Many patients recovering from treatment for glioblastoma multiforme, be it radiation, chemotherapy, or surgery, experience some degree of emotional difficulties and/or cognitive changes.
Cognitive dysfunction is a frequent complication in long-term survivors of brain tumors and can be related to both the brain tumor and its treatment. GBM treatment can also lead to behavioral changes, creating even more stress for the individual and the family. A therapy called cognitive remediation — also known as cognitive rehab or cognitive rehabilitation — can help.
Brain tumors and their treatments 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.
A glioblastoma may also affect mood and emotions, and this is not simply a reaction to being diagnosed with a life-threatening brain tumor. The area of the brain where a tumor is located determines what functions are affected, which could be speech, motor control, cognition, or even emotions. For example, a space-occupying lesion in the left temporal lobe is associated with low mood, but on the right side can produce manic reactions. A tumor in the frontal lobe will often modify emotional processing and behavior.
Cognitive remediation is a valuable therapy after brain tumor surgery to help a patient overcome these difficulties. Cognitive remediation treatment can teach long-lasting skills that help restore everyday functioning. Research has demonstrated that cognitive remediation interventions that incorporated elements of memory, processing speed, and attention led to significant improvements in a number of cognitive areas.
The good news is that everyone, even after experiencing a brain, 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 treatment incorporates all domains of functioning: emotional, behavioral, and cognitive.
Cognitive rehabilitation is based on the principle of neuroplasticity, meaning that the human brain is not a static organ but can be physically changed. These changes can occur within neural pathways and synapses after exposure to enriched environments. Cognitive remediation provides such an enriched environment.
What is cognitive remediation/cognitive rehabilitation?
Much of a patient’s distress over post-operative cognitive changes can be reduced by pre-surgical counseling and testing. Psychometric testing before surgery can help establish the patient’s abilities and strengths and set the stage for remediation after surgery. Individuals will also learn how to self-report their cognitive difficulties to help themselves and their treatment provider develop a rehabilitation plan.
Behavioral, emotional, and cognitive changes after brain tumor surgery can be stressful, but with preparation before and quality rehabilitation after surgery, a patient can achieve excellent results and a good quality of life.
Weill Cornell is pleased to offer several services to assist patients after brain tumor surgery, including a comprehensive Cognitive Remediation Program that focuses on improving working memory, attention, and focus. The five-week program includes personal consultation, telephone sessions, and online components designed to improve performance in a wide range of cognitive tasks. Find out more about the Cognitive Remediation Program.
Reviewed by: Amanda Sacks, PhD
Last reviewed/last updated: November 2020