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8 Tips for Improving Cognition During and After Cancer Treatment

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*The information in this blog post is based on the webinar, “Understanding Cancer-related Cognitive Impairment,” hosted by the Kimmel Cancer Center's Breast Cancer Program.

Q: What can I do to improve my cognition during and after cancer treatment?

A: Use areas of cognitive strength to compensate for any weaknesses, advises Tracy Vannorsdall, PhD, a neuropsychologist at Johns Hopkins in the Division of Medical Psychology. “You may have to do things a bit differently, and it takes work to create new habits,” she says. “Make things a habit whenever you can -- research shows habits are more deeply ingrained and resilient than telling yourself to remember things.”

For example, she says, leave your keys, cell phone and wallet by your front door. Have a routine every night to get ready for the next day so you don’t have to stop and think things through. Vannorsdall also recommends the following tips:

1. Pay attention and become an active listener. Remind yourself to pay attention; stop every few minutes when listening to someone talk or to a lecture and notice if your mind has wandered. If you meet someone new, say their name to yourself five times and use it when you say good-bye. When taking notes, take them in your own words and process them so you’re encoding them deeply. Make new information as rich as possible – think in multiple senses and think of where you were when you learned something new.

“Learning and memory is like a file drawer,” Vannorsdall says. “You really have to attend to what is going in and organize it so you can pull out the information you need later.”

2. Give your memory a rest. Use memory aids – take notes, use index cards to write things down, create detailed calendars, use smartphone applications/apps, take photos or leave yourself voice messages. Become an active reader using the PQ4R method: preview the material, ask yourself questions, read it, reflect on it, recite answers to your questions, review what you’ve just done. Review your day before falling asleep at night. Memories become stronger and more permanent when you pull them up and review.

3. Set yourself up for success. “Multitasking is difficult,” Vannorsdall says. “Limit yourself to one activity at a time. Make a list of what you want to do or break down the steps in a large task, pick one task, and work on and complete it before moving on.” Minimize distractions -- get materials together, work in a quiet area or use a white noise machine, turn off alarms for email or social media; and give yourself plenty of time. Take breaks as needed so you stay fresh.

4. Stay mentally active. There is no one magic activity but diversity and novelty are important. Do new things to keep your brain healthy. “Like with physical exercise, where your body acclimates and needs to be pushed harder, our brains adjust, too,” Vannorsdall says. Socialize, play card games, take a class, do puzzles, or go for walks in new neighborhoods.

5. Eat a healthy diet and exercise. Walking and low-impact exercise like yoga, Qigong, and Tai Chi have been shown to improve thinking speed, memory, executive functioning, and improvement in quality of life in as little as one month, Vannorsdall says. Exercise can also decrease fatigue and improve stress.

6. Get good sleep. “Fatigue is a major issue in those being treated for cancer,” Vannorsdall says. “It’s closely tied to one’s degree of distress.” There is good evidence that memories are consolidated during sleep, and adults need six hours of natural sleep to make stable memories. Sleep medications can interfere with natural sleep patterns, she says. Keep a regular schedule for meals, medications, and exercise. Avoid naps, caffeine after lunch and alcohol within six hours of bedtime. Don’t smoke before bed or be too hungry or too full. Avoid strenuous exercise before bed. Establish rituals to help you relax each night, and don’t go to bed unless you are sleepy. Keep your bedroom quiet, dark and cool.

7. Learn how to manage stress. Cancer treatment can be stressful, between a person’s reaction to the diagnosis, managing treatment challenges and its impact on work and family life, Vannorsdall says. Deep breathing exercises or progressive muscle relaxation can help.

8. Pursue treatment. Some patients benefit from psychotherapy or supportive counseling, medications, or formal cognitive rehabilitation programs, where you attend a session once or twice a week and learn tools to use at home. Start a diary or log to track your cognitive problems – When do they occur? In what settings? This can give you a sense of when you do well or when you need additional help, Vannorsdall says.