NEW YORKThe cognitive and behavioral effects of brain tumors
and their treatment are often invisible to patients, caregivers, and
even clinicians, Robert A. Stern, PhD, said at a Cancer Care, Inc.
teleconference for patients and their families. Dr. Stern is director
of the Neuropsychology Program, Rhode Island Hospital, and associate
professor of psychiatry and neurology, Brown University School of
He urged patients and caregivers to ask their physicians for
referrals to specialists who can evaluate their cognitive and
emotional status following treatment for a brain tumor.
The most important thing to realize, he said, is that brain tumors
and their treatments, including radiation and chemotherapy, are
commonly associated with alterations of cognitive and behavioral
may include changes in personality and problems in organization, the
ability to juggle more than one thing at a time, concentration,
language, abstract thinking, movement, facial expressions, memory,
emotional functioning, and how the patient relates to others.
Often the patients doesnt complain about any of these
difficulties, Dr. Stern said. To those who are
interacting with the patient, it may seem like denial or some type of
defense mechanism, but with brain tumors, the brain damage can cause
patients not even to be aware of their neurological problems.
Without special training and experience in the assessment of these
cognitive and behavior changes, a physician may quickly examine all
of these areas and still miss the deficits. The fact that the
individual is alive, walking, and talking may be considered enough of
a success, he said, but the remaining person is not the same.
Dr. Stern urged caregivers to ask the patients treating
physician for a referral to a neuropsychologist for an evaluation.
The evaluation, which can take anywhere from 3 to 5 hours, will
indicate the relationship between the brain damage and behavior.
Once specific neuropsychological strengths and weaknesses are
determined, an individual treatment plan can be developed. The goal
of any cognitive rehabilitation treatment, Dr. Stern said, is
to exploit the intact areas of functioning.
Among those who can provide cognitive rehabilitation are
neuropsychologists, occupational therapists, and speech therapists,
Depression and Anxiety
Brain tumor patients may also experience anxiety, aggression, and
even delusions or paranoia associated with the brain tumor.
Depression in brain tumor patients is often directly related to the
damage caused by the tumor and the treatment, Dr. Stern explained.
Neuropsychiatristsphysicians with special training and
experience in the psychiatric manifestations of neurological
disordersmay treat this type of depression as well as other
emotional difficulties arising from brain damage with medication.
Neuropsychologists may provide psychotherapy and counseling, as well
as cognitive rehabilitation.
Dr. Stern warned that insurance companies, although they may pay for
neuropsychological evaluations, may, at first, refuse to pay for
cognitive rehabilitation and other forms of therapy. My
recommendation is, dont give up. Make demands. Ask to speak to
a supervisor. Explain that there is no reason why someone should be
left without treatment.