Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Are Chances Of Developing Mild Cognitive Dysfunction While Treating Malignant Diseases?
Question: Hello. I am 61 yr old female, 5 4, 207 lbs. I have history of a CABG in 2000 of single vessel. Had 2 small MI's in 2007 & 2008. In 2010, I was diagnosed with MDS, and after treatment with chemo, and transfusions, I had a BMT in July 2012. Since BMT, I have been plagued with memory loss, inability to retain information read, trouble with concentration, following directions, forgetful of common words when speaking to others, and having balance problems. I have been calling it "chemo brain", but my oncologist poo hoos that theory. However, it is getting close to possibly going back to work, (I am an RN), but I am concerned that I will not be able to function and think as a RN needs to. I asked my PMD to order Neuro Psych testing consult, and it will be done on Aug 3. I also had an MRI of the brain with contrast on 6-11, and it showed scattered nonspecific foci of abnormal white matter signal (T2 and FLAIR) bilaterally. It is suggest may be on basis of chronic microvascular ischemic demyelination. I also had carotid doppler study done due to retinal hemmorhage found on eye exam to left eye. It shows mild stenosis 1-19% of left internal carotid artery. I am going to see my PMD tomorrow to discuss the findings, but was curious as to your thoughts...could my extensive chemo for the transplant, and my heart problems, be causes for the WMH showing up at my age and the cognitive problems also? Will I still be expected to return (or attempt to return) to work with these symptoms and MRI results? I am afraid to go off disability, get a job, then lose it, because I can't remember what I am suppose to do...Any thoughts would be appreciated...Thank you, XXXX
Brief Answer:
Imaging findings not alarming.
Detailed Answer:
I read your question carefully and I understand your concern.
It is true that in patient treated for malignant diseases there is noted a higher likelihood of developing some mild cognitive dysfunction. Generally it is mild though, improves after the first year and doesn't affect the overall functioning. At times part of the what is thought as cognitive dysfunction is due to issues like anxiety and depression which make concentration and retaining information more difficult.
Now as for white matter changes, they are a common finding in many people, even in the absence of any other prior condition. They develop due to blood vessel changes with age, so the older one gets the higher the likelihood of getting them to some degree. Of course conditions affecting blood vessels make it more probable for blood vessels in the brain to be involved as well. So in a way with your history of coronary disease and at your age those changes are to be expected to some degree. It is hard to assess how "normal" they are, because simply saying to have scattered nonspecific foci doesn't say much about how extensive they are, could be mild, moderate or severe. If mild, shouldn't be causing any symptoms, if moderate or severe could be at the base of your cognitive dysfunction. From reading that fragment of the report it would seem the changes are mild, to be expected for your age and not to be alarmed.
As to what caused them, I would say they are part of the same spectrum as your heart problems, same vascular risk factors for heart disease are risk factors for ischemic white matter changes. So not exactly caused by the heart issues, just accompanying changes in blood vessels in other organs.
Regarding whether you'd be able to work again, if only mild ischemic changes I would say yes. However I haven't seen the MRI images, and since there are other factors at play neuropsychological evaluation would be a more objective measure.
I hope to have been of help.
Imaging findings not alarming.
Detailed Answer:
I read your question carefully and I understand your concern.
It is true that in patient treated for malignant diseases there is noted a higher likelihood of developing some mild cognitive dysfunction. Generally it is mild though, improves after the first year and doesn't affect the overall functioning. At times part of the what is thought as cognitive dysfunction is due to issues like anxiety and depression which make concentration and retaining information more difficult.
Now as for white matter changes, they are a common finding in many people, even in the absence of any other prior condition. They develop due to blood vessel changes with age, so the older one gets the higher the likelihood of getting them to some degree. Of course conditions affecting blood vessels make it more probable for blood vessels in the brain to be involved as well. So in a way with your history of coronary disease and at your age those changes are to be expected to some degree. It is hard to assess how "normal" they are, because simply saying to have scattered nonspecific foci doesn't say much about how extensive they are, could be mild, moderate or severe. If mild, shouldn't be causing any symptoms, if moderate or severe could be at the base of your cognitive dysfunction. From reading that fragment of the report it would seem the changes are mild, to be expected for your age and not to be alarmed.
As to what caused them, I would say they are part of the same spectrum as your heart problems, same vascular risk factors for heart disease are risk factors for ischemic white matter changes. So not exactly caused by the heart issues, just accompanying changes in blood vessels in other organs.
Regarding whether you'd be able to work again, if only mild ischemic changes I would say yes. However I haven't seen the MRI images, and since there are other factors at play neuropsychological evaluation would be a more objective measure.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
