One of the most frequent fears about brain tumors is that they might affect a person’s mind. We often divide the cognitive or intellectual functioning of the mind from the emotional, though they are intertwined. The most common cognitive deficits occurring in association with brain tumors are memory or attention loss. However, depending on the precise location of the tumor, deficits may be more specific – such as the loss of the ability for calculation or differentiation of right from left – or more subtle and generalized. They might simply involve a change in the speed of processing information or an alteration in judgment and insight. The deficits may be temporary or more permanent, depending on whether the cause is temporary swelling or permanent nerve damage in a particular part of the brain.
How are such cognitive deficits measured?
The simplest way to determine this is a brief mental status examination performed by an experienced clinician. The more definitive way is by neuropsychological testing, administered by a specially trained psychologist. Important to both tests are the observations provided not just by the patient, but by close family members or friends who are in a position to notice changes in thinking or behavior.
A brief mental status exam usually involves orientation to time and place, the ability to repeat and then remember new information (for example, three randomly chosen words), the ability to follow a series of simple tasks, the ability for sustained attention (for example, naming the days of the week in reverse order), the ability to use language (write a sentence, recall names of common objects, or repeat a phrase), or the ability to copy a simple drawing.
Neuropsychological testing involves a more detailed (2-4 hours) series of paper and pencil tests in all of these domains. Such testing can be threatening, but it is important to remember that its purpose is to measure change and not underlying intelligence. Detecting changes in judgment or planning is generally more difficult than detecting changes in memory or attention.
This kind of detailed information is helpful in evaluating the course of treatment, weighing the risks and benefits of a particular treatment, and in planning rehabilitation. Testing may also clarify very specific difficulties so that communication can be tailored to the needs and strengths of the patient.
What kinds of treatments are available?
Sometimes testing might even clarify that the reason for cognitive difficulties has more to do with an underlying depression than anything else. If this is the case, anti-depressants may be prescribed.
Some occupational and other therapists are trained to help patients compensate for deficits by writing down and organizing information in new ways, using techniques that rely on a patient’s existing strengths to overcome difficulties.
Knowing the extent of the difficulty might also help determine whether patients are able to resume driving, return to work, or even manage safely on their own.
Sometimes certain medications, such as stimulants, will be prescribed, which might increase the level of alertness and help to improve general cognitive function.
Such information about cognitive function might also help families cope with changes in loved ones and gain a greater understanding of those changes, however profound. There is sometimes a natural tendency, arising from frustration, to think that someone is not trying hard enough or making certain mistakes on purpose, or even being selfish.
A clarification that certain behavioral changes are neurologically based and beyond the patient's control can often be very helpful to families. Counseling may also help families respond as helpfully and realistically as possible in addressing the needs, not only of the patient, but of the whole family.
Dr. Malcolm P. Rogers is a psychiatrist at Brigham and Women’s Hospital in Boston, Massachusetts.
