Cognitive Impairment Associated with Cancer Treatment (More Commonly Known as Chemo Brain) - Written by Marilyn Abrahamson

Cancer patients undergoing chemotherapy treatment often grapple with a type of brain fog that manifests as a change in memory and thinking that can occur before, during, and after their cancer treatment. This disruption in cognition is widely referred to as chemo brain. 

Members of the healthcare community may use various terms to characterize this condition, such as cancer treatment-related cognitive impairment, cancer-related cognitive changes, or post-chemotherapy cognitive impairment.

Although the exact cause of chemo brain remains elusive, it can occur at any stage of cancer treatment. These alterations in memory and thinking skills can make it more difficult to perform everyday activities for work, school, or social engagements. Unfortunately, many people do not report it to their doctors until the symptoms significantly impact their daily lives. For this reason, it is crucial to get help and support, and promptly inform the doctor, regardless of the severity of the symptoms.

Specifically, people affected by chemo brain may experience memory lapses, difficulty with focus and concentration, challenges in recalling details, impaired multitasking abilities, difficulty learning new information, slower processing of information, and struggles with word retrieval in conversation. The duration of these symptoms varies among individuals. Some experience cognitive changes that resolve over time, while others endure more persistent symptoms. In most cases, the changes are subtle and may not be noticeable to others. Nevertheless, those affected by chemo brain are acutely aware of their symptoms, whether others notice them or not.

Can Chemo Brain Be Formally Diagnosed?

Whenever possible, it is important to diagnose the cause of any symptoms a patient may be experiencing as diagnosis validates a patient’s experience. It also improves quality of life by enabling appropriate treatment planning, supporting psychological well-being, ensuring safety, fostering research and development, and facilitating long-term planning for those affected. 

At this time, there are no widely used formal measures specifically designed to test for chemo brain, however, there are ways to confirm that symptoms are not always in the patient’s head.

Dr. Robert Bard, internationally known and recognized as a leader in the field of 21st Century 3-D Ultrasonographic Volumetric Doppler Imaging, and founder of Bard Cancer Diagnostics in New York City provides insight into this topic. Dr. Bard asserts that to determine the appropriate treatment protocols, it is important to assess intracranial pressure. In chemotherapy patients, intracranial pressure can be increased as a result of neuroinflammation (swelling in and around the brain), which can result in an alteration of cognitive function. One way to assess intracranial pressure is by using a non-invasive device called Transcranial Doppler Ultrasound. Dr. Bard explains that this device can also help differentiate cognitive symptoms caused by chemo brain from those caused by other symptoms experienced by cancer patients, such as depression or fatigue. 

Treatment of Chemo Brain

Currently, there are no medications approved for treating the symptoms of chemo brain. However, some activities can help manage the symptoms, such as exercise, cognitive rehabilitation and brain training, yoga, meditation, and mindfulness practices. 

Individuals dealing with chemo brain can also implement various compensatory strategies in everyday life. These could include writing down notes, tackling demanding tasks early in the day when energy and focus are at their peak, engaging in brain-stimulating activities, prioritizing good quality sleep, and seeking support from friends and loved ones. Keeping a detailed notebook or diary to document cognitive issues can help identify patterns that can be reported to the doctor.

Consulting with a healthcare professional is recommended if cognitive problems interfere with daily activities. Specialists such as neuropsychologists, speech-language pathologists, brain health specialists and coaches, occupational therapists, or vocational therapists may be involved to assess and offer guidance on managing cognitive problems.

Prevention of Chemo Brain

At present, there is no known method to prevent the cognitive changes associated with chemo brain as the underlying causes continue to be a subject of research. However, it is observed that chemo brain is more prevalent in individuals receiving high-dose chemotherapy and those undergoing concurrent radiation therapy of the brain.

In closing, this condition known as chemo brain, while often subtle, calls for a proactive approach that includes seeking support from friends and family, adopting coping strategies and compensatory techniques, and maintaining open communication with healthcare providers. The resilience of those affected serves as a reminder that understanding, support, and ongoing research are essential in addressing the impact that cancer treatments have on cognition. It is also a testament to the strength of the human spirit in the face of adversity.

MARILYN ABRAHAMSON, MA, CCC-SLP-CBHC is co-owner of BrainThrive Consulting and co-creator of the ©Long Live Your Brain program, an online group brain health coaching program for people striving for more reliable memory, attention, and clearer thinking. More information can be found at www.longliveyourbrain.com. Marilyn is also an Amen Clinics Certified Brain Health Coach and has been a Speech-Language Pathologist since 1987.