Ask the Expert: Cognitive Effects of Brain Tumours and Treatment

All sensations, perceptions, emotions, experiences, movements and memories involve the brain. Individuals diagnosed with brain tumours often report difficulty focusing, processing what they read, finding words when speaking, recalling event details, completing tasks in a timely fashion, remembering why they entered a room, and/or coordinating movements. Family members may notice changes in their loved one’s behaviour and/or motivation.

Neuropsychological effects depend on tumour size, momentum (the higher the grade, the faster the growth, the more evident the changes), and location. For example, most high-grade brain tumours involve the frontal and/or temporal lobe, which are highly developed areas responsible for memory formation, language, complex attention, visual processing and execution of movements, reasoning, planning and personality. In addition to specific changes, most individuals also experience diffuse, non-specific changes in mental stamina, alertness, speed of thinking, and overall ability to hold and work with information in mind. These changes may be due to a combination of inflammation, co-existing conditions (e.g., seizures), disconnection of functional networks, and/or the effects of the tumour pressing on healthy tissue.
 
Whereas treatment is crucial for survival, it may also result in adverse effects. Neighbouring healthy tissue may inadvertently be damaged during surgery. Chemotherapy agents may result in healthy cells being affected, especially in individuals with vascular risk factors. The early effects of radiation treatment may include headaches, nausea, and drowsiness as a result of increased swelling but these symptoms tend to improve with steroids. Later effects of radiation treatment, thought to be due to white matter damage, may involve slowed information processing, word and memory retrieval deficits, and diminished executive function (i.e., planning and organizational skills, and decision making). Age, genetic predisposition and other individual factors also play roles.
 
Due to the complex and variable nature of brain tumours, rehabilitation must be customized to address the individual’s specific pattern of challenges. Below are 10 general strategies to help address some difficulties:
 
  1. Implement a daily routine to reduce active processing of mundane tasks (e.g., always leave your keys in the same place)
  2. Pace yourself and rest as often as needed throughout the day
  3. Complete tasks during “peak” times of alertness and attention
  4. Reduce the number and complexity of tasks to complete; intersperse easy and fun activities
  5. Make short and long-term goals; break tasks into manageable “chunks” to be completed in a logical, step-by-step sequence
  6. Reduce distractions (internal and external) and avoid interruptions when completing tasks
  7. Use sub-vocal reminders and reorientation when completing tasks
  8. Use alarm clocks, to-do lists, or a daily planner to keep track of medications, tasks, and appointments
  9. Leave notes for yourself in prominent places (e.g., a list of morning routine on nightstand)
  10. Make sure to have conversations with others in the same room, while making eye contact
 

A special thank you to Dr. Matias Mariani, clinical psychologist and clinical neuropsychologist for the Supportive Care Program of the Northeast Cancer Centre, for generously offering his time to provide this important information.
 

Dr. Matias Mariani is the clinical psychologist and clinical neuropsychologist for the Supportive Care Program of the Northeast Cancer Centre. He also conducts assessment and treatment in private practice, has an appointment as assistant professor at Northern Ontario School of Medicine, and is a part-time instructor with the Psychology Department at Laurentian University.
 
At the Northeast Cancer Centre, Dr. Mariani assesses and treats individuals with brain tumours who are experiencing neurocognitive and/or psychological difficulties associated with their cancer diagnosis and/or treatment. Dr. Mariani has previously received Brain Tumour Foundation of Canada’s Award for Excellence in Psychosocial Oncology for his work with individuals with brain tumours. 
 

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