Although cognitive dysfunction has been most closely associated with chemotherapy, people who receive immunotherapy (interferon, interleukin), radiation therapy, or hormone therapy are also likely to be affected. People who take medications such as opioids (for pain), corticosteroids, or drugs for nausea and vomiting may also have cognitive impairment as a side effect of these drugs.

Why does this occur?

The causes of cognitive dysfunction are not clearly understood. It may be the result of damage to healthy cells from chemotherapy and radiation therapy. Studies have shown that, in some people, the parts of the brain that deal with memory and planning are smaller after chemotherapy. In addition, chemotherapy can cause anemia and fatigue, both of which may also result in cognitive dysfunction, especially the ability to pay attention.

When does this occur?

Cognitive dysfunction related to immunotherapy, chemotherapy, radiation therapy, or hormone therapy can occur during treatment but often does not occur until months or years after the end of treatment. Cognitive dysfunction related to other medications usually occurs during the time the medications are taken and resolve when they are no longer taken. How long cognitive dysfunction lasts varies from person to person.

How can this be managed?

If cognitive dysfunction is found to be caused by something other than cancer treatment (such as anemia, unmanaged symptoms, or a chemical imbalance in your blood), your doctor can prescribe appropriate treatment. If no underlying cause is found, your doctor or nurse will suggest simple measures to help you cope with the changes and improve your mental processing. If the cognitive dysfunction gets worse or continues for many months after treatment, there are additional treatment options. A drug commonly used to treat Alzheimer’s disease, donepezil hydrochloride (Aricept) has been effective for some people, as have stimulant drugs, such as methylphenidate (Ritalin). Occupational therapy or vocational rehabilitation may be helpful in improving the skills needed for daily living or for performing your job. Cognitive rehabilitation (also referred to as neuropsychologic rehabilitation) and cognitive training can help people improve their cognitive skills and learn ways to cope with cognitive deficits.

Ways to Cope Day-to-Day with Cognitive Dysfunction

Use a calendar or daily planner to keep all your important information in one place	Write down all appointments, activities, medication schedules, important dates (birthdays and anniversaries), “to do” lists, phone numbers and addresses, names of movies you want to see and books you want to read
Exercise your brain to strengthen your mental ability	Do crossword puzzles or other word or number games, do jigsaw puzzles, play card games, play a musical instrument, learn a new hobby, learn a new language
Get physical exercise to improve your mental alertness	Walk, swim, bike ride, do aerobics or yoga, garden
Establish healthy habits to help keep your mind and emotions healthy	Get proper sleep, eat a balanced diet, use humor to cope with your forgetfulness
Track memory and attention problems to help you determine when you are most affected	Write down the time of day, the situation, and any medications that are associated with cognitive problems
Don’t try to multi-task	Focus on one thing at a time
Ask for support	Tell friends and family that you’re having cognitive problems, ask people to repeat information or to write down new information (phone numbers, dates)

When should I talk to my doctor?

You should ask your doctor or nurse about the possibility of cognitive dysfunction with the treatment you’re receiving. It is also important to tell them when you first notice signs of cognitive dysfunction. Your doctor may want to do some blood studies to see if there is an underlying cause that can be corrected. Your doctor or nurse can also help you track the dysfunction to see if it gets worse and prescribe medication or rehabilitation, if necessary.