It is common and frustrating for cancer survivors to experience a condition generally referred to as “brain fog.” Some people may notice difficulties with concentration, memory, and/or thinking. They may have a hard time reading a book; repeating the same paragraph over and over, or they may find themselves needing to jot down notes that will help trigger their memory. Thinking may be slower and less efficient leading to difficulties, especially when trying to multitask.
While brain fog can manifest itself both during and after treatment, you may be surprised to learn that it can even start before actual cancer treatment begins. You may have heard the term “chemo-brain” but this reference is not quite accurate in its description since the clinical entity is often the result of a combination of many factors.
Researchers have found that this condition can be caused by many different factors: the tumor itself (through the secretion of circulating agents), lingering side effects of sedation (from procedures), changes in medications, new levels of physical activity, changes in nutrition, sleep patterns, vitamin levels, hormonal changes, cancer treatments and the emotional roller coaster that all of these new stimuli bring about. People who may have been on the verge of developing sleep apnea, may find that weight gain leads to the development of full-blown sleep apnea, which results in less oxygen to the brain overnight, and then less brain function during the next day.
Dementia screening tests usually do not pick up any abnormalities, because this type of brain dysfunction tends to be more subtle. The most essential part of a work-up includes talking with a provider who will work with you to try to find out when the brain fog started, which symptoms you experience and if they change over time, and what else may be going on in your life that may be a contributing factor. Sometimes your provider may order labs, brain imaging, or even neuropsychology testing. The more dysfunction one experiences from this, the more diagnostic and therapeutic tools providers will need to explore. On very rare occasions the condition may become so bothersome that a person may need to consider special accommodations such as seeking a disability status.
In general, there is no one remedy that is able to correct the condition quickly and completely. Relief is often the result of a multi-prong approach which tackles the most significant problems that were identified through a variety of options. Talking with your provider is the best first step. They will be able to discern what course, e.g. correcting laboratory abnormalities, referencing sleep apnea issues, and addressing resources for emotional support is the best path for your individual situation. Surprisingly, exercise has been the one consistent and most potent intervention found to be a major factor in cancer survivors to help many symptoms, including brain function. While we do not yet understand the connection fully, current studies are underway to explore these findings (better perfusion of brain or toxin removing organs?). A smaller subset of individuals may benefit from provider prescribed stimulants and/or brain training exercises
As far as current evidence tells us, “brain fog” does not represent a precursor of dementia. With the proper attention and intervention, the brain can, and and in most cases will, continue to improve. This process can take time and patience, but is an achievable result!
Relevant links from major cancer organizations: