Many patients treated for a Chiari malformation experience some degree of emotional difficulties and/or subtle cognitive changes. Patients who were treated as teenagers or young adults may report these symptoms continuing into adulthood. Weill Cornell Medicine Neurological Surgery offers integrated psychotherapy with cognitive remediation — also known as cognitive rehab or cognitive rehabilitation — to help.
Cognitive dysfunction is one possible complication of Chiari malformation or the surgery to repair it. The condition and the surgery may cause physical changes to brain tissue and can lead to diffuse cognitive deficits, including problems with attention, memory, executive functioning, and information processing.
Executive functioning problems include difficulty with executing “everyday actions,” such as carrying out a sequence of actions, planning a task, beginning a task, knowing when one has completed a task, or even becoming “lost” while in the middle of a task. Executive functioning problems are highly related to problems carrying out everyday activities.
Surgery for Chiari may also affect mood and emotions, and this is not simply a reaction to being diagnosed with a frightening condition or undergoing surgery to repair it. The brain is a complex organ, and its physical structures are responsible for emotional processing and behavior.
Cognitive remediation combined with cognitive behavioral therapy is a valuable treatment to help a patient overcome all of these difficulties. Cognitive remediation treatment can teach long-lasting skills that help restore everyday functioning and optimize quality of life. Research has demonstrated that cognitive remediation interventions that incorporated elements of memory, information processing, and attention led to significant improvements in a number of cognitive areas.
The good news is that everyone, even after Chiari surgery, has intact cognitive abilities and strengths. Cognitive remediation therapy teaches a patient to use those existing abilities to compensate for deficits in other areas. Cognitive remediation in combination with cognitive behavioral therapy incorporates all domains of functioning: emotional, behavioral, and cognitive.
Cognitive rehabilitation is based on the principle of experience-dependent neuroplasticity, meaning that the human brain is not a static organ but can be physically changed when exposed to challenges or exercises. These changes can occur within neural pathways and synapses after exposure to enriched environments. Cognitive remediation provides such an enriched environment.
Behavioral, emotional, and cognitive changes associated with a Chiari diagnosis can be stressful, but with quality treatment a patient can achieve excellent results and a good quality of life. The Weill Cornell Medicine neuropsychology service within Neurological Surgery is pleased to offer several services to assist patients diagnosed with Chiari malformation, including a comprehensive Cognitive Remediation Program that focuses on improving working memory, attention, and focus. Individual and group sessions are available, and there is special group program reserved for teenagers. Find out more about the Cognitive Remediation Program.
For more information, contact Dr. Sacks-Zimmerman at 212-746-3356.
Reviewed by: Amanda Sacks-Zimmerman, PhD
Last reviewed/last updated: May 2024
