Cognitive impairment –common in cancer treatment. Also known as ‘brain fog’ or ‘chemo brain’. Cognitive functions include communicating, reasoning, judgment, attention, perception, learning, organising, problem-solving, and memory.
Cognitive impairment is when one or many of these is effected. For some, it can manifest itself as vagueness and forgetfulness; for others, it may be mood swings, disorientation, irrational behaviour or confusion. There are complex reasons as to why people experience these deficits when they’re having treatment for cancer. And the onset of symptoms can vary –it could be during treatment, immediately after, or years later.
Genetics or older age can predispose some to being at higher risk of cognitive impairment. Additionally, the type, dose and length of cancer treatment can be contributors. The effects on attention, memory or problem-solving caused by chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells can be worsened with more toxic doses over longer periods.
Age can also be a factor in determining the severity of impairment –in children it can result in long-term challenges with learning, focus, delayed emotional and behavioural development, comprehension and memory. However early identification and intervention can certainly reduce the severity of these.
Often it’s easy to miss the signs of cognitive problems because they can be confused with depression or fatigue. Usually family members will be the first to notice, and from there, a doctor or psychologist can assist with the steps forward. Your doctor might do a physical exam, discuss the cognitive changes that have been experiencing, and do some preliminary cognitive checks and memory testing. They also might order a head MRI or CT scan to rule out other conditions that can mimic ‘chemo brain’.
There has been significant research into the benefits of treating cognitive impairment with rehabilitation. This involves re-teaching reasoning, thinking and memory skills to help people cope better with cognitive difficulties, and improve quality of life during and after cancer treatment. Some symptoms may need additional treatment with medications, such as stimulants, which may help concentration and memory.
Cognitive rehabilitation usually involves a multidisciplinary team (MDT) including the oncologist, neurologists, geriatricians in the elderly, neuropsychologists, occupational therapists, and sometimes physiotherapists Rehab strategies are tied to basic cognitive re-training and physical exercise programs. In an MDT, occupational therapy might help with everyday tasks and job-related abilities; neuropsychologists can help identify the exact deficits and design targeted exercises; counseling can assist with emotional adjustment.
All this is to say that the ‘brain fog’ phenomenon during cancer treatment is quite normal. It’s normal to not feel able to function as well as you used to. You might feel irritated, defensive and embarrassed about some reduced abilities, you may also feel helpless and frustrated, but there is help out there. It doesn’t necessarily mean that everyone will make a complete recovery, but there are some ways of learning to operate around major deficits. And most people report a return to normality after treatment.
For now, if you’re in the throes of diagnosis and beginning cancer treatment, or even further down the track and perhaps just starting to notice things are not quite right, keep a record of your experiences. It can show you things that you may have missed or not noticed. It can also identify simple solutions for certain symptoms –for example knowing what time of the day you function best can help you plan ahead and work around difficult tasks during your days.
Set up a reminder system or a detailed calendar to record appointments, other activities and important dates, and to remind you about your priorities. And get into the habit of checking it regularly so that you can reschedule things if needed. The top-tip people report – write it down! Carry a notebook or use you phone, it’s OK to need help remembering the little things. Be gentle on yourself and don’t over-commit when you know your brain’s already struggling.
Take care of yourself with activities that are restful and enjoyable, interacting with support people or groups, and partaking in physical activity, such as walking, swimming or something else you enjoy. All these have been shown to boost mental alertness, reduce stress, enable better sleep, clarify thinking, and improve mental health. Exercising your brain with different activities, such as puzzles, languages, playing musical instruments, painting, learning a new skill, and chatting to friends and family are all important to optimise cognitive function. Most importantly don’t panic; it can feel like things may never be the same again, but it is quite normal to have these experiences and recover cognitive functioning.
It is vital that you feel cared for through this process, it’s crucial to have people who are aware of what you’re going through and are ready to assist or support. If you’re worried talk to your healthcare team who will monitor you and develop a management plan.
Like all aspects of a cancer diagnosis, everyone’s experience is different, but most people will experience some version of ‘brain fog’ or ‘chemo brain’. Cancer survivorshipthe ongoing care and support people with cancer receive after cancer diagnosis and treatment programs are well-placed to help with recovering from cognitive impairment and there is extensive ongoing research looking to identify best practice for expediating brain recovery.
Authored by Dr Emily Isham