Cancer-related cognitive impairment: 6 questions to ask yourself

Have you ever struggled to think of a certain word, recall where you left your car keys or remember why you walked into a particular room? If you find yourself in these situations frequently, you might start wondering if your overall brain health is OK.

But how many missed exits or forgotten appointments should you register before you really start to worry? Are there any particular signs to look for that might indicate a problem with your cognitive abilities? And, do the answers change if you’re receiving chemotherapy or some other type of cancer treatment that affects brain function, a condition sometimes called chemobrain or brain fog?

These experiences could be signs of cancer-related cognitive impairment (CRCI), a common symptom of cancer or side effect of its treatment that affects memory, attention and mental clarity.

Here are six questions to ask yourself when determining whether or not to seek a cognitive assessment.

What types of changes have my loved ones or I noticed?

Any time you’re concerned about your cognitive abilities, the first thing to do is identify the trouble spots. These may include:

• Attention problems: Are you finding it hard to focus on projects or getting easily distracted during conversations?
• Cognition problems: Does problem-solving or multitasking feel harder than it used to be or take more time to accomplish?
• Executive function problems: Does decision-making seem more difficult? Have you not been following through with any items on your to-do list?
• Language problems: Is it harder to find the right words to express your thoughts or feelings?
• Memory problems: Are you struggling to remember what someone just told you or what you intended to do?

Pinpointing your particular areas of concern is important. Because if you’re a 72-year-old with a recent history of cancer complaining of memory problems, those might be due to a neurodegenerative disorder. But they could also be due to cancer, treatment side effects, fatigue, distress, other medical conditions or normal aging.

How long ago did the changes start?

When did you first start noticing that it took more effort to process information or that you couldn’t always express yourself well? Did it coincide with diagnosis and treatment? Or did you and/or your loved ones have concerns even before that?

Here at UT MD Anderson, we often see patients either during or after chemotherapy, because that’s when they first notice a difference in their cognitive ability.

Did the changes come on suddenly or gradually?

Pinning down the onset of your symptoms can be really helpful.

Difficulties based on cancer may first be noticed in the context of diagnosis and treatment and might accumulate over time. Neurodegenerative processes, on the other hand, tend to develop more gradually.

Sudden and dramatic changes in cognition may signal an acute complication (such as an infection or a reaction to medication) that warrants an immediate medical work-up.

Do the changes ever come and go, or do they just get progressively worse?

When cognitive changes are cancer/treatment-related, most patients find that their issues even out or get better the further away from treatment they get. With dementia and Alzheimer’s disease, though, cognitive deficits are expected to progressively worsen over time.

Do any neurodegenerative diseases run in my family?

The odds are a bit higher that you may experience cognitive decline if Alzheimer’s or dementia runs in your family. But even having an immediate family member with one of those diseases is no guarantee that you will develop it, too.

Could anything other than mental decline be causing these changes?

Aside from cancer treatment and neurodegenerative diseases, your cognitive function can be influenced by many other factors, including:

• Anxiety
• Depression
• Fatigue
• Insomnia
• Menopause
• Stress

All of these conditions can temporarily reduce your mental capacity and cause you to forget things, make absentminded errors, or have trouble concentrating and making decisions. So, if you find yourself occasionally putting the salt shaker away in the freezer or a pint of ice cream away in the pantry, don’t panic. These are normal human errors.

When to be evaluated

Everyone forgets a name, misses a turn or puts something in the wrong place occasionally. We all have good days and bad days. They don’t necessarily mean anything is wrong with you.

It’s when an isolated incident becomes a recurring pattern that we need to start paying closer attention. Having to look at your calendar to keep track of a busy schedule is very different from constantly having to ask the same question repeatedly because you can’t retain any new information. The latter may indicate cognitive impairment, which is worth evaluating, regardless of its source.

So, my advice is to look into a cognitive assessment any time you notice consistent changes in your thinking that differ markedly from your usual baseline. Any significant, sudden change in cognitive function also warrants an evaluation, as do any issues that are getting progressively worse over time.

The goal of a neuropsychology evaluation is to determine each individual’s strengths and weaknesses and to identify factors that may be causing their difficulties. So, don’t worry if you can’t even fully explain your concerns. Each person’s circumstances might be different, but their reasons for seeking evaluation are usually very similar. It’s our job to clarify possible contributors and guide plans for intervention, regardless of the underlying cause.

Mariana Bradshaw, Ph.D., is a neuropsychologist at UT MD Anderson.

Request an appointment at UT MD Anderson online or call 1-877-632-6789.