Thinking, learning and memory problems

Up to 60% of people experience problems with learning, thinking and memory after their BMT. Problems with cognition after a BMT are often called chemo brain or chemo fog.

Although these problems can be frustrating and challenging, they generally improve over time. They do not increase the risk of developing dementia.

Symptoms

In most people, the changes are very subtle and often unnoticeable, but in a small number of people the changes can be significant and long-lasting. Symptoms of thinking, learning and memory problems include:

• Memory lapses (forgetting things or having trouble remembering things like names and dates)
• Trouble concentrating (difficulty focusing on tasks, spacing out and having a short attention span)
• Difficulty multi-tasking
• Problems with organisation and taking longer to finish things
• Difficulty remembering words during a conversation or finishing sentences

These problems usually improve or completely resolve over time, but some people may continue to experience this type of problem long after their transplant.

Causes

Many things can contribute to problems with thinking, learning and memory after a BMT:

• Chemotherapy
• Total body irradiation (TBI)
• Radiotherapy
• Long and/or recurrent admissions to hospital
• Fatigue and lack of sleep
• Depression and anxiety
• Hormonal changes
• Pain

Medications, such as:

• steroids
• pain relief medications
• sedatives
• anti-depressants
• anti-nausea tablets
• ciclosporin and tacrolimus.

Physical problems, such as:

• anaemia
• diabetes
• high blood pressure
• abnormal thyroid function.

Diagnosis

Sometimes it can be difficult to separate problems with thinking, learning and memory after a BMT from memory issues related to age or depression. There is no single test to diagnose these problems after BMT.

Depending on the symptoms and situation for each person, tests may be done to look at whether cognitive problems exist and how severe they are. These tests can also help find anything that may be causing or making the cognitive problems worse.

These tests may include:

• Full blood count
• Kidney, liver and electrolyte levels
• Urine, faecal and assorted infection tests
• Vitamin levels – particularly vitamin B12
• Thyroid function tests
• MRI scans of the brain.

Treatment

Treatment will target both the cause (if this can be identified) of problems with thinking, learning and memory and the symptoms.

Depression and anxiety:

• You may be referred to a psychologist or psychiatrist to assist with diagnosis and management of depression and anxiety. They may assist you by developing a treatment plan that may include cognitive behavioural therapy (CBT) or cognitive rehabilitation. These treatments help you re-learn some skills and learn new ways of managing and coping.
• You may also be prescribed medications to treat depression (anti-depressants), fatigue (modafinil), sleep problems (melatonin) or difficulty with concentration (methylphenidate).

For other symptoms, you may be referred to specialists including:

• Occupational therapists: can assess and help with activities of daily living
• Exercise physiologists: can help give you strength and energy, and keep you active and healthy
• Social workers: Can help you with strategies to reduce the symptoms of chemo brain and reduce the impact that it has on your life
• Cognitive rehabilitation specialists: can help by teaching you new methods and new tools for remembering
• Speech therapists: can help with swallowing and speaking clearly
• Job training and vocational counsellors: can help with new skills training.

Looking after yourself

There are many things you can do to help with thinking, learning and memory problems.

Seek support

• Talk with your BMT team. Let them know if problems with thinking, learning or memory are worrying you or are interfering with your daily life.
• Ask for help when you need it.

Live a healthy lifestyle

• Exercise. Even short periods of exercise can help improve memory, mood, concentration and learning ability. This doesn’t need to be vigorous exercise – walking, running, cycling, swimming or dancing can help.
• Get enough sleep and get treatment for sleep problems (including sleep apnoea). Rest is important too.
• Eat a healthy diet.
• Don’t smoke, avoid illicit drugs and drink alcohol in moderation.
• Reduce stress. Try meditation, yoga or any other activities you enjoy.
• Slow down. Take time to relax. Spend more time doing simple things. Think about what you want to say and do.
• Stay calm.

Use memory techniques

• Establish routines. Park your car in the same space every day, do chores and tasks in the same order.
• Use memory aides to help jog your memory and keep yourself organised. Calendars, daily planners, to-do lists or mobile phone reminders can all help.
• Make lists. Prioritise what you want to do and then check things off your list when you have completed them.
• Reduce distractions and try to avoid multi-tasking. Remove distractions, like the TV, when you are trying to concentrate.
• Create a memory station – a place where you can always put things you need every day, like your wallet, keys or glasses.
• Exercise your brain. Keeping mentally active is important. Reading, puzzles, crosswords, sudoku or playing cards – whatever you (and your family and friends) enjoy and find most stimulating.