Coping with cognitive changes (chemo brain)

How are cognitive changes diagnosed?

Speak to your doctor or specialist nurse if you have symptoms of cognitive changes because of cancer or its treatment. They will want to understand more about your symptoms and what is going on. You might have blood tests or a scan to rule out other possible causes first.

They might ask you to fill out a questionnaire. Or they might refer you to a specialist for a neuropsychological assessment. This is to check how your brain is working.

The neuropsychological assessment involves an interview. You also usually carry out different tasks. At the end the specialist goes over their findings and suggestions of what to do to help. This is also fed back to your doctor or nurse who referred you.

Potential treatments for cognitive changes

There are no established treatments for cognitive changes. Several studies are looking at potential treatments that might help, but we need more research.

Some of the researched treatments include:

Cognitive training or rehabilitation

Cognitive training means regularly practising skills to improve:

• your attention

• the speed at which you’re doing things

• your memory

• executive functioning, meaning your ability to plan, focus attention, remember, and juggle multiple tasks

Physical activity

Physical activity can help with the physical and psychological symptoms of cancer and its treatment. There is some research that shows exercise can help with cognitive changes. We need more research to recommend the:

• type of exercise

• level at which you should do it, for example, moderate or vigorous

• length of an exercise session

Mind-body treatments

Treatments that might help with cognitive changes include:

• meditation

• guided imagery

• mindfulness

Talking therapy

Cognitive behavioural therapy (CBT) is a talking therapy. It can help you change and understand your thought patterns and how they affect how you feel. This can help reduce stress, anxiety and depression.

Drug treatment

The National Comprehensive Cancer Network (NCCN) recommends trying the above treatments before any drug treatment for cognitive changes. Some of the drugs that studies have looked at include:

• anti depressants

• anti dementia drugs

• medicines that stimulate the central nervous system (neuro stimulants)

Tips for coping with cognitive changes (chemo brain)

• Try to keep your life as simple as possible.

• Avoid trying to do too many things at the same time.

• Write lists about what you need to do, things you need to buy and where you have left important things. Stick or place them up where you can see them.

• Try to do the most difficult tasks earlier in the day.

• When away from home, it might help to carry a notebook to write things down or put them in your phone.

• Before an appointment write a list of questions and things you want to talk about.

• Keep a record of your previous hospital appointments and planned appointments.

• Ask if you can record conversations with your healthcare professional so you can listen to it again to remind yourself.

• When arranging to meet someone or organising an event, it may be helpful to write the details down and tell someone else.

• Try to talk to people somewhere quiet with few distractions.

• Keep a calendar on your wall in plain site or use the calendar on your phone.

• Try to follow a healthy well balanced diet.

• Aim to get a good night's sleep and rest in the day when you need to. Try to avoid becoming over tired.

• Try to do some physical activity each day if possible. This can help you to sleep and lift your mood.

• Keeping your mind active may help. For example doing crosswords, sudoku and puzzles.

• Use technology to help with reminders and set alarms. For example using a virtual assistant that you control with your voice such as Amazon Alexa, Google Assistant and Apple’s Siri.

It might help to tell those around you about your problems with thinking and concentration. They might have noticed some changes already. If family and friends are aware, they can help you with some of the above tips.

You might find some activities or tasks too stressful right now. It might help to avoid these things altogether if possible. Your family and friends can help with this. You may only have to do this for a short time until you feel more able to cope.

Further support

Talk to your doctor or nurse if you have cognitive changes and are finding it difficult. They might be able to refer you to a specialist to help you.

People with cognitive problems might also experience anxiety and depression. Counselling might help with this. Your GP might be able to refer you to a counsellor. Or there might be local services or charities you can contact.

Read about coping with cancer