Brain fog or cognitive impairment

Many people report feeling vague or mentally foggy during treatment. They find it hard to concentrate or have memory loss. For some, this can be distressing and can affect their quality of life, their work, and even their sense of self.

This is ‘cognitive impairment’ – a very real and common side effect of chemotherapy and hormone-blocking treatments. People often describe it as ‘chemo brain’ or ‘brain fog’. It can also cause fatigue and sleeping problems.

For most people, the changes are small and they recover in the 6 to 12 months after treatment finishes. For some it takes longer.

Help and coping strategies are available.

Signs of cognitive impairment

Most people are still able to do everyday things. But you might notice you can’t do things quite as well as before you had cancer. You may also notice that doing those things takes more effort to concentrate and is tiring.

The side effects people describe include:

• memory loss and forgetting things you normally remember
• difficulty finding the right words for something
• difficulty following the flow of a conversation
• trouble doing (or focusing on) more than one thing at a time (multitasking)
• difficulty organising things or planning ahead.

These effects are significant for some people. They may mean they can’t do everything they could before treatment.

Causes of cognitive impairment  

The cause of memory and concentration problems in people affected by cancer is not clear. Possible causes include:

• the stress of the cancer diagnosis
• the chemotherapy treatment itself
• hormonal changes related to hormone-blocking treatments such as anastrazole, letrozole, exemestane, tamoxifen
• the natural ageing process.

Doctors sometimes describe it as mild cognitive impairment (MCI) or cognitive dysfunction.  

Where to find help

Remember to be easy on yourself. You are probably dealing with a lot of things, such as:

• stress around your diagnosis
• the impact of treatment for breast cancer
• family or work issues caused by your diagnosis and side effects
• pain and fatigue, which can also contribute to cognitive impairment.

It is important to reach out to your treating team and ask for help if you need to. They can develop a plan with you to address what might be affecting your cognitive function.

Cognitive rehabilitation

Cognitive rehabilitation programs aim to improve, restore or maintain mental function.

Programs includes mental challenges that you need to complete. Tasks are structured and repeated to encourage you to problem solve.

Ask if you can access a cognitive training rehabilitation program.

Occupational therapy

You may also benefit from occupational therapy. Occupational therapists work with patients to improve overall cognitive function and quality of life.

They may already be part of your treating team or work in your health service. If not, ask your GP to refer you to an occupational therapy plan as part of a Chronic Disease Management Plan.

To find a private occupational therapist in your area, visit Occupational Therapy Australia.

Support for anxiety and depression

Many people experience anxiety and depression during treatment for breast cancer and metastatic breast cancer. You may need psychological support or medication. Make sure you ask for the support you need, as depression and anxiety can make cognitive problems worse.

Find out about Counselling and psychology support and Ways your GP can help.

Workplace support

If you are struggling at work, you may be eligible for Service Australia's Work Assist program. This is for people who are at risk of losing their job because of illness, disability or injury. The program helps people access changes in the workplace so they can keep working.

Help from family and friends

Support for practical tasks can help to reduce the everyday demands on you. 

Let people close to you at home and work know about cognitive changes your treatment is causing. Try not to feel ashamed - this is not your fault. Telling them helps them know what you are trying to manage. Tell them how you’re trying to manage your mental load. Suggest ways you would like them to help, such as:

• checking in with you regularly
• asking you questions
• giving feedback.

Activities to improve brain fog

In our Online Network, people talk about brain fog and share what works for them. For many, it helps to find an activity that they enjoy.

Mindfulness and meditation

Any kind of yoga or mindfulness practice such as sitting or walking meditation can help. You will develop your ability to pay attention and focus and it can lead to better memory.

Think about stress management techniques that have worked for you in the past and try them again now.

Quizzes and ‘brain training’

‘Brain exercises’ or ‘brain training’ activities include reading, puzzles and quizzes. Some people find they feel more alert and have better memory if they do:

• crosswords or other word puzzles
• sudoku or maths quizzes

Digital ‘brain training’ applications (such as Brain HQ) have been found to improve how people affected by cancer perceive their memory.

Learning a new language, musical instrument or skill can also be helpful.

Physical exercise

Memory and the ability to make decisions (‘executive function’) have been shown to improve after mild to moderate exercise. Read about supportive exercise.

Note-taking

Carry a notebook or make notes or voice memos in your phone for things that are important to remember. 

Routines and rituals

Try rituals that help you remember, such as putting your keys in the same place each evening.

Focus on your strengths

Try things you know you can do well, rather than focussing on your weaknesses. Don’t be too hard on yourself.

Ways to manage daily tasks better

To reduce the feelings of overwhelm, here are some tips to make daily activities easier:

• At the start of the day, set aside some quiet time to plan out your tasks. 
• Make tasks easier by starting with an overall goal, then breaking it into smaller or more immediate goals, tasks or lists.
• Tick off the task once you complete it. This can create a surprising sense of satisfaction and achievement!
• Set time frames – but be realistic! Gradually work towards improving the time spent on tasks.
• Take regular breaks. 
• Keep your focus on one task at a time from your list.
• Keep your completed lists and plans for a while, in case you need to refer to them.
• Use reminders on your phone or computer to help you remember to take medications or attend appointments or tests.
• Take time to relax and wind down.
• Where possible, plan activities that need the most focus for the best part of your day.
• Try and get enough sleep.