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After treatment and remission

Memory and attention

After leukaemia treatment some people notice changes in memory, attention or thinking speed. This topic explains why, how it is assessed and what helps in daily life.

Last updated: ~3 min read
A lantern in mist that is slowly clearing.
Figure 1.Thinking can feel foggy, but it often clears.

01Short answer

Memory and attention problems after treatment are often called “chemo brain” or cancer-related cognitive impairment. Signs include forgetfulness, trouble finding words, difficulty keeping focus, trouble doing several things at once and slower thinking. There are several causes: chemotherapy into the spinal fluid, high-dose methotrexate, cranial radiation (especially in ALL treatment and at a young age), as well as tiredness, poor sleep, anxiety, depression, anaemia and hormone changes. For many people the difficulties ease over the months or years after treatment; in children they sometimes appear years later as school demands grow. The COG recommends a neuropsychological assessment for children at risk. Things that help include planners and reminders, breaking tasks down, sleep, physical activity, school and work adjustments and cognitive rehabilitation.

02Simple explanation

This is often called “chemo brain”.

Signs: forgetfulness, poor focus.

Causes: treatment, tiredness, sleep, mood.

It often improves over time.

Help: organisation, sleep, movement, adjustments.

03Scientific explanation

Risk factors: according to the NCI, intrathecal and high-dose methotrexate, cranial radiation, treatment at a young age and female sex raise the risk of neurocognitive late effects.

In children: the COG notes that children treated for ALL more often have difficulties with processing speed, working memory and attention, which may appear later; a neuropsychological assessment is recommended.

Other causes: the ACS and CRUK stress that tiredness, insomnia, anxiety, depression, anaemia and medicines also affect thinking — and these can often be treated.

Support: the NCI notes that memory aids, daily routines, physical activity and cognitive rehabilitation can help.

04What happens in the body?

What does it feel like?

People describe thoughts feeling “foggy”, forgetting names or plans, and finding it hard to remember what they read.

Why does it happen?

Treatment can affect connections between brain cells; tiredness, sleep, mood and hormones also play a part.

A brain made of points joined by threads of light.
Figure 2.Memory is connections between brain cells.

How is it assessed?

The doctor first checks treatable causes such as tiredness, anaemia, thyroid, sleep and mood. A neuropsychologist assesses memory, attention and thinking speed with tests.

What helps day to day?

Planners and phone reminders, keeping things in the same place, focusing on one task, breaking big tasks into small steps, enough sleep and regular movement.

Organisation supports memory
Figure 3.Organisation supports memory.

School and work

For children, an individual education plan, extra time and a calm setting; for adults, flexible working and written instructions.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05Supporting memory and attention

Steps.

Notice — Forgetfulness, poor focus.1NoticeForgetfulness, poor focus.
Assessment — Neuropsychological testing.2AssessmentNeuropsychological testing.
Organise — Planners, reminders.3OrganisePlanners, reminders.
Recharge — Sleep, movement, rest.4RechargeSleep, movement, rest.
ClarityThinking becomes clearer.
School/workAdjustments help.
CalmStress eases.

06What helps (simplified)

DifficultyApproachWho helps
ForgetfulnessPlanner, remindersYou, family
Poor focusOne task, a quiet settingTeacher, employer
Slow thinkingExtra time, breaking tasks downSchool, work
Persistent problemsAssessment, rehabilitationNeuropsychologist

* Make a plan together with your doctor and specialists.

07Key terms

Chemo brain
A foggy feeling in thinking after treatment.
Cognitive
Related to thinking, memory and attention.
Working memory
Holding information for a short time.
Processing speed
How quickly information is handled.
Neuropsychologist
A specialist who assesses thinking skills.
Cognitive rehabilitation
Exercises that build thinking skills.

08Key points

  • These difficulties are common.
  • They often improve.
  • Get treatable causes checked.
  • Use planners and reminders.
  • Sleep and movement help.
  • Tell school and work.

09Frequently asked questions

Will this last forever?

For many people it improves over time; if it persists, support is available.

My child’s grades have dropped — what should I do?

Tell the doctor and the school; an assessment can help.

Do medicines help?

Sometimes your doctor may discuss this; the main approaches do not use medicines.

Are brain games useful?

Structured cognitive rehabilitation is more helpful.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Will this last forever?

  2. My child’s grades have dropped — what should I do?

  3. Do medicines help?

  4. Are brain games useful?

  5. Does this information replace medical advice?

My questions

12Sources

  1. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers
  2. National Cancer Institute (NCI). Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version
  3. National Cancer Institute. Memory or Concentration Problems and Cancer Treatment
  4. American Cancer Society. Chemo Brain
  5. Cancer Research UK. Cognitive changes (chemo brain)
  6. National Cancer Institute (NCI). Follow-Up Medical Care
  7. National Cancer Institute (NCI). Cancer Survivorship
  8. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  9. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
  10. NHS. Strength exercises
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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