Forgetfulness, Confusion and Disorientation--Symptoms of Chemobrain

[Sangye]

This is from a JHU email newsletter I got today. I don't see why it wouldn't apply to lower doses of chemo, too.

Most cancer patients who undergo chemotherapy mentally prepare themselves for the side effects of chemotherapy: fatigue, nausea, mouth sores and hair loss. However, many are not ready for problems in concentration and memory -- the forgetfulness, confusion and disorientation that affect some people undergoing chemotherapy treatment. This condition has been dubbed "chemobrain" or "chemofog."

Chemobrain is an important issue for cancer patients because cognitive problems can have a negative impact on their ability to work or complete everyday tasks, and memory issues have a negative effect on quality of life in general. While cancer survivors have talked about these cognition problems for years in their support groups, the medical field had not given it much credence -- until recently, that is.

Research carried out over the past few years has involved cognitive testing, laboratory studies and brain imaging of patients undergoing chemotherapy. In a study in the journal Cancer, researchers from the National Cancer Center Hospital East in Chiba, Japan, noted that the shrinking of brain structures due to chemotherapy might be a cause of the memory complaints.

If you are a cancer patient and you have memory complaints, don't immediately suspect your chemotherapy. There could be other causes at work. Underlying medical issues, such as anemia or hypothyroidism, can cause cognitive deficits, and so can depression and poor sleep, with its accompanying daytime fatigue. Certain medications can also cause cognition problems.

If you are undergoing any type of cancer treatment or have just finished up your chemotherapy sessions, be sure to tell your doctor any problems you've observed with your memory or your ability to concentrate.

Although we still don't know definitively what causes cancer-associated cognitive changes and whether these changes will be temporary or permanent, one way to limit any mental confusion you may be experiencing is to stick to a routine, with written schedules and reminders to track appointments, activities and important dates. Using Post-It notes and placing them around the home and workplace is also a great way to create daily visuals to keep you focused.

[pberggren1]

Very interesting. Thanks Sangye. I have been quite foggy at times the past few weeks.

[Al]

This is good stuff, Sangye.

The one thing that raised a flag is the final note: "...one way to limit any mental confusion you may be experiencing is to stick to a routine, with written schedules and reminders to track appointments, activities and important dates. Using Post-It notes and placing them around the home and workplace is also a great way to create daily visuals to keep you focused." While this may indeed may be a good way to "keep you focused", I have to say that is does nothing for promoting cognitive health. That comes from novel experiences--doing something new every day, facing unpredictable situations and dealing with them. If you can't get out and explore new roads, at least solve puzzles, write letters, meet new people or start new conversations with old friends, learn a new language sort of thing. We can't help the brain fog that is part and parcel of the evil drugs, but we can do a pretty decent work-around.

Al

[Chris G]

These cognitive symptoms are the exact reason I told my doctors I wanted to stop taking mtx. I practically demanded it. I was in such a fog every day that I could not complete simple tasks. About 2 weeks after stopping mtx, I was sitting @ my desk @ work and I almost said outloud "omg I feel so alert!" Obviously the lower doses we take won't affect everyone the same way. But mtx caused bad chemo brain for me.

[HopeinTN]

I'm sure the Cytoxan is causing my brain fog. In additon to me locking myself in the bathroom while replacing a door knob, leaving the car in the garage for the night...still running...just to mention a couple, I leave myself post-its everywhere. Just yesterday I left one on my purse so I wouldn't forget that my dog was at the Vets. Good Times!

[Al]

I'm sure the Cytoxan is causing my brain fog. In additon to me locking myself in the bathroom while replacing a door knob, leaving the car in the garage for the night...still running...just to mention a couple, I leave myself post-its everywhere. Just yesterday I left one on my purse so I wouldn't forget that my dog was at the Vets. Good Times!

Right, Katrina. You need that pup around to remember those things you forget, and bail you out of the trouble you get yourself into!

Al

[HopeinTN]

Yes, he keeps me straight for sure! I've started forgetting if I have fed him or not. I need to create a sign to remind me. If can't ask him as he always thinks it's time to eat.

[drz]

I'm sure the Cytoxan is causing my brain fog. In additon to me locking myself in the bathroom while replacing a door knob, leaving the car in the garage for the night...still running...just to mention a couple, I leave myself post-its everywhere. Just yesterday I left one on my purse so I wouldn't forget that my dog was at the Vets. Good Times!

Are you on prednisone?

My neuropsychologist told me that my concentration problems (short term memory like forgetting an appointment or that you left dog outside and poor typing and proofreading skills) are from the prednisone I take. It was a surprise to him and me and my wife that my other cognitive functions had actually improved from a year prior to my Weg diagnosis and one year after gaining a drug induced remission. During my initial treatment for Wegs I had CTX, RTX, very low hemoglobin from anemia and bleeding, and was intubated in a drug induced coma for a couple weeks, plus numerous hypoglycemic episodes over many years from diabetes; all of which usually lower cognitive skills. So most of my lower cognitive skills must come from my diabetes and hypoglycemic (low blood glucose episodes--for Phil) since the Weg treatment didn't seem to result in any further decline. But I still forgot to attend the concert tonight even though I bought my ticket two days ago and wrote several notes to remind myself but put them away when cleaning lady came and forgot to take them out again. Darn pred meds!

[HopeinTN]

I'm on prednisone, cytoxan and bactrim, as well as knocking on the door to 40. I'm sure there are several contributing factors to my plight.

[Sangye]

Prednisone and ctx are the most likely culprits. High-dose pred is famous for messing up short-term memory and cognition. I was definitely more muddled while on it. Hormonal changes due to pred and ctx can cause cognitive problems. And if ctx is putting you into an early menopause, you've got those hormone changes as contributors as well. Fatigue is a major factor in cognition problems, too.

Unless you are seriously malnourished, I doubt that age itself is a factor in your case.