Gerald Voelbel, Ph.D., a cognitive neuroscientist at NYU, talks about a way to reduce brain fog created by chemo.
Interview conducted by Ivanhoe Broadcast News in November 2016.
The studies that you’ve done related to chemo brain what did they consist of generally speaking? What basically was the study all about?
Dr. Voelbel: The studies were looking if we can improve cognitive deficits of people that experience chemo brain. We use brain training exercises to see if we can improve their cognitive abilities.
Brain training exercises that essentially consist of?
Dr. Voelbel: Exercises that address different areas of cognition such as attention, working memory, things that we use every single day all the time.
Exercises that involve what?
Dr. Voelbel: Responding to information on the computer in order to go through these exercises. They get more difficult as you improve to make sure that you are still engaged and find it challenging. That improves your ability as you progress through the exercises.
We’ll take some video of someone using these but when people are watching these at home and they’re seeing what the images look like that the person going through that is seeing basically what’s going on there?
Dr. Voelbel: A participant will go find or will have instructions of how to respond to a specific exercise. If it’s a working memory exercise they will have to use their working memory in order to respond to the computer and get the answer correctly.
They are sort of glorified brain teasers in a way right?
Dr. Voelbel: Yeah, we don’t like to call them as brain teasers we like to emphasize that they are brain exercises.
Participants engage in brain exercises that—-
Dr. Voelbel: Participants exercise in brain exercises that challenge their brain and train them how to improve their cognition. I’m trying to keep it more general because from what my study did versus what their study did is a little bit different. I can say they heard a sound in my study; they heard a sound and had to respond to it. They had a choice whether it was this sound or this sound.
What did your study find as related to chemo brain?
Dr. Voelbel: My studies with chemo brain, the brain training studies, show that we can improve attention and working memory in order to improve people’s lives.
How does that happen, what’s going on through these exercises, you used the analogy if you want to build up your biceps you do curls. Obviously there’s something taking place there that makes that happen. What’s taking place here?
Dr. Voelbel: It won’t be in layman’s terms. If I start talking about synapse and physiology of the brain, I can say the idea is that it’s making stronger neural connections.
Maybe just start with that and tell me what that means.
Dr. Voelbel: The exercise, the theory behind it, is that we are improving neuroplasticity of the brain. Neuroplasticity is where we’re making more or stronger neuro connections within the brain to make our brain more efficient to do everyday activities.
Now these are things that are used in general outside of this though, right? What would be another use for this type of exercise if somebody doesn’t have chemo brain?
Dr. Voelbel: The other reasons why to use this exercise or these brain exercises is to improve everyday cognition. I have a study with traumatic brain injury that we’re showing that we can improve their cognitive abilities after they were lost after a significant head injury. Other studies have shown that this improves cognition in older adults so that they can drive better or longer.
Your study basically has found that this is applicable to people with chemo brain, with traumatic brain injury, older people that have started to have some cognitive loss. How significant is this to have these findings?
Dr. Voelbel: The significant findings are that we a can actually reverse cognitive decline. We can actually improve someone’s life by improving their cognitive abilities, whether it is chemo brain, traumatic brain injury in older adults or in people with schizophrenia.
I presume that figuring out ways to improve someone’s cognitive state is not new in and of itself but it’s relatively new where this work is concerned right?
Dr. Voelbel: Correct.
This particular application so to speak right?
Dr. Voelbel: There is a whole line of neuropsychologists, rehabilitation psychologists, occupational therapists, physical therapists, and all do rehabilitation. This is another tool in the toolbox to demonstrate that we can improve cognition. I didn’t go in to the traditional part, and actually if you want to ask me that question again I would leave physical therapist out because they don’t deal with cognition.
It’s essentially a new form of brain rehab, right?
Dr. Voelbel: This is new in terms of what has been don’t traditionally.
What has been done traditionally?
Dr. Voelbel: Either group therapy, holistic therapy where it’s a whole research team that works with the patient in order to address different areas of their rehabilitation. This is showing that we can target specific cognitive abilities and improve them.
The improvement that you see how long does that, if I remember right from what I read, there’s a short and a long term benefit right? How long does it take for someone to see this improvement?
Dr. Voelbel: How long that improvement lasts is still under investigation. There are studies out there with chemo brain studies that show that it lasts up to six months. Patients are reporting that they still feel good after six months of going through the brain training exercises.
At which point you might have to keep it up?
Dr. Voelbel: This is what we don’t know. If we have to keep it up, or such as booster sessions. Just like inoculation with a shot. But that still needs to be investigated.
Typically how long does it take before they first start to see improvement?
Dr. Voelbel: Relatively fast. After a few sessions my participants have told me that they start to feel better. That brain fog starts to lift after just a few sessions.
That’s a good comment, so it’s sometimes referred also as chemo fog?
Dr. Voelbel: Right.
This is kind of lifting that fog, can you tell me about that again?
Dr. Voelbel: This is essentially lifting that chemo brain fog where they just don’t feel like themselves and they have difficulty with everyday tasks and they can’t pay attention where it affects their job, or even holding conversations. They can start to feel this improvement in just after a few sessions.
When they’ve done the sessions for your work it’s done here or at home?
Dr. Voelbel: For my studies they’re done here at NYU.
It’s done here and how long is a typical session?
Dr. Voelbel: One hour.
And how frequently?
Dr. Voelbel: Three times a week.
How long would you do that for, what’s the duration?
Dr. Voelbel: The duration is forty, one hour training sessions.
It goes on for like a few months?
Dr. Voelbel: It goes on for about three months. In order to get it, it takes about twelve weeks.
Like going forward in this industry from your expertise how significant is this?
Dr. Voelbel: What we’re showing is significant, people are able to do these brain exercises at home and not have to go to a doctor’s office or a clinic in order to do these and get the same benefit. But what I found in my TBI study is that they don’t do it at home. Actually, the bray article shows that also, people are not doing it at home.
Why is that?
Dr. Voelbel: Motivation. Time.
Even if they know it’s helped them they don’t keep it up?
Dr. Voelbel: Yeah, the analogy that I give is that I’ve got a gym membership, right, and how many times do I go? Not very often. But if I have an appointment with a personal trainer I will show up to the appointment. My participants do the exact same thing and I’ve shown the exact same thing. That if they do it at home, if I give that for them to do it at home, they don’t do it. If they have an appointment with me they will show up and do the exercises.
We don’t really know, am I correct, but specifically what it is about chemo that causes this?
Dr. Voelbel: We don’t know the mechanism that causes chemo, we know that a large percentage of people that undergo chemo therapy report that they have this chemo brain fog.
And experts there are sure that it’s the chemo and not the cancer because it’s only chemo people?
Dr. Voelbel: Sure, because people that have cancer that don’t get chemotherapy don’t report the chemo fog.
It’s the chemo they don’t know what it is about the chemo?
Dr. Voelbel: That’s correct. Now there are some theories that it’s all about cytokines and what crosses the blood brain barrier but nothing has been proven.
Anything we’ve left out that you feel compelled to get across that we haven’t covered? You’ve done two different studies essentially.
Dr. Voelbel: I’ve done two different studies one with chemo brain patients, and then one with traumatic brain injury. That’s from people that have had just a concussion all the way through being in a coma, coming out of a coma. With the brain injury, you know after they’ve already gone through the traditional rehabilitation, they’ve reached a plateau and I’m showing that even after they’ve gone through the traditional rehabilitation I can improve their cognition. It’s important to know that this stuff that they do with you these exercises still should be done in conjunction with whatever their standard care is.
Dr. Voelbel: For chemo brain, this is the significant part about chemo brain and treating chemo brain fog, is that there is no standard care to treat their cognitive deficits, their cognitive problems. The significance is that there are studies coming out to show we can actually improve it. This is new; we can actually show the improvement in chemo brain fog where traditional care doesn’t address that.
Your study was when, the chemo brain?
Dr. Voelbel: I completed the recruitment about a year ago.
Okay, for chemo brain.
Dr. Voelbel: For chemo brain, yes.
When was that completed?
Dr. Voelbel: It was completed about a year ago. The recruitment part and we presented about a year ago our first paper. What we showed was that because it addressed verbal or auditory information, that people’s auditory or their verbal working memory and verbal attention improved greatly.
Okay.
Dr. Voelbel: I don’t know of anything else. That bray article showed that people’s auditory perception improved. The participants that went through the brain training exercises felt significantly better compared to those that did not do the brain exercises. That’s the significant part: that it was their own feelings that this lifted, that this brain fog lifted.
And Melissa is part of this? Was she part of the chemo brain?
Dr. Voelbel: She was part of the chemo brain study, my study yes.
Okay.
Dr. Voelbel: While Tasso was sitting up she was talking to Rachel and was saying like, I mean I really felt the difference and so she’ll attest to that.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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