Chemo brain

Chemo brain refers to changes in memory, concentration, and the ability to think clearly. It is also called mild cognitive impairment (MCI). At the moment we don’t know exactly what causes these problems, or how many people are affected by them.

Chemo brain was first noticed by women who were treated with chemotherapy. But the term chemo brain can be misleading. Changes in memory and concentration can affect people with cancer who haven’t had chemotherapy.

Symptoms of MCI are mild or subtle and include difficulty concentrating, trouble remembering things, extreme tiredness and a feeling of mental ‘fogginess’. This can be frustrating and have a big impact on everyday life. Research is still going on to find an effective treatment. But there are things you can do to help yourself:

  • Keep a diary of your symptoms.
  • Make lists and taking notes to help you remember things.
  • Do mental exercises, such as crosswords.
  • Reduce your stress levels by listening to music or going for a walk.
  • Talk to your family, friends, doctor or nurse for more support.

What is mild cognitive impairment?

The word ‘cognitive’ refers to thinking or the way we process information. Impairment or dysfunction means that something isn’t working properly.

Mild cognitive impairment is a term used to describe changes in memory, concentration, and the ability to think clearly and put thought into action. Some people notice these kinds of changes happening during and after cancer treatment.

Originally, these problems were first noticed by women who had treatment for breast cancer. They reported changes in memory and concentration, which they linked to their chemotherapy treatment, and called it ‘chemo-brain’. However, the term ‘chemo-brain’ is probably misleading as research has shown that changes in memory and concentration can also happen in people who have had cancer but who have never had chemotherapy.

At the moment it’s not clear which treatments may cause these problems, or whether they may be caused by the cancer itself or by emotions such as anxiety and depression. So the term that’s now usually used to describe these problems is mild cognitive impairment (MCI) or cognitive dysfunction.

MCI can be very frustrating as it can have quite a big impact on your life. Its effects are usually temporary, but it can interfere with your normal activities. It may delay some people from going back to work, school or to social events.


Symptoms

The symptoms of MCI are usually mild or subtle, and vary from person to person. Most people are able to do everyday things, but they may find certain things are more difficult than usual. Common symptoms may include:

  • being unusually disorganised
  • difficulty concentrating and not being able to focus on what you’re doing
  • trouble finding the right word or being unable to finish sentences
  • trouble remembering facts you would usually remember such as names and dates
  • extreme tiredness (fatigue)
  • mental ‘fogginess’
  • difficulty doing more than one thing at the same time (multitasking), such as answering the phone while cooking
  • taking longer than usual to complete simple tasks
  • difficulty learning new skills.

If you think you may have symptoms of MCI you should discuss them with your doctor.

It can be helpful to keep a record of your symptoms to show the doctor, so that they can see how often and how much they are affecting you.


Who gets MCI?

It’s not clear how many people develop these problems with their concentration or memory during or after cancer treatment. Different research studies suggest quite different figures, ranging from about 1 in 6 people (16%) to more than two-thirds (69%). MCI can affect both men and women.


Causes and risk factors

The causes of mild cognitive impairment are unclear. Research suggests that it may be caused by a combination of factors. Some of the following may be possible causes and/or risk factors:

  • Cancer treatments, including chemotherapy, hormonal therapy, radiotherapy and surgery.
  • How or where in the body treatment is given. For example, chemotherapy into the fluid around the spinal cord (intrathecal chemotherapy), high-dose chemotherapy or radiotherapy, a combination of chemotherapy and radiotherapy (chemoradiation), and radiotherapy to the brain may make it more likely that you’ll experience MCI.
  • Side effects of cancer treatment, such as infection, low number of red blood cells (anaemia), extreme tiredness (fatigue), sleep problems, poor nutrition and menopause.
  • Emotional reactions to cancer and treatment such as anxiety and depression.
  • Other factors could be your age, and non-cancer medicines such as painkillers or anti-sickness (anti-emetic) medicines.


Can MCI be prevented or treated?

It’s difficult to prevent or treat MCI as it’s not clear what causes it. A number of drugs have been tried to help people with MCI, but as yet none has definitely been proven to be successful. Research is ongoing to find an effective treatment.

MCI doesn’t affect everyone and its effects are usually mild. It’s worth remembering that the benefits of your cancer treatment will usually far outweigh any risks of developing MCI. Your doctor or nurse will be happy to discuss your treatment with you if you’re worried about MCI.


Coping with MCI

The symptoms of MCI are usually temporary and improve with time. There are a number of things you can do to help yourself. Your doctors or specialist nurse can give you more information and support.

Keep a diary

Keeping a record of your symptoms may help you identify when you’re more distracted, or whether certain things make your memory worse. For example, you may notice that symptoms seem worse first thing in the morning, or when you’re tired or hungry. Noticing triggers or patterns like this can help you to plan your day so that you do more difficult tasks when you feel at your best.

Learn new coping strategies

You may find it helps to do some things a bit differently, to help you to concentrate and remember more. For example:

  • carry a notebook and make notes during conversations, after meeting new people or after making arrangements
  • use Post-it® notes with reminders on them and put them where you can easily see them
  • keep a calendar or diary - or use your mobile or smartphone calendar if you have one - to help you remember important dates and appointments
  • when making arrangements, check with people at the time to make sure you have the right information
  • make lists, such as a shopping list or a ‘to-do’ list, so that you feel confident that you won’t forget anything.

Mental exercises

Memory and repetitive exercises may help to train your brain and improve your memory and concentration. You can help keep your mind active by doing crosswords, word games or number puzzles like Sudoku.

It can also help to do some physical exercise as this can help you feel more alert and reduce fatigue.

Try to reduce stress

Stressful situations can affect everyone’s memory. Relaxation can help to reduce stress and may help to improve your memory and concentration.

Try doing some activities that will help you relax, such as listening to music or going for a walk. You could try using relaxation CDs or DVDs, or do some relaxation exercises.

Talk to your family and friends

Many people find that talking to family and friends about what they are going through can help. Mild cognitive impairment is often less obvious than other side effects of treatment, so you may need to explain how you’re feeling and how it’s affecting you.

Your family and friends may not be aware of MCI as a side effect of treatment. If they’ve noticed any symptoms, they may be relieved to know that they are fairly common and should improve with time.

Your family and friends will be able to support you better when they understand more about how you feel, and may be able to suggest ways they can help.

Other things that might help

Some other tips that might help are:

  • keep things simple - don’t take on too much and try not to multi-task
  • develop a manageable daily routine and try to keep to it
  • avoid distractions - for example, if you need to concentrate on something, sit in a quiet area and turn off the TV/radio
  • eat a healthy, well-balanced diet, especially lots of fresh fruit and vegetables - your doctor or nurse can give you advice or refer you to a dietitian, if needed
  • take regular breaks, and get plenty of rest and sleep
  • seek support from others in a similar situation - perhaps join an online forum or a local support group.

Talk to your doctor or nurse

Tell your doctor or nurse if you think you may have some of the symptoms of mild cognitive impairment. They should be able to help relieve any side effects of treatment (such as anaemia), that could be contributing to your MCI. They can also refer you to other people for specialist help, such as a dietitian, a counsellor for relaxation support, or a support group.

Before you see your doctor, it’s a good idea to write down how MCI is affecting you and to make a list of questions to ask. If your memory is bad, it may help to take someone with you or to record the conversation so that you don’t forget anything.


Research into MCI

To help understand more about MCI, research is being done to find out:

  • which chemotherapy drugs or combinations of drugs affect cognitive functioning
  • whether other cancer treatments affect cognitive functioning
  • what can be done to reduce the risk
  • what treatments can be used to improve symptoms of MCI.

To help guide the research, an international group was set up in 2006 by health professionals and patients. The International Cognition and Cancer Taskforce (ICCTF) aims to coordinate research, produce guidelines and give information to people affected by cancer. You can get more information about the ICCTF on their website.

You may be asked to take part in a research trial, and your doctor or nurse will explain fully what this involves. You don’t have to take part in the trial if you don’t want to and you don’t have to give a reason why.


Back to Side effects of chemotherapy

Possible side effects

There are many possible side effects to chemotherapy treatment, but they can be reduced. There are practical ways to manage them.

Possible effects on fertility

Chemotherapy can affect your fertility. If this is a concern for you, it’s very important to discuss it with your doctor before treatment.