Attention, Thinking, or Memory Problems

Approved by the Cancer.Net Editorial Board, 12/2016

Cognitive problems occur when a person has trouble processing information. This includes mental tasks related to attention span, thinking, and short-term memory.

Up to 75% of people with cancer have cognitive problems during treatment. And 35% have issues that continue for months after finishing treatment. These problems vary in severity and often make it hard to complete daily tasks. If you experience serious cognitive problems, talk with your health care team about managing those issues.

Signs and symptoms of cognitive problems

Managing symptoms of cognitive problems is an important part of cancer care and treatment. Talk with your health care team if you develop any of these symptoms or changes:

  • Trouble concentrating, focusing, or paying attention

  • Mental fog or disorientation

  • Difficulty with spatial orientation

  • Memory loss or forgetting certain things, especially names, dates, or phone numbers

  • Problems with understanding

  • Difficulties with judgment and reasoning

  • Impaired math, organizational, and language skills. This includes tasks such as not being able to organize thoughts, find the right word, or balance a checkbook.

  • Problems multitasking

  • Processing information slower

  • Behavioral and emotional changes. This includes irrational behavior, mood swings, intense anger or crying, or socially unsuitable behavior.

  • Severe confusion

The level of these symptoms often depends on several factors. These can include:

  • A person’s age

  • Stress level

  • History of depression or anxiety

  • Coping skills

  • Access to psychological resources

  • Types of cancer treatment a patient is receiving

Causes of cognitive problems

Cancer survivors commonly use the term “chemobrain” to describe problems thinking clearly after treatment with chemotherapy. But people who do not receive chemotherapy also report similar symptoms. Additional factors that can cause cognitive problems include:

  • Radiation treatment to the head and neck or total body irradiation

  • Brain surgery, when areas of the brain are damaged during a biopsy or the removal of a tumor

  • Hormone therapy, immunotherapy, and other medications, which may include:

    • Anti-nausea medicine

    • Antibiotics

    • Pain medicine

    • Immunosuppressants

    • Antidepressants

    • Anti-anxiety medications

    • Heart medicine

    • Sleep medicine

  • Infections, especially those of the brain and spinal cord, and infections that cause a high fever

  • Brain cancer

  • Other cancers that have spread to the brain

  • Other conditions related to cancer or its treatments. These include anemia, sleep problems, fatigue, high blood calcium, and electrolyte imbalances.

  • Emotional responses, such as stress, anxiety, or depression

  • Not having enough of certain vitamins and minerals, such as iron, vitamin B, or folic acid

  • Other brain or nervous system disorders not related to cancer

Managing cognitive problems

Cognitive problems often get better after taking care of a treatable condition, such as anemia or an electrolyte imbalance. Likewise, problems caused by a medication generally go away after stopping the drug. Problems related to cancer in the brain often improve with treatment, but some symptoms may continue.

Cognitive problems related to chemotherapy, radiation therapy, or other cancer treatments may be long term. Ways to manage these lasting cognitive problems include:

  • Medications, including stimulants, cognition-enhancing drugs, and antidepressants

  • Occupational therapy and vocational rehabilitation, to help people with daily tasks and job-related skills

  • Cognitive rehabilitation and cognitive training, to help patients improve their cognitive skills and find ways to cope with cognitive problems

Strategies for coping with cognitive problems

These strategies may help you better cope with attention, thinking, and memory difficulties and help you stay mentally sharp:

  • Keep a checklist of daily reminders. Put it in a convenient location, where you can look at it frequently. If necessary, keep another copy at work.

  • Do one task at a time and avoid distractions.

  • Carry around a small pad and a pen or pencil to easily write down notes and reminders. Or, download a note-making app on your smartphone and tablet.

  • Use a calendar or daily planner to keep track of upcoming appointments, tasks, and important dates.

  • Place sticky notes around the house and workplace to remind you of important tasks. You can also set reminders using your phone or email calendar.

  • Use word play, such as rhyming, to help you remember things.

  • Get plenty of rest.

  • Make time for physical activity to increase mental alertness. Try walking, swimming, or gardening. Yoga or meditation can also help you relax and clear your mind.

  • Try tasks that may help improve cognitive function, such as solving crosswords or puzzles, painting, playing a musical instrument, or learning a new hobby.

  • Don’t be afraid to ask your doctor questions, even if you feel like you are repeating yourself.

  • Keep track of the important facts you discuss with your doctor. You can use a special notebook, a voice recorder, the Cancer.Net mobile app, or an ASCO Answers guide. If it is too overwhelming, ask a friend or family member to go to the appointment with you. He or she can take notes and review them with you afterward.

  • Ask your doctor for a referral to a neurologist, psychiatrist, or palliative care physician for additional help.

  • Talk with your employer if you are having problems at work. Discuss ways your employer could support you, such as changing your workload or deadlines. Read more about going back to work after cancer.

  • Prepare for the next day by setting out the things you will need the night before.

  • Color code or label certain cabinets or drawers where you store things around your home.

  • Put things, such as car keys, back in the same place every time so you can easily find them.

  • Get rid of clutter.

  • Store important phone numbers in your cell phone or display them next to your home phone. You can also carry an address book in case you forget to bring your cell phone when you go out.

Also, don’t be afraid to ask your family and friends for help. And, talk with your doctor or other health care team members about counseling and other resources.

Cognitive problems in children

Young children (age 5 and younger) are more likely to have long-term cognitive problems. These cognitive problems can occur months or years after treatment ends and can continue into adulthood. The following treatments are more likely to cause cognitive problems:

  • Radiation therapy directed at the head, neck, or spinal cord

  • Total body radiation

  • Chemotherapy delivered directly into the spine or brain

Some of the possible cognitive problems include:

  • Decreased overall intelligence

  • Learning disabilities

  • Decreased attention span and attention deficit disorders

  • Delayed development, including delayed social, emotional, and behavioral development

  • Lower academic achievement, especially in reading, language, and math

  • Decreased ability to understand language or to put thoughts together in a way that makes sense

  • Decreased nonverbal and verbal memory skills

There are many ways to manage cognitive problems for children. These may include occupational therapy, speech therapy, behavior therapy, social skills training, cognitive rehabilitation, and medications for attention deficit disorders. Some children may need to change how they learn in school or pay attention.

Additional in-school options such as specialized reading and math instruction and special education programs are also helpful. Because early intervention seems to offer the most benefit, parents must be aware of possible cognitive problems. They should talk with their child's health care team as soon as they suspect a problem.

More Information

Managing Emotions

Survivorship

Late Effects of Childhood Cancer

Side Effects

Additional Resources

American Cancer Society: Chemo Brain

LIVESTRONG Foundation: Cognitive Changes After Cancer Treatment

CancerCare: Chemobrain