Attention, Thinking, or Memory Problems

Approved by the Cancer.Net Editorial Board, 04/2018

Problems related to mental abilities are called cognitive problems. They 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 experience 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 activities. If you experience serious cognitive problems, talk with your health care team about managing those issues.

Signs and symptoms of cognitive problems

Managing symptoms, which can include cognitive problems, is an important part of cancer care and treatment. This is called palliative care or supportive care. Cancer and some cancer treatments can cause cognitive symptoms. Talk with your health care team about any symptoms you or the person you are caring for experience. This includes the following symptoms or changes:

  • Trouble concentrating, focusing, or paying attention

  • Mental fog or disorientation

  • Difficulty with spatial orientation

  • Memory loss or difficulty remembering 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, such as irrational behavior, mood swings, inappropriate anger or crying, and socially inappropriate behavior

  • Severe confusion

The level of these symptoms often depends on several factors including the person's:

  • Age

  • Stress level

  • History of depression or anxiety

  • Coping abilities

  • Access to emotional and psychological resources

  • Type and location of cancer

  • Type of cancer treatment

Causes of cognitive problems

Cancer survivors commonly use the word “chemobrain” to describe difficulty thinking clearly after cancer treatment. But people who do not receive chemotherapy also report similar symptoms. Some patients report these symptoms prior to beginning any form of treatment. Many factors can cause cognitive problems in addition to chemotherapy. These include:

  • Radiation therapy to the head and neck or total body

  • Brain surgery, in which areas of the brain may be damaged or disrupted during a biopsy or the removal of a cancerous tumor

  • Brain cancer, which could be either a primary brain tumor or cancer that has spread to the brain

  • Medications, which may include:

    • Hormone therapy

    • Immunotherapy

    • Anti-nausea medication

    • Antibiotics

    • Pain medication

    • Immunosuppressants

    • Antidepressants

    • Anti-anxiety medication

    • Heart medication

    • Sleep disorder medication

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

  • Other conditions or symptoms related to cancer or cancer treatments, including:

    • Anemia

    • Sleep problems

    • Fatigue

    • Calcium and electrolyte imbalances

    • Dehydration

    • Organ failure

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

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

  • Other brain or nervous system disorders unrelated to cancer

  • Social issues, such as:

    • Not being able to work

    • Loss of income

    • Change of role within the family

Managing cognitive problems

Cognitive problems from a treatable condition, such as anemia or an electrolyte imbalance, usually go away after the condition is treated. Likewise, problems caused by a medication should go away after stopping or adjusting the medication. Problems related to cancer in the brain usually improve with treatment, but some symptoms may continue. Unfortunately, cognitive problems related to chemotherapy, radiation therapy, or other cancer treatments can be long term. Management of these lasting cognitive problems may include:

  • Medications, including stimulants, cognition-enhancing drugs, antidepressants, and drugs that block how narcotics work, such as morphine

  • Occupational therapy and vocational rehabilitation to help people with the activities of daily living and job-related skills

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

Strategies for coping with cognitive problems

The following 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 write down notes and reminders. Or download a note-making app on your smartphone and tablet.

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

  • Place sticky notes around the house and at work 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.

  • Conduct brain-strengthening mental activities, 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. Then 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 help take notes and review them with you afterward.

  • 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.

  • Eliminate 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, do not be afraid to ask your family and friends for help. And talk with your health care team 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 therapy

  • Chemotherapy delivered directly into the spine or the brain

Possible cognitive problems include:

  • Decreased overall intelligence

  • Learning disabilities

  • Decreased attention span and attention deficit disorders

  • 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

Your child may receive occupational therapy, speech therapy, behavior therapy, social skills training, cognitive rehabilitation, and/or medications for attention deficit disorders to help treat cognitive problems. Some children may need to use new ways of learning in school or paying attention.

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

Related Resources

Mental Confusion or Delirium

ASCO Answers Fact Sheet: Chemobrain (PDF)

Long-Term Side Effects of Cancer Treatment

Late Effects of Childhood Cancer

More Information

LIVESTRONG: Cognitive Changes After Cancer Treatment

ASCO answers; ChemobrainDownload ASCO's free Chemobrain fact sheet. This 1-page printable PDF gives an introduction to chemobrain, including causes, symptoms, treatment, words to know, and questions to ask the health care team. Order printed copies of this fact sheet from the ASCO Store.