Coping With the Cognitive Effects of Brain Tumors

Cognitive rehab programs can help with the thinking and memory problems from a brain tumor or its treatment.

Elaine learned she had a tumor deep within her brain. After recovering from brain surgery, Elaine started getting lost on short trips to the grocery store--the same store she’d been driving to for years. Then she began having trouble with numbers, such as balancing her checkbook. After returning to work, she had trouble focusing on complex tasks. Often she could not remember conversations with coworkers. These problems continued after Elaine switched to an easier position. She eventually quit working altogether.

How Brain Tumors Affect Cognition

Elaine’s story is not unique. Brain tumors may affect your cognition, which is your ability to think, reason, and remember. Many people with brain tumors have problems with these kinds of cognition skills as well.

• Concentration

• Language skills

• Memory

Treatment for the tumor may also harm the brain and cause cognitive problems. Talk with your doctor to find out if your treatment might do this. These are some treatments that can cause damage.

• Surgery

• Radiation

• Chemotherapy

According to Yehuda Ben-Yishay, MD, professor of clinical rehabilitation medicine at New York University Medical Center and director of the Rusk Brain Injury Day Treatment Program, cognitive problems may affect both basic and advanced functions.

• Basic functions are thought, attention, and impulsive behavior

• Advanced functions are the ability to plan, organize, and make decisions

The location of a tumor and extent of brain damage determine the type and severity of the problems.

Cognitive problems may be slow to appear. You may not notice any problems at all while physically recovering from the effects of surgery or radiation. But when you get back to your normal routine, you may find tasks that used to be easy have become harder or even impossible.

Cognitive Rehabilitation Can Help

Cognitive rehabilitation can help people who have these problems. Mental exercises are one part of rehabilitation. Here are examples of exercises a therapist may design.

• To improve thinking and reasoning skills, a therapist may ask you to identify the key points in a paragraph, or review some facts and make the right conclusion.

• To improve planning skills, a therapist may ask you to organize a set of instructions.

Learning to use memory tools is another part of cognitive rehabilitation. For example, someone who misses a lot of appointments can learn to use a detailed schedule or calendar. Timers and alarm clocks may help you remember to do household tasks, such as turning off the oven. As you get used to using these tools, you will regain confidence in your ability to make it through the day without forgetting something important.

Ask your doctor or psychologist about cognitive rehabilitation programs. Many major medical centers and university hospitals have a rehabilitation center, which may have a cognitive rehabilitation program.

Step One: A Comprehensive Evaluation

Your first step in cognitive rehabilitation is a thorough evaluation by a neuropsychologist trained in brain-behavior relationships. This involves a series of interviews and standardized psychological tests. Your family may participate to help the neuropsychologist learn about your behavior both before and after the brain tumor. For school children with brain tumors, the psychologist may interview teachers and observe the child’s behavior in class. The evaluation paints a detailed picture of the cognitive problems and allows the psychologist to design a rehabilitation plan.

Cognitive Rehabilitation Takes Commitment

Cognitive rehabilitation programs can vary. They often involve a team of therapists, such as speech therapists and cognitive training specialists. Ben-Yishay describes the Brain Injury Day Treatment Program at NYU Medical Center as the most intensive and holistic (whole person) program of its kind. “Our trainees, as we call them, participate in 5-hour sessions 4 days a week, for a semester of 20 consecutive weeks. Half of our trainees engage in 2 semesters before returning to work.” Although other cognitive rehabilitation programs may be less demanding, be prepared to make a serious effort with your rehabilitation.

Before you start cognitive rehabilitation, you should be medically stable and have the physical and mental strength to have several hours of therapy a day. Once you enter a rehabilitation program, you may notice an improvement within a few weeks. Other problems may require months or years of work and persistence before improvement is seen.

Rehabilitation Can Be Expensive

Unfortunately, cognitive rehabilitation can cost a lot. Many medical insurance plans pay for most of rehabilitation. But some plans may not pay for extended rehabilitation or for approaches thought to be “extra.” Medicaid and Medicare may also limit payments for cognitive rehabilitation.

Here’s where to find information about free help.

• The Individuals with Disabilities Education Act (IDEA) provides for transitional programs for school children age 14-years and older.

• Community vocational rehabilitation programs can help you learn new job skills.

• State or federal disability compensation programs may provide financial aid to help if you are out of work during rehabilitation.

“The most important thing is to be your own advocate,” says Elaine. “Trust yourself, be persistent, and seek out avenues of assistance.”