Meg Haskell

Jul. 4, 2008 (McClatchy-Tribune Regional News delivered by Newstex) -- Deena Weinstein is a professional storyteller. She's also a writer, counselor, educator and notary public. She officiates at weddings and funerals and visits sick people at home and in the hospital. She's a wife and mother. She loves to travel. It could be hard to keep track of all of her interests and activities -- and indeed, the 60-year-old Garland resident said in a recent interview that she has always been a little scatterbrained.

But back in 2004, while undergoing chemotherapy for breast cancer, Weinstein found her brain feeling more scattered than usual. She was more forgetful, less able to concentrate, failing to recall people's names, losing items she had just set down. She took wrong turns while driving familiar routes. She forgot what she was about to say.

Her oncologist assured her these changes were related to her cancer treatment and told her they would dissipate when she finished her treatments.

"But instead of getting better, it got worse," she said. The symptoms fueled her fears that she was developing Alzheimer's or some other form of dementia. Her family was growing frustrated with her changed behavior. Finally, when the problems had persisted for more than a year after she finished her chemotherapy and radiation treatments -- successfully sending her cancer into remission -- her doctor referred her to Bangor psychologist Robert Ferguson.

"Chemo brain" is the term Ferguson uses to describe the changes in the way Weinstein processes and organizes information. It's a common, widely recognized but poorly understood side effect of chemotherapy and radiation, he said, and in most patients it does begin to resolve shortly after treatment ends, as Weinstein's oncologist suggested.

But for as many as 25 percent to 50 percent of patients, Ferguson said, the brain changes persist and in some cases worsen over time. With an estimated 1 million Americans undergoing cancer treatment each year, he said, there are a lot of people living with impaired brain function associated with chemo brain.

"Cancer is now considered a chronic disease," Ferguson said, with many people surviving years beyond their diagnosis and treatment. While cancer specialists may consider a patient cured once cancer is in remission, Ferguson said behavioral psychologists like him hear from survivors whose careers and personal lives have suffered because of the changes cancer treatment has made in their cognitive abilities.

At work, individuals may find themselves unable to "multitask" the way they once could. They may miss meetings, draw a blank when trying to remember the name of an important business associate, or forget midway through a sentence the point they were trying to make. Many find themselves getting unsatisfactory job performance reviews for the first time in their lives. Some struggle daily to meet workplace standards that were not problematic before their cancer treatment, others switch to jobs with less responsibility, and others simply get fired.

At home, family members and friends may grow impatient with the lingering symptoms of chemo brain -- forgotten conversations, misplaced items, overlooked social obligations and a pattern of increased distractibility, for example.

Ferguson has developed a behavioralist's practical approach to helping people counteract such problems. They include such familiar and common-sense steps as developing a routine for keeping track of car keys and other important items, minimizing distractions, simplifying to-do lists at home and work, carrying a small notebook to jot reminders in, and using mnemonic tricks to help remember people's names. (That woman who works in marketing has curly hair, and "curly" rhymes with "Shirley" -- oh yeah, her name is Shirley.)

While these devices are nothing new, Ferguson said, it helps people to be reminded to use them and to confirm that they have a legitimate cognitive impairment. He typically sees patients for four sessions to help them clearly identify their problems, develop customized solutions and adopt new habits. He's considering expanding the recommended number of sessions to eight to further implant and strengthen the new behavior.

For Deena Weinstein, Ferguson's approach has been a lifeline.

"I'm a storyteller" -- she performs in cafes and runs workshops for senior citizens and other groups -- "so it's important for me to be able to recall the details of my stories," she said. She has learned that bringing a physical object to a story workshop -- in one case it was a military medal -- helps jog not only her own memory but also that of her elder participants.

She also has learned to advocate for herself, to admit she needs reminders and ask for support from family members and colleagues. She recently forgot all about a long, personal conversation she had with her adult daughter, she said -- an aggravating episode for both of them.

"I've had to ask them to please be patient with me ... and remind them not to get too frustrated," she said. She finds that other interventions also help her memory and focus, including meditation, yoga and regular exercise.

Meanwhile, Ferguson and other psychologists have begun studying chemo brain in humans, trying to map which parts of the brain are affected by drugs and radiation. These studies have included testing brain activity in groups of people who have undergone cancer treatment and comparing the results to similar groups who have not been treated, as well as measuring brain activity in individual patients before treatment and again after treatment. At least one study using identical twins has been done.

Studies on humans are complicated by issues of normal aging, lifestyle, overall health and other factors, Ferguson said, but progress is being made. Additionally, other researchers -- including one scientist at the University of Maine -- are using mice to study genetic factors that could increase susceptibility to long-lasting brain changes caused by cancer treatment.

Newstex ID: KRTB-0135-26445415