How do common cognitive changes affect patients with brain metastases?

Many patients with brain metastases (cancer that has spread to the brain) notice changes in their thinking, memory, and attention. These are known as cognitive changes.

Some common cognitive changes can affect your ability to:

• Focus on tasks such as reading or writing
• Pay attention for long periods of time
• Remember details such as names, dates and phone numbers
• Understand what other people say
• Multitask (doing more than one thing at a time)
• Problem solve
• Remember what you want to tell someone

You may also:

• Feel lost or confused
• Have mood changes and mood swings
• Have trouble wanting to do things
• Feel upset about changes to your memory and thinking

What causes cognitive changes in patients with brain metastases?

Cognitive changes are different for every patient. These changes may be caused by:

• The brain metastases themselves
• Treatments for the cancer and the brain metastases
• Medicines for cancer and non-cancer related medical problems
• Medicines for sleep or pain
• Stress about your cancer diagnosis
• Pain
• Lack of sleep
• Dehydration (when you don’t drink enough water)
• Other changes to your body from cancer
• Lack of proper nutrition (diet and food)

Some patients will have more cognitive changes than others. Some patients will have more or less severe symptoms than others. This depends on many things, including:

• Your age
• The type of cancer you have
• The treatment you had
• The number, location, and size of your brain metastases
• Hormone changes (such as menopause — changes women go through when they stop having a period)
• Access to support and counselling
• Stress levels
• Sleep and being tired
• Mood troubles such as anxiety and depression

What can I do to manage my cognitive changes?

These tips may help you manage your symptoms:

Calendars. Use an agenda or day planner to keep track of things you want to remember. These may include dates and names. You can also use the calendar on your phone so you do not forget appointments and events.

Use sticky notes. Use sticky notes as reminders of things you need to do. Put them in places that you see often, like on your fridge.

Electronic reminders. Use your cell phone or iPad to remind you of things. You can set alarms for things you want to remember.

Take a picture. Use your phone or camera to take a picture of what you need to remember. For example, take a picture of the sign showing where your car is parked.

Use GPS, maps, or directions. Use GPS systems on your phone or in your car. A GPS system can help you know where to drive or walk.

Create regular routines. Keep your routine the same every day or every week. This makes it less likely that you will forget something.

Organize your home. A messy home makes it hard to find things. It is also easier to relax in a clean home.

Return things to their proper place when you are finished using them. For example, put your keys, phone and wallet in the same place every day. This will make it easier to find it when you need them.

Repeat. Say things you want to remember silently or out loud. Ask people to repeat what they say to you. Hearing things more than once can help you remember them.

Write in your journal or diary before you go to sleep. Include details you might want to remember in the future.

Relate new information to yourself or things you already know. This might help you remember it later. For example, if you meet a new person, think of someone you know with the same name.

Avoid multitasking. Complete one task before starting another. It is easier to focus when you only do one thing at a time.

Give yourself extra time. Give yourself extra time to do tasks.

Stay active. Do physical, social, and mental activities. These activities can help you feel better and have more energy. Examples of activities include:

• Crossword puzzles
• Painting
• Playing music
• Talking to friends

Eat healthy meals. Eat a balanced diet of fruits, vegetables, proteins, and grains. Your doctor can send you to a dietitian for more information. A dietitian is a health care worker who can help you choose which foods are healthiest for you to eat.

Drink enough water. Keep your body hydrated by drinking lots of fluids (especially water). Keeping hydrated is important for your brain health.

Get enough sleep and try to lower your stress levels. Cognitive changes can be worse when you are fatigued (when you have low energy) or stressed.

Below are some tips to reduce fatigue:

Get enough sleep. Try these tips to improve your sleep quality:

• Try to go to bed and wake up at the same time every day.
• Try to avoid electronic screens at least 1 hour before bedtime. Bright lights from screens can make it harder to fall asleep.
• Talk to your doctor if you are having trouble sleeping.

Reduce your stress. Stress causes mental fatigue. Here are some things you can do to reduce stress:

• Practice regular “breath” breaks. Take a few slow and deep breaths when you feel stressed.
• Practice mindfulness – you can find mindfulness exercises and apps online. Mindfulness means focusing on the present moment, which can help calm you.

Reduce noise. Noise can make it hard to pay attention. Try to make your spaces quiet. For example, turn the TV off when reading or talking.

How to keep yourself safe when you have cognitive changes

Confusion, memory loss, and stress can cause safety concerns. For example, you can put yourself in danger if you forget to turn off your stove. The tips below can help you stay safe at home.

Use timers and alarms. Always use cooking timers when using the oven or stove. This will help you remember to turn them off.

You can also use alarms to help you remember to do things. For example, you can also set an alarm at bedtime to check that your doors are locked.

Use your phone calendar to remind you to take your medicines. Set a daily alarm in your phone calendar to remind you to take your medicines.

Keep track of your medicines. Ask your pharmacist to put your medicines in a blister pack. A blister pack puts your pills in small containers for each dose. It shows you what day and time to take your medicine.

You can also buy a pill sorter at the drug store. You or a family member can put your pills in the sorter each week.

Write things down. Keep track of questions you want to ask your doctor during your appointment. Write down the answers during your appointment. Also write down anything they teach you.

Involve family and friends. Bring a friend or family member to your appointments. Your friend or family member can help you remember what is said at appointments.

Record your appointments. Record your appointments with your phone or sound recorder so you can listen to the information again.

Talk to your doctor

Talk to your doctor if you have questions about cognitive changes. Your doctor can help you manage these changes at home.