For many patients, a surprising side effect of transplant is a change in the way they process information.
These changes are called cognitive changes and can be very frustrating for both the survivor and family caregiver.
In some patients the changes are very subtle; in others they are more severe. You may experience:
- memory lapses
- trouble concentrating
- difficulty multi-tasking
- problems with organization
- difficulty remembering words during a conversation
These problems usually diminish or completely resolve over time, but some patients continue to experience cognitive issues long-term.
What Causes Cognitive Problems after Transplant?
Cognitive problems, often called "chemo brain" or "chemo fog", can be caused by a number of factors such as:
- depression or anxiety
- lack of adequate sleep
- hormonal changes
- medications, such as pain and anti-nausea drugs
- medical problems, such as anemia and hypothyroidism
The medical problems are easy to treat, so ask your doctor whether these may be contributing to your cognitive difficulties.
Managing Cognitive Problems after Transplant
There are several steps you can take to help with attention and memory problems.
- Exercise can help improve memory. It doesn't need to be vigorous exercise. Even short periods of exercise each day can help.
- Get sufficient sleep.
- Establish routines like parking in the same space each day or doing daily chores in a particular order.
- Use memory aids like calendars, daily planners or daily reminder features on an electronic device to keep yourself organized.
- Eliminate clutter. This includes visual distractions as well as distracting sounds, such as a TV turned on or conversations in the same room, while you are trying to concentrate.
- Slow down the pace of your life, even in daily conversation. Think about what you want to say and get your thoughts out one at a time.
- Repeat and rephrase what you hear in conversation. Stating it in your own words can help you remember it.
- Make lists and prioritize what needs to be done first. Check items off the list when you have completed them.
- Create a memory station for yourself - a place where you always put items you'll need the next day such as your keys, wallet and glasses.
- Automate when possible. Have your paycheck directly deposited into your bank account. Set up automatic, electronic payments for routine bills. Use automatic timers to turn appliances on and off.
- Reduce stress. Yoga and relaxation programs reduce stress, which can help with memory problems. Joining a support group or talking with a counselor can also reduce stress.
- Conserve energy. Schedule tasks for the times of day when you have the most energy. Break tasks into manageable segments and rest between.
- Don't stress about brain games. Keeping mentally active is important, but there is no evidence that brain games improve memory after transplant any more so than reading, playing cards, working puzzles or other activities that involve concentration. Choose the activity that is most fun and stimulating for you.
If you have cognitive changes that are severe or are interfering with daily activities, you may want to consult a neuropsychologist. The doctor can evaluate you and develop a treatment plan tailored to your needs.
The plan may include:
- cognitive behavioral therapy to help you re-learn old cognitive skills
Although no drugs have been specifically approved by the FDA for the treatment of cognitive problems after transplant, several drugs have been used "off-label" for this purpose, including:
- methylphenidate (Ritalin®, Concerta® or Focalin®)
- modafinil (Provagil®)
- antidepressants to address mood issues
- sleep medications