfunction associated with age-related brain changes.
CONCLUSION: Data from this study
support the hypothesis that systemic
chemotherapy can have a negative impact
on cognitive functioning as measured by
standardized neuropsychologic tests and
self-report of memory changes.
“…they (the studies) consistently suggest
that between approximately 15% and 25%
of chemotherapy-treated breast cancer
patients will have evidence of cognitive
dysfunction some years after
chemotherapy, compared to about 10% of
breast cancer survivors who did not receive
chemotherapy…”
Neuropsychologic deficits and cognitive
complaints after systemic cancer
chemotherapy
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
Genetic and other risk factors
Symptoms associated with cognitive dysfunctiondifficulties with memory, concentration, and
language-are frequent among breast cancer
survivors after chemotherapy.
Models of cognitive dysfunction suggest multiple
possible contributors including changes in hormonal
milieu, direct effects of chemotherapy, medications
given as supportive care, psychiatric changes
including depression and anxiety, and mediators of
inflammation.
Novel neuro-cognitive testing and imaging methods
are being evaluated in breast cancer survivors to
better understand cognitive side-effects of therapy.
“There may be enough data to
consider discussing the possibility of
cognitive dysfunction as an adverse
effect when assessing the risks and
benefits of adjuvant chemotherapy”
The greatest gap in our knowledge regarding
chemotherapy-related cognitive changes
Several pathophysiological candidates include
Direct neurotoxic effects leading to atrophy of
cerebral gray matter (GM) and/or demyelination
of white matter (WM) fibers
Secondary immunologic responses causing
inflammatory reactions, and microvascular injury
Altered neurotransmitter levels and metabolites
could constitute an additional mechanism related
to neurotoxic effects.
Directly or indirectly assess many of these
mechanisms
Very limited application of these tools in studies
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.
Encephalopathy (brain swelling)
Vasculitis (blood vessel
damage/inflammation)
White matter damage (plaques)
Neurotransmitter abnormaoities
Neurotoxicity - Axon, cell body and other
CNS damage
Electrophysilogic damage (“short circuits”)
Malonyldialdehyde – dozens of antioxidants
Glutathione reductase – sel, glutathione, etc.
Ascorbic acid/dehydroascorbit acid levels – vitamin C
Homocysteine/methylmalonic acid: B6, B12, folic acid
C-reactive protein – vitamin E, etc.
Vitamin D (25-D3 and 1, 25 D3) – Vitamin D analogues
Essential fatty acids – omega 3, and omega 6
Phosphotidylcholine, phosphotidylserine – choline, serine,
lecithin, etc.
Neurotransmitter imbalances – glycine, GABA,
tryptophane, etc.
B-vitamins – B1, B2, B3, B5, B6, biotin, folic acid, B12, etc.
Selenium
Magnesium
Zinc
Autonomic nervous system dysfunction
Omega 3 fatty acids
L-carnitine
B-vitamins
Antioxidants
Bio-identical Hormones
Testosterone
Growth hormone
Other hormones
Detoxification assays
Hormonal assays
Antioxidant assays
Vitamin assays
Mineral assays
Neuro-degenerative
markers
CRP
Homocysteine
Fibrinogen
Others
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