Cancer and Treatment-related Cognitive Impairment or Decline

What is cognitive impairment?

Cognitive impairment is the decline in mental functioning, ranging from mild impairment, such as lack of concentration, to extreme impairment, known as delirium. Delirium can cause a state of confusion, excitement and disorientation.

How do people describe cognitive impairment?

People may describe cognitive impairment as “mental fatigue” or “chemo brain” and includes increased problems with distraction, feeling exhausted by tasks that require mental energy, or problems with handling complex information. In more extreme impairment, people may have difficulties with the sleep/wake cycle, changes in mood, or disorganized thinking and speech.

What causes cognitive impairment?

• The central nervous system, including the brain, is particularly sensitive to many cancer treatments. Many cancer treatments such as chemotherapy, radiation therapy and immunotherapy are not precise. They affect more parts of your body than just where the cancer tumor is located.
• Studies have shown that nearly 20% of individuals undergoing standard doses of chemotherapy, and 50% of individuals receiving immunotherapy (interleukin or interferon) experience memory loss, lack of concentration and mood alterations.
• Some cancers produce hormones or other chemicals that can alter brain function (acute leukemia and small cell lung cancer are two examples).
• Medications, such as those to treat infection and nausea, steroids and pain medications can impair mental function.
• Other causes include a lowered red blood cell count (anemia), nutritional deficiencies, and brain tumors.

How do people cope with cognitive impairment?

Here are some strategies that may work for you:

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

Brain-protecting exercises:

• 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

Education:

• 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.

Change your behavior:

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

• Try making lists to help you remember
• Develop a system to remind yourself of things you may forget such as appointments or birthdays
• Keep a calendar that lists what you may be forgetting

What can family members and friends do to help with cognitive impairment?

• 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 member and friends to buy crossword puzzles to work though.

How can I talk with my family members about cognitive impairment?

• 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.

What should I report to my doctor or nurse?

• Any changes in speech pattern, such as slurred speech
• A change in level of consciousness, not longer alert, or no longer able to recognize loved ones
• Changes in personality
• Serious mood changes

Where can I get more information?

Web Resources:

1. National Cancer Institute at http://www.nci.nih.gov/cancerinfo/pdq/supportivecare/delirium/patient/
2. Kaplan, J. & Kaplan, M. (2000). Chemo-Brain prevention plan at: http://www.managingmanagedcare.com/Controversies/CHEMOBR.doc
3. Oncology News International. (2001). New Directions in cancer-related cognitive impairment, fatigue and pain: http://www.cancernetwork.com
4. On the Internet at: http://www.cancersymptoms.org, click on cognitive dysfunction.

Other Resources:

1. Contact your health care providers
2. Contact the National Cancer Institute at 1-800-4-CANCER or through the internet at: http://cancer.gov/cancerinformation
3. 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.cancercare.msu.edu/