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Understanding Memory/ Thinking Dysfunction
Reviewed: December 2006
 The causes of memory/ thinking dysfunctional problems are many, including the direct effects of cancer within the central nervous system, indirect effects of certain cancers, or effects of cancer treatments on the brain. Memory/ thinking impairments may be subtle and go unnoticed, but they may also represent a devastating collection of symptoms for people with cancer.
Possible Causes of Memory/ Thinking Dysfunction:
Medications
Many medications used to manage medical complications may cause side effects of cognitive impairment (immunosuppressive agents used in bone marrow transplant, antibiotics, steroids, drugs used to manage pain, nausea/ vomiting, and other cancer-related symptoms).
Infection and Anemia
Infections and low red blood cell counts (anemia) are common in people with cancer and may result in memory/ thinking dysfunction. People undergoing active treatment are particularly susceptible to infections and anemia.
Metabolic Problems
Some cancers themselves produce hormones or neurochemicals that alter the brain's function (small cell lung cancer and acute leukemia are two examples). Also, decreased production of thyroid hormones, produced by the thyroid gland in the neck, may reduce acuity of thinking and may be associated with low mood states. Dysfunction of the liver or kidneys may cloud mental functioning due to the accumulation of toxins within the blood that are normally excreted.
Nutritional Deficiency
Deficiencies in iron, vitamin B and folic acid may cause a decline in attention, perceptual-motor speed, memory, and verbal fluency.
Direct Causes of Memory/ Thinking Dysfunction
Tumors located in the central nervous system cause a predictable and progressive decline in mental functioning. In addition, the spread of cancer to the central nervous system can lead to memory/thinking dysfunction.
Symptoms of Memory/ Thinking Dysfunction in Cancer
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The symptoms of memory/ thinking impairment among people with cancer vary widely based upon severity of dysfunction.
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The symptoms of mild memory/ thinking impairment are often referred to as "chemo brain" or "mental fatigue" and include vulnerability in complex information handling, susceptibility to distraction, and exhaustion with tasks requiring mental energy. "Chemo-brain" represents a lack of clear thought, not remembering what you are talking about, failing to remember what you are doing, forgetting phone numbers, and asking questions only to repeat them 15 minutes later.
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A more extreme form of memory/thinking impairment more common in advanced illness is known as delirium. The symptoms of delirium include disordered attention and thinking commonly associated with lack of coordination in executing activities, disturbed sleep-wake cycle, disorganized thinking and speech, altered perceptions, and changes in mood. Different than dementia, delirium has an acute onset, has a fluctuating level of alertness, and generally only affects short-term memory.
A Short Portable Mental Status Questionnaire May Help Identify Memory/ Thinking Dysfunction
- What are the date, month, and year?
- What is the day of the week?
- What is the name of this place?
- What is your phone number?
- How old are you?
- When were you born?
- Who is the current president?
- Who was the president before him?
- What was your mother's maiden name?
- Can you count backward from 20 by 3's?
Scoring
0-2 errors: normal mental functioning
3-4 errors: mild cognitive impairment
5-7 errors: moderate cognitive impairment
8 or more errors: severe cognitive impairment
Reading the Scores
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One more error is allowed in the scoring if a patient has had a grade school education or less.
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One less error is allowed if the patient has had education beyond the high school level.
The BC Cancer Agency maintains a database on commonly used unconventional therapies available to cancer patients.
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