Re-treating -got brain fog?

Cognitive function does not worsen during pegylated interferon and ribavirin retreatment of chronic hepatitis C.

Fontana RJ, Bieliauskas LA, Lindsay KL, Back-Madruga C, Wright EC, Snow KK, Lok AS, Kronfol Z, Padmanabhan L; HALT-C Trial Group.

Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0362, USA. ***@****

Treatment of chronic hepatitis C with pegylated interferon (peginterferon) and ribavirin can cause or exacerbate depression but its effects on cognitive function are largely unknown. The aim of this study was to determine whether treatment with peginterferon and ribavirin adversely impacts cognitive function in patients with chronic hepatitis C. Prior nonresponders to interferon were retreated with peginterferon alfa-2a and ribavirin for 24 (n=177) or 48 weeks (n=57) in the Hepatitis C Antiviral Long-term Treatment Against Cirrhosis trial. Cognitive function was prospectively assessed using a battery of 10 standardized neuropsychological tests at weeks 0, 24, 48, and 72. Cognitive impairment was defined based upon a global deficit score. The Beck Depression Inventory and Brief Symptom Inventory were used to assess mood status. The 57 subjects who completed 48 weeks of antiviral therapy reported significant increases in difficulty concentrating, emotional distress, and symptoms of depression, all of which improved after cessation of therapy [P<0.0001, analysis of variance (ANOVA)]. Nonetheless, the frequency of cognitive impairment did not increase during the first 24 weeks of treatment in 177 patients (34% versus 32%, P=0.64) nor in the 57 patients completing 48 weeks of treatment (P=0.48, ANOVA). CONCLUSION: Retreatment of prior non-responders with peginterferon and ribavirin was not associated with objective evidence of cognitive impairment as measured by a comprehensive battery of neuropsychological tests. The lack of cognitive impairment is reassuring and suggests that self-reported symptoms of cognitive dysfunction are more likely related to the systemic and psychiatric side effects of antiviral treatment rather than measurable changes in cognition.

Mike

[wyntre9]

i was afraid the TX would sc*rew with what's left of my mind as well as my liver so I bought nintendo's Brainage.  it has suduko and a dozen other math, memory and logic games.  It's great coz it tracks your progress (like a brainometer)

when i first started i was (mentally) senile!  Now I'm down to 20 (the best score you can get).

I've gotten addicted to it since starting tx.  I do suduko on my ninentendo gameboy every night before going to sleep and i do the newspaper puzzle Monday through Friday (I still can't get the weekend solutions).

It's great coz it beeps you if you put in a wrong number!

wyntre

[wyntre9]

I've been confused my entire life.  :)

uh-oh - I mean:  *LOL*

wyn

[web52]

im treating for the 1st time (in week 39 of 48). i can tell you that my "information processing" and problem solving ability in both the verbal and nonverbal domains has significantly slowed, and my short-term memory is much poorer. i'm attributing this to the meds (brain fog), and assuming it's temporary (till i get this stuff out of my body). i would like to review the study you posted. they used some kind of "global deficit score"; gotta see the data and statistical comparisons from the individual tests and their subtests.  

[FlGuy]

Thanks. Had to read it twice.

[mikesimon]

I re-treated twice and both times I thought my brain wasn't functioning up to par so I found this enlightening .... or at least thought provoking. Mike

[Bill1028]

I'm retreating and my brain isn't functioning that well either.  Then again, according to my dear wife, it is more likely a pre-existing condition.

[SJL]

I wish all of the "Specialists" could go through a rd. or 2 of therapy & then make their assessment! I know that my "cognitive,- short-term memory," has been affected hugely.

I can think one thing and type a totally different non-associated word. I can be speaking and say something totally different than the subject being discussed.

It is not due to old age, knowledge, depression, etc.

I am disputing your information, I am only telling you the hopefully short term problems that I have, although I am 9 mths. post 100+ wks. of therapy.
Sjl

[willows]

There was a GREAT article here about two weeks ago on "Chemo brain" and that article suggested there was some evidence to support brain fog.  Now, being someone that confused you with someone else may not make me very reliable........the previous post was really a great article and it was done it a way that could also support interferon's effects on our cognitive functioning...or the lack there of.  

Still embarrassed  

[mikesimon]

Don't give it another thought. I wasn't offended or bothered in the least. At first I didn't understand your post at first but then I figured it out. Everything is fine. Mike

[willows]

http://www.nytimes.com/2007/04/29/health/29chemo.html?ex=1179460800&en=047770169b19befd&ei=5070

Good article on chemo brain.  Now these women take big doses, but only for about eight weeks, so I have to wonder what small doses, every week for a freakin year would do.

I liked reading it, made me feel better about forgetting the stuff I forget.

[FlGuy]

As part of my 'mental gynastics' and to pass the time with my daughter on drives, we play tic-tac-toe.  She sits in the back seat with paper and pencil and tells me where she puts her X ; 'upper left, Dad'. Not being able to see the paper myself, I'd say 'O, in lower left' And so on.  I could keep track of where her marks were and where my marks are and win a fair percentage of the games. Two weeks ago we are in the car and driving.  I look in the rear view mirror and see her sitting in the back seat in full softball uniform, including that cute powder blue visor.  I asked, "where are we going?"

[mikesimon]

Yeah, but did you win the tic-tac-toe game? That's what counts. Mike

[friole]

At first glance, I thought maybe it was the testing used so I googled them both.  The Beck Depression Inventory doesn't seem to be on point to me.  But I finally did find the Brief Symptom Inventory, and I find it likely that this one would be answered significantly different on treatment.

Here is the BSI:

http://chipts.ucla.edu/assessment/IB/List_Scales/BSI.pdf

Now here is a Wikepidia explanation of the BDI

http://en.wikipedia.org/wiki/Beck_Depression_Inventory

Beck developed a triad of negative cognitions about the world, the future, and the self, which play a major role in depression. An example of the triad in action taken from Brown (1995) is the case of a student obtaining poor exam results. [4]

The student has negative thoughts about the world, so he may come to believe he does not enjoy the class
The student has negative thoughts about his future, because he thinks he may not pass the class
The student has negative thoughts about his self, as he may feel he does not deserve to be in college
The development of the BDI reflects that in its structure, with items such as "I have lost all of my interest in other people" to reflect the world, "I feel discouraged about the future" to reflect the future, and "I blame myself for everything bad that happens" to reflect the self. The view of depression as sustained by intrusive negative cognitions has had particular application in cognitive behavioral therapy (CBT), which aims to challenge and neutralize them through techniques such as cognitive restructuring.

[willows]

Do you two think that games can really help mental acuity when someone is...oh, say over 40?  My husband plays sudoku every night and honestly, that game makes me nuts!  But I have wondered if I should put some stress on the ole gray matter with some sort of puzzle I do like.  I read a lot, but I'm wondering if that is too passive?

Willow

[mikesimon]

I believe in the benefit of exercise - physical and mental. Mike

[mikesimon]

I agree about mood but is that relevant to the cognitive tests which is what interested me?  Mike

[friole]

So the Beck depression survey doesn't seem to cut it to me, but look at some of the questions on the Brief Symptom Inventory

-Trouble remembering things
-Faintness or dizzyness
-Feeling easily annoyed or irritated (ha - score high for me!!!)
-Temper outburst that you could not control
-Feeling lonely even when you are with people
-Feeling no interest in things
-Your feelings being easily hurt
-Nausea
-Trouble falling asleep
-Difficulty making decisions
-Trouble getting your breath  
-Numbness or tingling in parts of your body
-TROUBLE CONCENTRATING
-Having urges to  injure or harm someone
-The idea that something is wrong with your mind

There are 53 questions in this survey  - give me a break!  I know my answers would be significant different on tx.  I question deeply the results of this survey
frijole

[GrandmaA]

At my doctors appointment last week. She asked me so many times if I was confused, it started to confuse me.

[Tater-ToT]

I'm still confused.. shish!

[rosebud57]

i have worked with this inventory.  its been explained to me by my supervisor when i used it, but i am not "studied" on it. but i do have a good familiarity.

it measures long term memory, short term memory, sequencing and dates (do you know who the president is, do you know where you are, what floor are you on, what is your room number), write a sentence on the back of this paper, write anything you want (to test ability to use proper syntax of language, also repeat after me.. "no Ifs, ands or buts" supposedly if they can not repeat that sentence it means their is some sort of cognitive deficit. depression scale there are two measures one the interviewer asks questions clients (i am tearful, I am sad, my life is fulfilling, etc.) and the responses are rated of 0= no,1 = sometimes, or 2 = frequently.  there is subjective portion answered by the person administering the scale. basically asking is what you observe match what person just told you.  scores are tallied.  

while i have many cognitive lapses for example can walk into a room and forget what i went for, can drive in circles forget my turn multiple times causing many u turns (not so bad now), forgeting what i was saying mid-sentence among the many others....  i really don't think this (BDI) measurement tool is an appropriate measure of what we experience in our cognitive deficts (brain fog, headaches). we clearly could answer all questions and i only provided a few examples above.  and whatever we say many don't seem to take our word for it.  

alternatively they could try a bit of their own medicine as others suggest.  i'd like to see how many will passenger in a vehicle with someone on  interferon/riba  (or have them nanny their kids - wouldn't that be a riot).

[Kit07]

Based on personal experience, my conclusion is that this study is a colossal piece of BS.  I wonder who funded it...

Thanks for the post
Kit

[friole]

Dose playing Spider Solitaire on the  computer count?  I should check into some of those brain games.  I think I need them.

frijole

[wyntre9]

only if you time yourself and keep trying to get faster - it's a speed and mental agility thing - the score is based on how accurately and how quickly you perform.

it really is challenging - and fun.

of course it could all be total BS - but i'm enjoying it, and, after all, that's what counts!  *LOL*

wyntre

[ladybug52]

"Prior nonresponders to interferon were retreated"

Well that line summed up the validity of the test! (to me) How about doing a before and after cognition test. I was just complaining to my husband tonight about the changes, that I hope are temporary. I asked him if he noticed I'm having problems and I didn't ask him in my "does this dress make me look fat?" voice. I asked him straight up and he was honest and straightfoward and said "Well, um, you know, all that kind of stuff affects people" So there you have it. My husband is better than doing the mini mental exam.
Bug

[rosedarling]

I love to do crossword puzzles while eating my popsicles!  Seriously, I'm addicted to them, not the real hard New York Times ones just regular crossword puzzles.  I swear it helps keep the fogginess at bay sometimes.

[fishdoc]

Hey Mike, all I can say is BullSh!t!!  I have been off tx 7 weeks now, and my brain started coming back in about ten days..........I have gotten more brain work accomplished in the last 6 weeks than I did the entire year prior........perhaps the next go round I will retain mental faculties.......but I rather doubt it!!  yall take care now, hear?

[friole]

Hey doc of fish -- how's it going this morning.  YOu know, you can tell how treatment is going when about week 36 or so people just start to disappear.  Glad you have resurfaced.  The fish are happy too, I am sure

frijole

[mikesimon]

Hey, I didn't conduct the study or write the article - I just posted it. I don't necessarily buy into it and it does address second time treaters and not first time TXers. I just thought it was thought provoking but I'm not treating so maybe that explains it. Mike

[friole]

About those Prarie chickens ---- No, those Prarie chicken were in Yoakum Co Texas (kind of SW from Lubbock).  (They don't even come as far south as Midland, much less the Bend).  It was a field trip for  the Master Naturalist Program program I am taking (a program I started AFTER TX , I might add - there was no way my brain could absorb anything new not hep c related during tx -(that ties this into this thread, ha ha)). We heard a Praire Chicken expert with the TPW ( who is supposed to be writing the conservation plan for them) speak too.  They are concerned about the wind farms popping up all over the place and have determined that one per 160 acres is all a ranch can sustain.  Prairie chickens don't like noise OR high objects. They are cool dudes - stutting their stuff and I will never forget the booming sound.  

  Last week with the Master Naturalist program we went to another ranch that had a wind farm, and I tell you, I have never seen so many wind generators.  No way they will keep those to 1 per 160ac - especially w/ damages plus $5000 per year rentals per unit!!!!

bean

[GoofyDad]

Nice to see you fishy...

I guess we all get it different - but one year later and my mental situation is still improving, one bit at a time.

Master Naturalist Program: Friole, ain't those the people who run around outdoors with no clothes on?    

[fishdoc]

Hey Mike, not aiming the BS at you, but at the scientific approach of studying mental functions........that stuff is not hard science (as opposed to soft science)........where's the can man when I need a quip!!!  I think the main brain issue is the inability to focus, something like temporary ADD.  When someone put me on the spot and asked a tough question......my brain would eventually pull it up......but as far as sitting down all day and writing proposals or manuscripts.......forget it....so how are you doing these days anyway?

Hey Friole, yes, I'm still here, headed to town today...PCR time...as you probably know..I don't have a good feeling.  Had a guy stop by yesterday that is trying to get funding to captively rear PC.  Its feasible because they are not state listed yet (duhhh I wonder why?? did I mention oil fields..)

Goofers...how are things going for you?  My brain is slowly coming back..I can't remember if you were going to retreat or not?

Wheres beemer, and what are his results so far??

[mikesimon]

I wasn't offended at all - that's my weird sense of humor. You said: "I think the main brain issue is the inability to focus, something like temporary ADD." I agree but what interested me was the idea that this could be attributed, in whole or in part,"to the systemic and psychiatric side effects of antiviral treatment rather than measurable changes in cognition." But, it probably doesn't really matter why we become less functional as long as we recover whatever cognitive ability we had prior to treatment when we discontinue the drugs.
BYW, I am feeling good and my labs are good. I am waiting for Heptimax results from a draw on Wednesday but I am not really worried. I should have them later today but I will be clear - I hope. Mike

[friole]

Belive me, mr goof man ya don't want to see this bod nakid!

fish - let's put a call in for candoman.  This should be his last Riba at regular dose.

bean

[Dee1956]

Thank you so much for this post, I am about to retreat and have been worried about my cognitive skills which have sloowly improved since tx ending 2008
This give me hope that I may stay the same or at least not get worse.
I know, old post but it is a good one for retreating population
Dee

[Mary4now]

During treatment my main focus was just getting through the day, and I tried to keep it simple.  When I had to exert myself such as during my roof leak, interviewing roofers and their bids timelines etc.  I had to write everything down and even then my lack of motivation, energy due to not feeling good created an attitude of complacency which could be viewed as forgetfulness.  BUT I see myself as forgetful, and if something is really important I recommend writing it down.  Someone at work asked me if I  remembered the woman she was talking to 2 weeks on Mon.  NO I do not remember.  I'm trying to leave room for remembering what is important and I am still trying to figure out what that is and eliminate the rest from 62 years of remembering.

[Dee1956]

Hi thanks so much for your post, I treat once before and had cognitive problems. While I was on tx in 2008 I did not worry, it was after wards when I no longer had the excuse of the tx that I got worried. I start tx next Friday and am so afraid of the confusion so this post (though old) made me feel so much better.  
Thanks again
D
if anyone knows of anything else regarding the original post I would love to hear about it

[alagirl]

Well, for me, there was a lot going on.  I had a very low rbc count most of the time, so I was prob dealing with some hypoxia.  I noticed a marked difference in my cognitive function as my hemaglobin dropped.  Add to that the narcotics, ad's, tx drugs, phenergan...  I was literally talking to myself out loud, and answering.

[rnangel]

The main cause of confusion, brain fog, cognitive impairment or whatever you want to call it is high ammonia levels. When the liver's functioning is impaired its ability to breakdown ammonia is compromised. This excess ammonia spills into the blood and readily crosses the blood-brain barrier. Ammonia is highly toxic to brain cells and they are unable to effectively transmit messages to various parts in the body. Some people can even experience uncoordinated muscle movements if ammonia levels are high enough. The common treatment to decrease ammonia levels is lactulose. It is a syrupy sweet laxative. It binds with ammonia in the gut so it can be excreted in stool. Unfortunately, you may need to titrate the doses so you have 6-8 stools per day. Of course this is not pleasant but it is the ONLY way to rid the body of excess ammonia. It does work though. I have seen major improvement in cognitive functioning with this treatment. To make the it more pleasant to drink you can mix it with club soda. Just wanted to share :o)

[nygirl7]

Agree with alagirl in my case it was the hypoxia due to extreme anemia = made it just impossible to think (let alone not listen to my pounding heart and constant ringing in my head).

I didn't think ammonia levels were that high in folks with just low/mid/late range fibrosis that it would matter?