Memory Problems - Memory Loss and Chemotherapy

Related: Confusion, Cognitive Problems, Memory Problems, and Seizures

Description: Memory is the ability for you to recall or remember information. Your short-term memory helps you to recall things; such as what you did a few minutes or hours ago. Your long-term memory helps you to recall things in your past, such as the name of your childhood pet, or where you lived when you were younger.

Memory problems occur when you are having trouble recalling information. A normal part of aging is to experience mild memory loss - have a little more difficulty with names, faces and places especially. This is because your brain stores information differently, and it may be harder to retrieve the information. Beyond simply age, however, some chemotherapy treatments are related to memory loss.

Symptoms:

• You may be unable to remember things, and have difficulty concentrating and following directions. You may feel "disoriented" at times.
• You may have trouble learning new things, or you may forget how to do things that you have done over and over again.
• You may have trouble handling money, or may forget what happened in a day.
• You may be more drowsy than usual. You may be overly tired, or very weak (fatigued). It may be hard for you to do any kind of your normal activities.
• You could have trouble falling asleep at night, or staying asleep. You may not feel rested after a long night of sleep.
• You may feel agitated, or "jumpy", with abrupt changes in your mood and behavior (mood swings)
• With severe confusion, you may not notice that your behavior is inappropriate. Your family and friends may notice the difference.
• You may have fever, or chills, if you have an infection

It is important to treat if possible the underlying cause of the memory problems, whether it is due to medications, illness, or your disease. Loss of memory may last from minutes, to days, or longer. This can affect your quality of life.

Cancer Therapies Associated with Memory Loss:

• Chemotherapy medications that contribute to confusion such as hydroxyurea, high dose ifosfamide or methotrexate.
• Biologic therapies such as: high dose interleukin-2, interferon.

Physical Conditions That Can Contribute to Memory Problems:

• Stress and anxiety - These affect your memory, concentration and your ability to learn things. With high levels of stress and anxiety, you may be unable to focus on important tasks, and perform your usual activities. It may be hard for you to concentrate, and function normally.
• Fatigue, or extreme tiredness- can cause problems with memory and concentration.
• Electrolyte disorders - such as high blood calcium levels (hypercalcemia); high or low blood sodium levels (hypernatremia or hyponatremia). Slightly elevated blood calcium levels may lead to a state of disorientation, or inability to concentrate. High blood calcium levels may lead to confusion.
• Dehydration- may lead to inability to concentrate.
• Heart problems- (your heart isn't pumping properly, causing less oxygen to travel to your tissues). This may make you confused, or disoriented
• Anemia- or low blood hemoglobin concentration may cause impaired memory. Hemoglobin carries oxygen to your tissues. With less oxygen, it becomes harder to concentrate.
• A severe infection in your blood or central nervous system, may lead to a state when you are not as alert.
• Brain cancer, or cancer cells in your central nervous system (such as lymphoma, or cancer that has spread to the brain), may lead to a confused state, or difficulty thinking.
• Endocrine or metabolic disorders - such as extremely high or low blood sugar levels in those with diabetes, or thyroid disorders

Other medications that contribute to cognitive problems are used to treat:

• Pain.
• Heart problems.
• Stomach upset.
• Infections - Infection in the blood, which produces a fever, may cause you to be less alert, or even confused.
• Alcohol use or abuse- the use of alcohol, and withdrawal from alcohol.

Symptom Management:

Things you can do (the patient):

• A memory problem should be evaluated if it begins to affect your lifestyle. If you have memory loss or any other changes in memory, thinking, or concentration, discuss them with your healthcare provider.

If you have a mild problem with your memory, or if you notice that you are starting to have difficulty with details:

• Keep one note pad or diary in your possession at all times. Write down everything that is important to you. Keep lists of things you need to do in the same place.
• Keep a detailed calendar of events at all times.
• With the help of friends or family members, try to keep a timeline, as to when you started having difficulty remembering things, and doing certain activities.
• Take a friend or family member with you to all your doctor's appointments. It helps to have someone else present, to clarify questions during and after the visit.
• Ask your family and friends for help. If you need assistance with certain activities, such as cooking, cleaning, and the laundry. It is okay to ask, especially if they have offered. You may need assistance in the home form awhile.
• Try to form a daily routine, and stick to it. Inform family and friends of your routine.
• If you are having trouble remembering names, ask a friend or family member, and repeat the name a few times. Although you may feel embarrassed, it is okay to admit that you are "forgetful", and ask the person for their name. (Ex: "Hi, I am ______. I know we have met before, but I am a little forgetful. What is your name again?")
• Keep your mind busy with crossword puzzles, or reading. Exercise your brain, just as you are supposed to exercise your body!
• If you take any new medications, or change your diet, make sure you tell all your healthcare providers. Certain medications may interact with one another, causing you to be confused.

If you are experiencing memory loss or other problems with your memory, they may lead to confusion. If you feel confused:

• Notify your friends, family and healthcare provider that you feel confused.
• Do not be left alone by yourself. It is important to have friends or family members around to assist you, when you need it.
• Make sure to keep familiar people around, to help re-orient you to your surroundings.
• Make sure you keep your environment quiet. Eliminate background TV or radio noises. Try to focus your attention while performing your tasks.
• If you are upset or agitated, your healthcare provider may prescribe certain medications to relax you.
• Wearing hearing aids and glasses may help to decrease the amount of confusion you are experiencing.
• Hallucinations are common, usually if the confusion is related to a medication. Discuss what you are experiencing. It helps to have someone around to explain or make "sense" of your possible visions and illusions. The visions that you see are very real to you, and may cause you to be frightened.
• If your hallucinations were an unfavorable side effect of medications, record the suspected name of the drug to tell other healthcare providers in the future. Also remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease.
• If you have pain, it is important to follow your healthcare provider's recommendations to control your symptoms. Prolonged episodes of pain can cause you to have problems with your memory and cognition. Make sure to keep a pain diary. Mark down the activities that affect your level of pain, and the things you do to relieve it.
• Pneumonia and the flu are common sources of temporary memory problems and confusion in adults. If you are over the age of 65 years, or have an altered immune system due to chemotherapy, chronic disease or steroid use, the Centers for Disease Control (CDC) recommends that you receive a flu vaccine every year, and a pneumonia vaccine every 5 years. Discuss this with your healthcare provider if this is right for you.
• Also to prevent pneumonia and lung infections: You need to circulate air from the bottom of their lungs and out of your lungs (oxygenation). Using an incentive spirometer for 15 minutes a day, twice a day, can help promote oxygenation.
• If you are still smoking, you should quit. Discuss with your healthcare provider techniques that can help you quit.
• Try to exercise, as tolerated, to maintain your optimal level of functioning. People with impaired memory may forget to exercise. Make a daily walk with a friend or family member a part of your routine. Even light walking may help you to promote the flow of oxygen in your lungs and blood (oxygenation), which will help your cognition. .
• Make sure to get enough sleep at night. People who do not sleep well at nighttime may have problems with memory and concentration in the daytime. If you have trouble sleeping:
• Do not eat or exercise within 2 hours of bedtime
• Make the room dark
• If you have an electronic clock, or one with an illuminated face, turn the face away from you.
• Use the bed only for sleeping
• Keep a consistent schedule. Make sure you go to bed each night and wake up each morning, at the same time.
• Minimize daytime naps. If you must take a nap, do not sleep for more than an hour at a time. Longer naps will make you feel more tired, and interrupt nighttime sleep.
• If these techniques do not work, consult your healthcare provider.
• Prolonged stress and anxiety may lead to memory and thinking problems. If you feel anxious, use relaxation techniques to decrease the amount of anxiety you have. Place yourself in a quiet environment, and close your eyes. Take slow, steady, deep breaths, and try to concentrate on things that have relaxed you in the past.
• Participating in support groups may be helpful to discuss with others what you are going through. Ask your healthcare provider if he or she is aware of any support groups that would benefit you.
• If you are ordered a medication to treat your memory problems, do not stop taking this, or any medications unless your healthcare provider tells you to.
• Take the medication exactly as directed.
• Do not share your pills with anyone.
• Many medications to treat pain may cause you to feel dizzy or drowsy. Do not operate any heavy machinery unless you know how the medication will affect you.
• If you miss a dose of your medication, discuss with your healthcare provider what you should do.
• If you experience symptoms or side effects or therapy, especially if severe, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Medications That May Be Prescribed for Treatment of Memory Loss

Treatment of memory problems is based upon treating the underlying cause.

Antianxiety medications - If your memory problems are due to long-term anxiety, your healthcare provider may prescribe an anti-anxiety medication, called an anxiolytic. These medications will help you to relax.

• It is important to take these medications only when you are feeling anxious.
• Do not operate heavy machinery, or drive an automobile while taking these.
• If these medications do not control your symptoms, discuss this with your doctor.

Antibiotics - If your doctor or healthcare provider suspects that you have an infection, he or she may order antibiotic pills or intravenous (IV).

• Commonly prescribed antibiotics for infections include azithromycin (Zithromax^®), and levofloxacin (Levaquin^®). These medications have broad-spectrum coverage, and are specifically good for lung infections, or pneumonia, that may have caused your confusion.
• If you are prescribed antibiotics, take the full prescription. Do not stop taking pills once you feel better.

Antidepressants - are used to treat depression in adults. People who are tired and depressed are at a higher risk for memory problems.

Bisphosphonates - Cancer cells that spread to the bone can secrete (produce) substances that can cause other cells found in the bone, called osteoclasts, to dissolve or "eat away" a portion of the bone. These tumors or lesions weaken the bone and can lead to complications. Some of the complications resulting from this bone breakdown are bone pain, fractures and hypercalcemia, (increased levels of calcium in the blood). Mild hypercalcemia can lead to changes in memory and concentration, while significantly high levels of blood calcium can lead to confusion.

• Bisphosphonates, such as pamidronate (Aredia^®), and zoledronate (Zometa^®) may be used to treat hypercalcemia (high blood calcium), and to decrease pain.

Corticosteroids: Corticosteroids work by decreasing inflammation (swelling) in many areas of the body. The corticosteroids prevent infection- fighting white blood cells (polymorphonuclear leukocytes) from traveling to the area of swelling in your body. This means you are more prone to infection while on steroids.

• You may be taking steroids if you have cancer that has spread to your brain. The swelling in the areas where the tumors are located could be causing your confusion.
• You may take steroids if you have a lung problem, such as Chronic Obstructive Lung Disease (COLD), and it is worse, which is altering your blood oxygen levels.
• It is important to note that while steroids are used to treat certain things that cause confusion, a side effect of this medication is mood swing. If you, a friend or a family member notice any changes in your behavior, notify your healthcare provider.

Narcotics -Long-periods of pain can cause you to be less attentive, and to have problems with memory. It is important to control your pain, to decrease your chances of memory impairment. However, a side effect of narcotics may be a confused state. However, be careful of narcotic medications that may cause you to be confused.

• Make sure you discuss with your healthcare provider common side effects, such as constipation, drowsiness, nausea and vomiting, and how to control these side effects.

Non-steroidal anti-inflammatory (NSAID) agents and acetaminophen - such as naproxen sodium and ibuprofen, may provide relief of headaches, and generalized pain. These may be appropriate medications in people with pain, who may feel confused. Unlike narcotics, NSAIDS and Tylenol^® rarely cause confusion.

• If you are to avoid NSAID drugs, because of your type of cancer or chemotherapy you are receiving, acetaminophen (Tylenol^®) up to 4000 mg per day (two extra-strength tablets every 6 hours) may help.
• It is important not to exceed the recommended daily dose of acetaminophen, as it may cause liver damage. Discuss this with your healthcare provider.

If you believe your memory loss and chemotherapy treatments are related, the following guidelines suggest when to call your doctor or health care provider:

• Fever of 100.5° F (38° C) chills or sore throat (possible signs of infection if you are receiving chemotherapy).
• Increased confusion, or falling "down"
• If you begin to become more confused, have trouble remembering how to handle money, or lose track of the days.
• If you have more trouble learning things than you usually do, or if you forget things that you have done repeatedly in the past.
• Feeling your heart beat rapidly, or experience palpitations
• Dizziness or lightheadedness, "feeling faint", especially if severe