How to Manage Your Brain Fog

Brain fog, previously known as “chemo brain” is the common term for what doctors call “cancer-related cognitive dysfunction.” It refers to changes in thinking and cognition that can occur before, during, and after cancer treatment.

As Annie Pettorelli, an occupational therapist at the JGH, explains, “chemo brain” is a bit of a misnomer.

“Doctors used to believe that chemotherapy caused brain fog,” she explains. “But research now shows it can happen to anyone after a cancer diagnosis. It doesn’t matter what treatments they receive.”

Around 40% or more of cancer patients will experience some degree of brain fog during their cancer journey.

The symptoms tend to be subtle and may not be obvious to people around them.

They include difficulty finding words, increased forgetfulness, and problems with planning or focus. Patients often notice these cognitive changes during active treatment and even years afterwards. Some people can even experience them before their diagnosis.

It’s annoying but not concerning

Brain fog is not a sign of progressive dementia. The symptoms tend to fluctuate and eventually improve rather than get steadily worse over time. However, brain fog can still significantly impact daily activities and the ability to work.

“Doctors don’t fully understand the causes of brain fog,” Annie explains. “It could be because of the cancer itself or toxicity from treatments building up in the body. Other causes include increased inflammation, high stress levels, poor sleep, and dietary changes.”

The best course of treatment focuses first on promoting healthy lifestyle factors. These are changes that benefit everyone, whether they have cancer or not.

“Stress management, sleep hygiene, eating well, staying active,” says Annie. “Those things have been shown to help manage the symptoms as much as we can.”

Research is ongoing on other treatment avenues.

“There’s some research into cognitive rehabilitation,” explains Annie. “The research is looking at brain games or word puzzles, for example. But the literature is mixed, so we focus on the more conservative things to start with.”

Lifestyle changes can help reduce symptoms, but are often not enough on their own. However, doctors don’t typically prescribe medication to treat the condition.

As an occupational therapist, Annie evaluates how brain fog affects daily activities and the ability to work.

“Maybe it’s difficult to engage in conversation with your loved ones because your concentration is not there,” she says. “Or maybe you can’t manage your medical appointments. You mix up dates and lose track of different appointments. You try your best to write everything down, but it gets all disorganized. You could also be worried about managing the household.”

Lifestyle changes aren’t the only solution

Sleeping more and having a better diet can help, but it’s often not enough. Occupational therapists will suggest personalized coping strategies and environmental modifications. For example, planning important tasks for times of day when your focus is better.

“For example, some people feel better in the morning,” Annie explains. “As the day progresses, they feel more fatigued. When they’re more fatigued, they have more brain fog. So we can look at scheduling important appointments in the morning. If you have to do something important in the afternoon, can someone go with you?”

The goal is to help patients carry out daily activities as fully as possible, despite the challenges of brain fog.

“When oncologists discuss the treatment plan, they don’t list all the side effects,” explains Annie. “It’s because they don’t want to overwhelm people. A lot of it is trying not to stress more about this situation. People with brain fog can see it as another unfortunate side effect of cancer. It’s relatively common and it shouldn’t be overly concerning.”

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