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How do experts assess ‘chemo brain’?

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*The information in this blog post is based on the webinar, “Understanding Cancer-related Cognitive Impairment,” hosted by the Kimmel Cancer Center's Breast Cancer Program.

Q: What type of cognitive assessments can be done for cancer patients undergoing treatment or who have completed treatment who complain about ‘chemo brain’?

A: Tracy Vannorsdall, Ph.D., a neuropsychologist at Johns Hopkins in the Division of Medical Psychology, says her assessments usually require a three- to four-hour appointment. “I will review a patient’s medical records, and spend an hour taking a medical history while focusing on issues such as stress, sleep, mood, and in what kinds of situations the patient notices cognitive difficulties.” One of her technicians provides formal, one-on-one cognitive testing designed to look at different thinking skills, such as the ability to pay attention, to think quickly, to remember, to plan and to reason and problem-solve. Then patients fill out questionnaires that address mood, stress, sleep and fatigue.

“I pull it all together and look at the pattern of strengths and weaknesses in terms of cognition – where do we expect a patient to be based on his/her age and background, where the person is doing well and where he or she is experiencing difficulties,” Vannorsdall adds. “I like to craft a tailored, research-supported intervention using a person’s cognitive strengths to help counteract their cognitive weaknesses. Sometimes that involves keeping diaries to track cognitive errors and their context, sometimes I need to refer patients on to additional providers for treatment for depression and anxiety or sleep difficulties. I work with patients to address all of the potential modifiable factors to improve cognition and can help get them moving toward where they want to be. I can also help patients returning to work to make appropriate requests for accommodations. Employers often want to help employees be as successful as possible.”

Neuropsychological evaluations may be less frequently available in rural settings but there are psychologists, social workers, and other mental health providers who are knowledgeable about complex medical issues and the contributing factors to cognitive difficulties, Vannorsdall says. Quite often, the service is covered by insurance.