|
This section has been reviewed and approved by the PLWC Editorial
Board, 02/05
Cognitive problems are difficulties in processing information, including
such mental tasks as attention, thinking, and memory. Cognitive problems
are also referred to as cognitive deficits or cognitive dysfunction.
Cognitive problems occur in as many as 20% of people receiving standard
dose chemotherapy. The problems can be very subtle or serious enough to
cause difficulties at work, disrupt relationships, and make it difficult
to complete daily activities.
Symptoms
Cognitive problems encompass difficulties in many areas, including:
- Difficulty concentrating
or paying attention (short attention span)
- Memory loss or
difficulty remembering things (especially problems with short-term
memory)
- Problems with
comprehension or understanding
- Problems with judgment and
reasoning
- Impaired arithmetic,
organizational, and language skills (such as not being able to
organize thoughts, find the right word, or balance a checkbook)
- Problems performing
multiple tasks (multitasking)
- Behavioral and emotional
changes, such as irrational behavior, mood swings, inappropriate
anger or crying, and socially inappropriate behavior (disinhibition)
- Confusion (delirium)
Of special note,"chemobrain,"
sometimes called "chemofog," is the
term often used by cancer survivors to describe the cognitive problems
experienced by some people after receiving chemotherapy. These people may
experience long-term problems with mental skills such as memory,
thinking, and concentration. People sometimes say that "chemobrain" feels like being in a mental fog.
Causes
Cognitive problems can be caused by many factors, including cancer,
cancer treatments, medications, or other disorders:
- Brain cancer
- Other cancers that
metastasize (spread) to the brain, such as breast or lung cancer
- Chemotherapy, especially
high-dose chemotherapy
- Head and neck radiation
or total body irradiation
- Brain surgery, in which
areas of the brain may be damaged or disrupted during biopsies or
the removal of cancerous tumors
- Hormone therapy and
immunotherapy (including interferon [Roferon,
Intron A] and Interleukin-2)
- Medications, including
some antinausea medications, antibiotics,
pain medications, immunosuppressants,
antidepressant/anti-anxiety medications, heart medications, and
medications to treat sleep disorders
- Infections, especially
those of the central nervous system (brain and spinal cord), and
infections causing a high fever
- Other conditions or
symptoms related to cancer or cancer treatments, such as anemia, fatigue,
stress, depression, insomnia, hypercalcemia (high blood calcium),
electrolyte imbalances, or organ failure
- Nutritional
deficiencies, especially iron, vitamin B, or folic acid deficiencies
- Other brain or nervous
system disorders unrelated to cancer
Management
Cognitive problems caused by a reversible condition, such as anemia or an
electrolyte imbalance, usually resolve after the condition is treated.
Likewise, problems caused by a medication should go away after the
medication is stopped. Problems related to cancer in the brain usually
improve with treatment, but some symptoms may continue. Unfortunately,
cognitive problems related to chemotherapy (such as "chemobrain"), radiation, or other cancer
treatments can continue indefinitely. Management of these long-term
cognitive problems may include:
- Medications, including
stimulants (methylphenidate [Ritalin]); cognition enhancing drugs,
commonly used to treat Alzheimer's disease (donepezil
hydrochloride [Aricept]); antidepressants;
opiate antagonists (naltrexone [ReVia]); and sometimes hormone replacement
therapy
- Occupational therapy and
vocational rehabilitation, to enhance daily living and job-related
skills
- Cognitive rehabilitation
(also known as neuropsychological rehabilitation) and cognitive
training, to help patients improve their cognitive skills and find
ways to cope with cognitive deficits
Suggestions for coping with cognitive problems
- Use a calendar or daily
organizer to keep track of appointments, activities, and important
dates (like birthdays).
- Ask people to repeat
information and write down new information (like names and phone
numbers); use a tape recorder or take notes during conversations.
- Post reminders and make
lists.
- Exercise your brain by
doing brain-strengthening mental activities, such as solving
crosswords or puzzles, painting, playing a musical instrument, or
learning a new hobby.
- Physical activity can
increase mental alertness. Try walking, swimming, doing yoga, or
gardening.
Cognitive deficits in children
Fortunately, approximately 70% of children with cancer can expect to be
cured. However, cognitive problems can occur in both adults and children,
and young children are especially susceptible to long-term (or late)
cognitive deficits. These long-term deficits are most common in children
who receive chemotherapy and/or radiation that is directed to the central
nervous system (CNS), such as head and neck radiation, total body
radiation, and chemotherapy delivered directly into the spine (intrathecal chemotherapy) or the brain (intraventricular chemotherapy). CNS-directed
chemotherapy and/or radiation are most commonly used to treat CNS tumors,
head and neck sarcomas, and acute lymphoblastic
leukemia (ALL). Children who are treated before the age of five are most
susceptible to cognitive deficits.
Long-term cognitive deficits can occur months or years after treatment
ends and can continue into adulthood. Long-term cognitive deficits in
childhood cancer survivors can include:
- Decreased overall
intelligence (lower IQ)
- Learning disabilities
- Decreased attention span
and attention deficit disorders
- Delayed development, including
delayed social, emotional, and behavioral development
- Lower academic
achievement (especially in reading, language, and mathematics)
- Decreased receptive and
expressive language skills
- Decreased nonverbal and
verbal memory skills
Children may be helped with occupational therapy, speech
therapy, behavior therapy, social skills training, cognitive
rehabilitation, and medications (such as methylphenidate [Ritalin] for
attention deficit disorders). Some children may need to learn new ways of
learning in school or maintaining attention. Additional in-school options
such as specialized reading and mathematics instruction, special
education programs, and IEPs (individualized
education programs) are also helpful. Because early intervention seems to
offer the greatest benefit, it is important for parents to be aware of
possible cognitive problems and to talk to their child's pediatrician or
oncologist as soon as problems are suspected.
Additional resources
CancerCare: Chemotherapy Related Memory
and Thinking Changes (Telephone Education Workshop, July 12, 2005)
Cancersymptoms.org: Cognitive Dysfunction
More Information
PLWC Feature: Late Effects of Childhood Cancer
PLWC: Managing Side Effects
Back
to Top
|
