Foggy Thoughts?

Elizabeth (Itzy) Otterbein, MS, CCC-SLP

Cancer related cognitive impairments (CRCI)- You may have heard it colloquially referred to as “chemo-brain.” Most individuals who have been through cancer treatment experience brain fog at some point in their journey and know it can be incredibly frustrating. But did you know that for some, the symptoms can last more than a year after concluding treatment?

If this sounds like you, you’re not alone! Recent studies estimate that around 40% of individuals who go through treatment for cancer report long-term changes to their cognitive functioning. A speech pathologist, trained in cognitive rehabilitation, can help you manage these symptoms.

What is it?

CRCI is defined as changes to memory, attention, processing speed, or executive functioning (problem solving, planning, self control, etc.) which begin at any point after a cancer diagnosis and impact daily function. In some cases, these changes are temporary. For many years, CRCI was believed to be an acute change due to the treatment toxicity which resolved with no lasting side effects after completing chemo; however, with higher survival rates, we now see more reports of cognitive changes beyond the first year after treatment.

What causes it?

The answer to this question is complicated and more research is needed to make a definitive answer, but here are some factors which likely contribute:

The cancer itself- Although it is often colloquially referred to as “chemo-brain,” research suggests some individuals with cancer experience changes to cognitive function before they start treatment. It is possible that the cancer itself causes systemic changes which stress the body and hamper cognitive function. This is especially true if the initial cancer is located in the brain or nervous system.

Chemotherapy- We now know that the chemicals involved in chemotherapy can cross the blood-brain barrier and can cause systemic inflammation including encephalopathy.

Radiation- This can cause changes to neural tissue, especially when delivered to the central nervous system.

Stress- Receiving a cancer diagnosis is one of the most stressful things that can happen to an individual. Research shows stress can impact cognitive function in a completely healthy system, causing racing thoughts and difficulty concentrating. It is likely that stress plays a role in the changes to cognitive function that cancer survivors experience as well.

Signs/Symptoms

If you are wondering what may qualify as cognitive changes here is a list of things that may indicate CRCI. If these sound like you, consider talking to your doctor about pursuing cognitive rehabilitation.

Changes to short-term and working memory: increased difficulty remembering names/ faces, frequently forgetting items such as phone/ wallet/ keys, walking into a room and forgetting why you are there, increased difficulty with mental math.

Changes to long-term memory: forgetting important dates, forgetting big events or important conversations.

Changes to attention: difficulty concentrating, feeling like you work harder to accomplish fewer tasks in a day, feeling overwhelmed when asked to juggle more than one task at a time.

Changes to executive functioning: struggling to create or stick to a plan, difficulty switching gears or feeling overwhelmed with rapid topic shifts in conversation, changes to your ability to self-regulate emotions or emotional outbursts.

It is important to note that everyone experiences bad days. None of us function at 100% all the time, but if these issues persist for several weeks and start to cause problems in your social, emotional, or work life, you may be experiencing CRCI.

Coping with CRCI

There are many lifestyle changes which can have a positive impact on your cognitive function. Here are some things you can do to improve your success.

expectations to reduce pressure. Practice advocating for yourself at work if your productivity expectations are unrealistic. Practice cognitive restructuring. Negative self-talk and catastrophization piles on the stress. We all do it, but practicing positive thinking patterns can make a big difference in your overall mental and cognitive health. If you need assistance making this change, seek out a mental health counselor.

Fatigue: While it may seem counterintuitive, exercise is one of the most reliable ways to manage fatigue. Exercise helps to regulate our sleep/wake cycles which can lead to better sleep and improved alertness during the day. If you need help understanding how to work out safely and effectively, consider asking your doctor for a referral to a physical therapist who specializes in fatigue management.

Nutrition: What we take into our body has a huge impact on our overall function. It is recommended to increase your intake of foods high in antioxidants. A daily dose of blueberries, strawberries, or raspberries is a great place to start!

Strategies

Self-talk: Speak out loud to yourself about everything you are doing to avoid getting off task. The auditory input also helps with short-term memory encoding.

Journal. A nightly journal is one of the single best ways to improve memory function. You don’t have to make long, involved entries to see the benefits. Keep it simple! Who did you see? What did you do? Did anything unusual happen that day?

Stress management: Consider practicing progressive muscle relaxation (PMR) before attempting demanding tasks. There are videos available online for free that can walk you through this practice. Implement diaphragmatic breathing into your daily routine. It’s great for stress and releases happy hormones! Review your work-load and try to set realistic daily goals and

Active Listening: 60% of individuals who experience CRCI report withdrawing from social situations due to feeling “lost” or “slow.” Practice frequently repeating back or reiterating what was said during a conversation. It will make your conversational partner feel heard, and help ensure you are focused and engaged!

Cancer related cognitive changes can feel overwhelming and scary. If you are going through treatments right now, know that they may resolve on their own! If you do have long-term changes, you do not have to face them alone. A speech therapist can help walk you through implementing the strategies and lifestyle changes mentioned in this article.

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