Neurooncology

Though many affective, cognitive, and behavioral symptoms may be related to the location of the tumor(s) within the brain, considerations also include effects from treatment (whole brain vs partial brain radiotherapy; chemotherapy) and psychological consequences of the disease (trauma of diagnosis and treatment, future uncertainty, living with a terminal illness, survivorship, etc).

• Radiotherapy is associated with irreversible and often progressive cognitive deterioration in 50-90% of patients across domains of learning, memory, processing speed, attention, and executive function (Makale et al, 2017).
  • Treatment options depend on specific complaints (Cramer et al, 2019)
    • Inattention can be targeted with methylphenidate (starting dose 5mg BID, titration to effect, max 60mg total daily dose) and cognitive rehabilitation
    • Poor memory can be targeted with donepezil or possibly memantine and cognitive rehabilitation
    • Significant fatigue can be targeted with modafinil / armodafinil, sleep hygiene, and exercise program
    • Depression is typically initially treated with antidepressants and psychotherapy

References

Cramer, C. K. et al. Treatment of Radiation-Induced Cognitive Decline in Adult Brain Tumor Patients. Curr. Treat. Options Oncol. 20, 42 (2019). PubMed link

Makale, M. T., McDonald, C. R., Hattangadi-Gluth, J. A. & Kesari, S. Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours. Nat. Rev. Neurol. 13, 52–64 (2017). PubMed link

Ohgaki H, Kleihues P. The definition of primary and secondary glioblastoma. Clin Cancer Res. 2013 Feb 15;19(4):764-72. https://pubmed.ncbi.nlm.nih.gov/23209033/