Mental blocks, forgetfulness, disorganisation, fogginess, problems with concentration – these are some things many cancer patients experience at some point. It could be mild, like forgetting where the keys are kept, or it could be severe, where the patient has trouble recalling events, names and dates; some even find it difficult to process a conversation.
Cognitive dysfunction - or chemo brain, as it is commonly known - is defined as a mental health disorder, which impacts a subject’s capacity for learning, perception, memory and problem solving, and affects almost 75 percent of all cancer patients.The general misconception amongst patients is that it is caused by chemo-therapy and radiation treatment.
However, the fact is that about 35 percent of cancer patients who complained of cognitive issues were not even on any treatment when the symptoms cropped up. Clearly, patients and families must be educated on the subject of cognitive dysfunction associated with cancer to facilitate effective management.
As the brain is the most complex organ in the human body, it is very hard to pinpoint the exact causes that lead to the disruption of cognitive facilities.
Radiation therapy may affect brain functionality when applied to or near the head, whereas certain chemotherapy medications and targeted drugs may affect the neurons and brain cells, causing mental dissonance.
Hormonal imbalance caused due to hormone therapy, particularly used in the treatment of breast cancer, may also hamper mental ability. However, contrary to public opinion, cognitive dysfunction may not be caused just by cancer therapy, but could be a result of the following factors as well:
The cancer itself, particularly brain, spinal or blood cancer
Medications used in conjunction with cancer treatment like anti-depressants, anaesthetics, steroids and the like
Fatigue or lack of sleep
Illnesses like diabetes, anaemia, electrolyte imbalance, hypocalcaemia and high blood pressure
Nutritional deficiencies, particularly vitamins and minerals like iron and folic acid
Genetic susceptibility to mental ailments
Secondary infections
Anxiety, stress or emotional pressure
Cognitive problems may occur at any time during diagnosis or treatment. Some patients continue to exhibit symptoms after the completion of cancer treatment, which may improve with time. The symptoms usually include:
Short attention span
Concentration issues Disorientation/mental fogginess Comprehension problem Difficulty with judgement or reasoning Memory loss/difficulty remembering details like dates, names and phone numbers Difficulty in having a conversation Impaired learning and lower IQ, particularly in younger patients Trouble with organisation as well as arithmetic Inability to multitask Emotional and behavioural changes; mood swings, irrational and inappropriate behaviour Delirium or severe confusion
The severity of these symptoms depends upon various factors like patient’s age, history of mental problems, patient’s ability to cope and emotional/ psychological resources available to the patient. Most patients are able to resume their everyday activities, but might need extra concentration and time to do regular tasks.
No definitive cures for cognitive dysfunction have been developed yet, but usually the patient’s cognitive functions improve with time once the problem causing it is treated.
In case the patient continues to suffer from long-term cognitive problems, medications like stimulants, opiate antagonists and cognition-enhancing drugs like those used for treatment of Alzheimer’s disease are found to be beneficial in restoring brain functionality to a sufficient level. Several do-it-yourself measures can also be implemented by the patient and family in order to manage the symptoms:
Organise everything neatly and remove the clutter. Label or colour code the drawers and cabinets; keep important things like keys at one place for easy access. Maintain and follow a daily schedule; maintain notes and reminders in planners, diary or cell phones for important tasks, like taking medication.
Mental exercises like puzzles, crosswords, learning a new hobby or playing a musical instrument could strengthen the cognitive ability.
Physical exercises, like swimming, yoga or walking, can improve motor function and mental alertness.
Avoid distractions when working; note down any distracting thoughts in a notebook for future reference. Try to avoid multi-tasking; instead, focus on completing one task at a given time.
Adequate sleep and plenty of rest could help the patient relax and decrease fatigue, while providing the brain adequate time to rejuvenate itself.
When implemented on a daily basis, these measures would not only help the patient in progressing towards normal functionality and decrease dependence upon family and friends, but also help restore the neurological function.
Vocation rehabilitation and occupational therapy are also available to provide assistance with day-to-day activities and job-related skills, whereas neuropsychological rehabilitation and cognitive training help patients to learn to cope with cognitive problems and improve their cognitive skills. Several studies and researches are also being conducted to determine the causes for cognitive dysfunction for developing definitive cures.
Cognitive problems may affect majority of cancer patients, but with adequate measures and support from family, friends and colleagues it is possible to help the patient lead a normal life. The challenge is not insurmountable; you just have to put your mind to it.
(The author is head, department of neurosurgery, Sri Balaji Action Medical Institute, New Delhi)
