Beating the Mental Effects of Illness
In many individuals, a serious illness is more than a challenge to the body—it’s also a major challenge to the brain. A health crisis may trigger feelings of depression and anxiety, or lead to cognitive symptoms such as confusion and problems with memory, decision-making and attention. These mental effects can be compounded by chemotherapy, radiation, or sedation. For older adults already weathering the brain effects of aging, a trip to the hospital or exposure to serious illness or rigorous treatment may be especially challenging.
It’s important for individuals battling illness to seek help for distressing mental effects, since they can result in structural alterations in the brain and/or permanent mental changes. For example, a recent review of chemotherapy-related cognitive dysfunction published in the journal Oncology cites data suggesting that five years after diagnosis, breast cancer and lymphoma survivors who received chemotherapy scored lower on cognitive tests than those who had not been treated with chemotherapy.
“A variety of factors related to serious illness may affect mood and cognition,” says William Pirl, MD, MPH, Director of the Center for Psychiatric Oncology at MGH. “These factors range from inflammation or fever to the effects of the illness and related medications or treatments. There is definitely some evidence that chemotherapy may affect the ability to focus attention. Not everyone will experience mental symptoms. However, when they occur, it’s important to ad-dress them.”
WHAT YOU CAN DO
Learning about the possible mental effects of a serious illness or injury can help you cope with symptoms if they arise. Good sources of information include:
- The patient’s medical team
- Associations linked to the patient’s condition, such as the American Cancer Society or the American Stroke Association
- Patient support groups
Patients can take steps to ameliorate some of these aftereffects by:
- Establishing a routine with fewer demands and responsibilities
- Organizing and simplifying the patient’s environment
- Minimizing distractions when performing cognitive tasks
- Using memory aids, such as to-do lists, calendars, Post-It notes, and organizers
- Asking for assistance when needed
- Getting plenty of sleep
- With a doctor’s permission, exercising regularly to promote the release of brain growth factors that speed recovery
- Seeking medical assessment for cognitive or mood problems that develop following their illness.
“Patients should ask their doctors about how their illness and recommended treatments are going to affect their mental functioning afterwards, in addition to their physical functioning,” Dr. Pirl says. “And if they are noticing cognitive or mood changes associated with an illness, they should consult their primary care doctor. They might benefit from changes in medication, screening and referral for the treatment of depression or anxiety, or a referral for cognitive rehabilitation to help them with their cognitive problems. In many cases there are things they can do to help them cope with the repercussions of their health crisis.”
Long-term challenges
Researchers have linked a long list of serious health challenges, including hospital-related experiences such as surgery, intensive care, or certain treatment protocols, with possible negative consequences for the brain that may last for days, months, or even years. Many involve direct harm to the brain, such as stroke or traumatic brain injury, or are caused by other factors, such as stress, fatigue, lack of sleep, anesthesia, certain medications, inflammation, delirium, chemotherapy, and radiation to the head. These factors may lead to cognitive symptoms, such as declines in attention, speed of information processing, memory, decision-making, and ability to multitask. Serious illness, disability, and loss of independence can cause psychological distress that may trigger agitation, irritability, frustration, anxiety, or depression.
Most of these effects improve over time for most patients. However, older patients may be more likely to have health issues that can aggravate cognitive problems. As many as 74 percent of older patients who spend time in the ICU develop delirium that is associated with serious and even permanent mood effects and cognitive changes in some patients. A recent study found that one year after being discharged from the hospital, 24 percent of ICU patients had cognitive scores similar to those of people with mild AD, and longer periods of delirium predicted greater cognitive impairment.
Coping
Awareness of the mental problems associated with serious illness is growing, and medical approaches are changing in an attempt to protect patients’ brains from negative effects. These changes include lowering anesthesia dosages, reducing sedation, and targeting physical problems that might lead to depression.
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