Re-treating -got brain fog?

[mikesimon]

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

[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?

[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)

[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.

[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

[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]

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

[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?    

[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

[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]

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

[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]

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

[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?

[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.

[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!

[mikesimon]

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

[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