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Feel Like You’re Losing Your Mind?

Chemo Brain May Be to Blame

by Gabriela Höhn, PhD

Knowledge image

Keep a memory log of everything on your to-do list and anything else you need to remember.

Undergoing chemotherapy for breast cancer several years ago, I began to fear that I was literally “losing my mind.” I knew about the usual side effects – hair loss, fatigue, nausea, loss of taste, insomnia – and was as ready for them as much as I could be.

But I hadn’t expected to forget new names or phone numbers, even after they were repeated several times. I didn’t know that I would have trouble concentrating on formerly routine tasks. I wasn’t aware that I could watch reruns of Law and Order without remembering that I’d already seen a particular episode, or if I did, that I wouldn’t remember how it ended. I even started doubting my own reality when I was told I had agreed to do something, as I had no recall of even having the conversation. And I would be easily distracted, finding items in odd places around the house – not because I had planned to leave my cell phone in the laundry basket, but because my attention had been pulled elsewhere at that moment.

Sometimes the simplest task or decision can seem too overwhelming, even for those who formerly juggled work, family, school, and other demands.

Author of Article photo

Dr. Gabriela Höhn

Much to my relief, my symptoms were “all in my head.” But I found out they weren’t that unusual. Many cancer survivors are all too familiar with the foggy thinking, frequent memory lapses, and concentration problems that are often part of the cancer treatment experience. Informally known as chemo brain, it often affects those in treatment for cancer with chemotherapy. However, chemo brain can appear in a variety of cancer diagnoses in which chemotherapy is not even used, suggesting that the symptoms may be caused by the cancer itself.

Whatever the cause, the effects are usually temporary and short-lived. Most survivors generally feel clearer and more like themselves when treatment ends, with continued improvement over the next year or so. However, for some of us, lasting difficulties in cognitive functioning can be unexpected and distressing.

Described clinically as cancer-related cognitive dysfunction, up to 30 percent of survivors experience long-term difficulties with memory, language, attention and concentration, visual-motor skills, and planning and organization. You may notice difficulties with word-finding (coming up with the correct word in a conversation) and problems focusing your attention or finding your way around. Sometimes the simplest task or decision can seem too overwhelming, even for those who formerly juggled work, family, school, and other demands. What can we do if we find ourselves wondering why the keys were left in the freezer – again? Quite a lot, it turns out.

Building on proven strategies I have used as a clinical neuropsychologist, here are some suggestions to help you cope with chemo brain.

Memory
Keep a memory log, journal, or even a voice recorder to keep track of everything on your to-do list and anything else you need to remember. If you’re tech-savvy, use your smartphone or laptop. Make checklists, and return things to the same place after using them. Write down names and phone numbers, and take note of when and where you meet someone new – it may come in handy later.

Attention and Concentration
Focus on one thing at a time, and minimize distractions. Establish daily routines, and take advantage of the times of day when your mental functioning is best. Don’t try to multitask; shifting attention between tasks takes a lot of mental energy.

Planning and Organization
Keep things as simple as possible. Organize your home, work, and medical papers. If needed, get help in setting up new organizational systems, or in maintaining ones you have already. Spread out appointments so that you don’t need to rush, and prepare as much as possible. For example, leave envelopes to be mailed on the floor by the front door so you won’t forget them when you leave the house.

Everyday Thinking
Double-checking can ensure that you haven’t left important things behind. Using your checklists frequently can reduce anxiety. Ask for help from others, even if you’re fiercely independent and never ask for help. Loved ones want to lend a hand. Exercise and good nutrition also help keep the brain in good shape.

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Dr. Gabriela Höhn is a licensed clinical psychologist and neuropsychologist in New York, NY. A cancer survivor herself, Dr. Höhn developed and conducts chemo brain workshops at Beth Israel Medical Center.

For a specialized chemo brain checklist, go to gabrielahohn.com.

This article was published in Coping® with Cancer magazine, November/December 2011.