Cancer treatments like chemotherapy can cause cognitive difficulties, ranging from temporary and mild to potentially long lasting.

Receiving a cancer diagnosis is undoubtedly challenging, and the treatments involved can bring various side effects, such as pain, fatigue, and cognitive difficulties.

Among the long-term side effects, “chemo brain” can be particularly challenging, leading to memory and concentration problems that significantly impact daily life.

Chemo brain, also known as cancer-related cognitive impairment (CRCI), is a term used to describe cognitive changes and difficulties in thinking, memory, and concentration that some cancer patients may experience during and after chemotherapy treatment.

These cognitive changes can affect your ability to process information, recall memories, and perform everyday tasks.

Chemo brain symptoms

Some common symptoms of CRCI include:

  • memory problems (difficulty in remembering names, dates, or recent events)
  • mental fog or trouble concentrating
  • difficulties with multitasking
  • slower thinking
  • decreased attention span
  • trouble finding words
  • reduced problem-solving abilities

The impact of chemo brain varies, with some experiencing mild and temporary cognitive difficulties, while others face more severe and lasting challenges.

Most research on chemo brain focuses on patients from diagnosis to 18 months post-treatment, but some evidence suggests that cognitive impairments may persist for years beyond this period.

In a study of breast cancer patients undergoing chemotherapy, the patients (36.5%) reported more cognitive difficulties than noncancer controls (13.6%) both after chemotherapy and at a 6-month follow-up.

Lower cognitive function scores in patients were linked to anxiety and depression, emphasizing the need to address both cognitive difficulties and emotional well-being during chemotherapy.

Long-term cognitive side effects of chemotherapy

Long-term side effects of chemotherapy can vary depending on the type and dosage of chemotherapy drugs used, as well as your overall health and response to treatment.

Some common long-term side effects of chemotherapy may include:

  • cognitive impairment
  • fatigue
  • peripheral neuropathy (nerve damage)
  • heart problems
  • fertility issues
  • risk of developing secondary cancers later in life
  • bone density loss
  • lung damage
  • hearing loss
  • emotional and psychological effects (e.g., anxiety and depression)

Research suggests that chemo brain affects up to 75% of cancer patients during treatment, with 35% reporting symptoms post-treatment.

Evidence indicates that chemotherapy can lead to structural changes in the brain, trigger neuroinflammation, and reduce the generation of new brain cells in the hippocampus. These changes may contribute to the cognitive dysfunction seen in chemo brain.

Overall, CRCI can be linked to:

  • cancer itself
  • chemotherapy
  • surgery
  • radiation
  • hormone therapy
  • immunotherapy

Chemo brain risk factors

Chemo brain appears to be more common in individuals who receive high doses of chemotherapy, according to the American Cancer Society. And its likelihood increases if the brain is also exposed to radiation therapy.

Here are some other risk factors for chemo brain:

  • type of cancer, such as brain tumors
  • older age
  • types of treatment drugs, including steroids, anti-nausea, or pain medicines
  • surgical procedures and anesthesia drugs
  • infections
  • hormone changes or hormone treatments, especially in postmenopausal individuals
  • nutritional deficiencies
  • other medical conditions, like diabetes or high blood pressure
  • substance use, including alcohol or other substances affecting mental state
  • presence of other symptoms like tiredness, pain, or sleep problems
  • emotional distress, such as depression or anxiety
  • weakness or frailty

Cisplatin is a chemotherapy drug commonly used to treat various types of cancer. While it’s effective at destroying cancer cells, it can also have side effects on healthy cells, including those in the brain.

Research suggests that cisplatin can lead to an increase in the levels of a fat molecule called S1P (sphingosine-1-phosphate) in certain areas of the brain. This increase in S1P is thought to play a role in the development of chemo brain by promoting inflammation and affecting mitochondrial activity.

Treatments targeting S1P receptors have shown promise in preventing or reducing chemo brain symptoms in animal models treated with cisplatin. These treatments involve drugs that are already approved by the FDA for treating multiple sclerosis.

As of now, there’s no specific cure for chemo brain, but there are strategies that may help alleviate its symptoms and improve cognitive function.

  • Balanced diet: Eating a healthy diet is important for brain health in general, but possibly more so for people with cancer. One review highlights the potential benefits of cancer patients increasing consumption of vegetables, nuts, Concord grape, and onions, but larger studies are needed.
  • Cognitive rehabilitation: Engaging in cognitive rehabilitation programs — which may include memory exercises, problem-solving tasks, and mental exercises — can help improve cognitive function and alleviate chemo brain symptoms.
  • Stay mentally active: Engage in mentally stimulating activities, such as puzzles, reading, or learning new skills.
  • Get regular exercise: Research shows that regular physical activity before and during chemotherapy is associated with better cognitive function immediately and 6 months after chemotherapy.
  • Limit alcohol and substances: Avoid excessive alcohol consumption and substances that can impair cognitive function.
  • Omega-3 fatty acids: A rodent study found that omega-3 fatty acids administered alongside doxorubicin chemotherapy may protect against depressive-like behaviors, reduce neuroinflammation, and prevent neural damage. The study also found that a diet high in sugar may counteract the beneficial effects of omega-3 fatty acids.

When to see a doctor

Consider seeing a doctor if you experience persistent cognitive difficulties, such as memory problems, difficulty concentrating, or mental fogginess, during or after cancer treatment. These cognitive impairments should be significant enough to impact daily functioning and quality of life.

Chemo brain, or cancer-related cognitive impairment (CRCI), is a real and challenging condition that affects some cancer patients during or after treatment.

While not everyone experiences chemo brain, those who do may face difficulties with memory, concentration, and mental sharpness, which can impact their daily activities and quality of life.

If you or a loved one is experiencing chemo brain, it’s important to communicate with healthcare professionals about these symptoms. They can offer support, assess cognitive function, and provide guidance on potential interventions.