Mental Fog or “Chemobrain”

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Numerous breast cancer patients experience chemobrain, also described as mental fogginess or cognitive dysfunction, during and after cancer treatment. This condition can have serious repercussions on the quality of life of these people. 

Chemobrain explained

Chemobrain refers to the cognitive changes that impair thinking, learning, processing or remembering information, which can arise during and after cancer treatment. Even though chemobrain is a commonly used term, it is misrepresentative since chemobrain is not restricted to the cancer survivors who only received chemotherapy; surgery and radiation can also contribute to cognitive dysfunction observed in breast cancer survivors.

Studies point out that there are a multitude of causes of brain fog. It is related to cancer itself, the impact of the announcement of the disease, anxiety and fatigue, but also to the neurotoxic action of chemotherapy, oxidative stress (which attacks the cells) and hormonal or immunity disorders.

Chemotherapy, radiation and surgery, used to destroy cancer cells, can also damage surrounding healthy cells either by direct administration or by targeting the brain indirectly. Research in animal studies has demonstrated that chemotherapy may induce temporary reductions in cell growth in certain brain areas (such as the hippocampus) that are important for learning and memory.

Signs and symptoms of chemo brain may include the following :

  • Being unusually disorganized
  • Confusion
  • Difficulty concentrating
  • Difficulty finding the right words
  • Difficulty learning new skills
  • Difficulty  multitasking
  • Fatigue
  • Short attention span
  • Short-term memory problems
  • Taking longer than usual completing routine tasks
  • Issues with verbal memory, such as remembering a conversation
  • Trouble with visual memory, such as remembering an image

According to NCCN, the best approach to receive a complete picture of cognitive function is to get neuropsychological evaluation. Oncologists will determine if patients need this test or not

Risk Factors of Chemobrain

Studies highlight that there are a multitude of causes to develop chemo brain, especially for the short-term symptoms. Brain function problems could be caused or aggravated by these factors:

  • The cancer itself
  • Radiation therapy to the brain
  • High doses of chemotherapy or radiation
  • Chemotherapy combined with whole-brain radiation
  • Hormone changes or hormone treatments
  • Immune related dysfunction
  • Genetic predisposition
  • Fatigue
  • Sleep problems
  • Comorbid illnesses, such as diabetes
  • Depression
  • Low blood counts
  • Emotional state (stress, anxiety, worry)
  • Age
  • Nutritional deficiencies

How to reduce symptoms of chemobrain?

There are multiple things to help alleviate mental dysfunction, including:

  • Regular physical activity decreases tiredness and improves mood and alertness.
  • Brain exercise: signing up for classes, solving puzzles, or learning new languages are beneficial. Brain games websites such as lumosity.com and positscience.com are effective as well.
  • Daily planners to keep track of appointments, tasks, “to do” lists, important dates, websites, phone numbers and addresses, meeting notes, and more.
  • Getting sufficient rest and sleep
  • Eating vegetables: Research have shown that eating more vegetables is associated to keeping brain power as people get older.
  • Choosing a specific place to store commonly lost objects (like keys).
  • Avoiding multi-tasking and focusing on one thing at a time.
  • Talking to others and asking for help. Friends and relatives can provide help with daily tasks.
  • Tracking memory problems by keeping a diary of when memory problems are noticeable (e.g. after taking a medication, certain time of day, specific situation, etc.). This record will help persons living with chemobrain to avoid planning important appointments during those times.
  • Accepting the problem by shifting from thinking how much these symptoms are bothersome to coping with the diagnosis. As many patients have noted, being able to laugh about things is very helpful.

Does chemobrain ever go away?

For the majority of patients, chemobrain symptoms improve within 9-12 months after finishing chemotherapy. A smaller proportion of people (approximately 10-20%) may experience long-term effects.