How do people describe difficulty with memory and concentration?

People may describe cognitive impairment as “mental fatigue” or “chemo brain” or “brain fog”. This includes problems with distraction, feeling exhausted by tasks that require mental energy, or problems with handling complex information. Common symptoms are: reduced ability to concentrate, or short-term memory loss, difficulty in multitasking, decline in language or mathematical skills. Problems with comprehension may occur. In more extreme impairment, people may have difficulties with the sleep/wake cycle, changes in mood, altered perception, disorganized thinking and speech, or short-term memory loss.

What causes difficulty with memory and concentration?

The central nervous system, including the brain, is particularly sensitive to many cancer treatments. Cancer treatments such as chemotherapy (18%), radiation therapy and immunotherapy (50%) are not precise. They affect more parts of your body than just where the cancer tumor is located. Changes in the central nervous system may result. Some cancers produce hormones or other chemicals that can alter brain function due to rapid change in hormones. Poor nutrition—low levels of iron, vitamin B, or Folic Acid may result in cognitive changes, hypercalcemia. Medications, such as those to treat infection and nausea, hormone blockers, steroids and pain medications can impair mental function. Other causes include a lowered red blood cell count (anemia), nutritional deficiencies, and anorexia. Spread of cancer to the brain or brain tumors may result in cognitive changes. Stress and depression. Discomfort from other side effects such as pain, fatigue or nausea.

How do people cope with difficulty with memory and concentration?

Check with your doctor to see if you your treatment may cause cognitive problems. Here are some strategies that may work:

Brain stimulating exercises:

• Work a crossword or other kind of puzzle.
• Play a musical instrument.
• Take up a hobby such as needlework, crocheting or knitting.
• Paint a picture.
• Take up a hobby such as woodworking or gardening.
• Daily calendar and reminders.
• Read.
• Keep a daily journal.

• Try walking every day for 15-30 minutes, preferably outside.
• Take the stairs instead of the elevator.
• Take up gardening.
• Hiking, cycling and driving are also brain-protecting activities.
• Observe wildlife, birds and animals.
• Try meditation or guided imagery exercises.

• Learn more about your cancer: the more knowledge you and your family members have, the more effectively you can cope with the disease, treatment and problems that may arise.
• Look for a support group in your area: other people are having the same concerns or a similar circumstance.
• Combat fatigue—learn management strategies. (See fatigue)
• Reduce stimulants such as caffeine from your diet.

These hints may help you keep track of events that might otherwise be forgotten:

• Write down information.
• Concentration on what matters.
• Try making lists to help you remember. Post reminders.
• Develop a system to remind yourself of things you may forget such as appointments or birthdays.
• Keep pocket organizers.
• Keep a calendar that lists what you may be forgetting.
• Reduce stimulants like caffeine and nicotine.
• Maintain good nutrition.
• Get enough sleep.
• Seek support from others.
• Manage other side effects like pain, fatigue, depression, anxiety, nausea, and infection.
• Chew – chewing is a stress release.
• Keep a journal.

What can family members and friends do to help with my difficulty in memory and concentration?

• Ask family members and friends to help you by reminding you of important events.
• Ask a friend or family member to walk with you, or take up a new hobby with you (see above suggestions).
• Ask family members and friends to help you get information on your cancer (through the Internet, the American Cancer Society or the National Cancer Institute are some examples).
• Ask family members and friends to buy crossword puzzles to work though.
• Ask them to help you to cope.

• Ask for ideas to help improve your mental functioning.
• Tell family members how the cognitive impairment is affecting your emotions.
• Ask your family members for suggestions how to better cope.
• Ask your family member how your cognitive impairment in affecting them.

• Any changes in speech pattern, such as slurred speech.
• A change in level of alertness, no longer alert, or no longer able to recognize loved ones.
• Changes in personality.
• Serious mood changes that last more than a few days.
• Disorganized thinking.
• Inability to carry out usual daily activities due to cognitive abilities.

Web Resources:

• On the Internet at: http://www.cancersymptoms.org, click on cognitive dysfunction.
• People with cancer at: http://www.plwc.org, go to side effects.

• Contact the National Cancer Institute at: 1-800-4-CANCER or through the internet at: http://cancernet.nci.nih.gov.
• Contact the American Cancer Society at: 1-800-ACS-2345 or through the internet at: http://www.cancer.org.
• Visit the Family Care Research Program at: http://www.healthteam.msu.edu/fcrp.

• National coalition for cancer survivorship: cognitive issues. (2003). Retrieved July 14, 2003, from http://www.cansearch.org/resources/essential/default.aspx
• Cohen, M.Z. & Armstrong, T.S. (2003). Cognitive dysfunction. Pallative Care and Symptom Management. In C.H. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer symptom management, 3rd Ed. (pp. 635-650). Boston: Jones and Bartlett.