How Patients With Glioblastoma Can Cope With Cognitive Impairments

For patients with glioblastoma — a type of brain cancer — developing Alzheimer’s is not particularly common, an expert said. However, patients may experience progressive neurocognitive dysfunction, or an effect on short-term memory.

On a day-to-day basis, brain functions, such as short-term memory, may be affected by the brain tumor or the treatments patients receive, Dr. Stephanie E. Weiss, chief, Division of Neurologic Oncology and professor, Department of Radiation Oncology at the Fox Chase Cancer Center told CURE®.

“[Patients] may notice that functions, such as memory, particularly short-term memory, and the way and rate in which we process information coming our way, seem different,” Weiss said during an interview. “The classic example would be patients who say, ‘I have senior moments more often.’”

Examples of these “senior moments,” as Weiss described, included going into a room and forgetting why they went there and taking a longer amount of time to respond during conversations.

Nevertheless, she noted that patients with glioblastoma often worry that they will develop Alzheimer’s disease (a common progressive disease that causes memory loss and confusion).

“People often come in and say, ‘What I’m worried about is [developing] Alzheimer’s,’ that’s what they think about,” Weiss said. “That kind of profound manifestation where somebody isn’t recognizing [other] people, can’t function [independently] and can’t remember what they did five minutes ago, is a level of dysfunction in this patient population who’ve had typical treatment — that’s really significantly less common.”

Quality of Life and Progressive Neurocognitive Dysfunction in Patients With Glioblastoma

Depending on patients’ day-to-day lives, their quality of life may be negatively impacted by progressive neurocognitive dysfunction, Weiss explained.

“You’ll have people say, ‘I work full-time, I’m a lawyer and I speak with [people] all the time,’ or ‘I’m an accountant, I’m adding figures,’ and any change for them is noticeable,” she said. “Now, if you perceptively take away function, because they've had this tumor and this treatment, they are certainly going to notice it. And that affects well-being, right? ‘If I can't do what I did quite as well as I used to, I'm going to notice,’ [they’d say].”

Other patients, though, may not feel the impact of progressive neurocognitive dysfunction as much, Weiss noted.

“Other people with the same changes may feel less impacted, simply because they might say, ‘My day-to-day is usually pretty low key, I'm with my family, I'm seeing my friends, I get the senior moments,’ but they'll almost kind of chuckle at it because it's not bothering them so much,” Weiss said. “So even the same deficit, how that impacts a person is going to depend a lot on what that person expects and wants to be able to do.”

Interventions for Patients to Maintain Quality of Life

Certain interventions, such as medications, may be helpful to mitigate some of the effects patients feel regarding neurocognitive dysfunction, Weiss said.

The feeling of this dysfunction may feel like staying up late, she described, and patients’ “thinking isn’t going to be quite as sharp.” So, medications for alertness may be helpful, she said.

Aside from medications and therapies to help, interventions at home may also help. Because many patients experience more of an impact on their short-term memory, building habits for the long-term can help patients significantly, Weiss said.

“On the more day-to-day level, what really can help are just notes — stick something on the fridge. Also for the patient, having a little notebook to write things down, and having very regular processes for routine things at home,” she suggested. “In other words, if you get a phone call, here's a little book or pad, I put it right by the phone to write the message down. Just things like that, that lower frustration level.

“So it works into long-term memory, anything I need to check, it will be on the fridge every morning. What my schedule is going to be — [having] that makes things easier. The patient wakes up [and asks] ‘Well, what do I have to do today? I know I will go to the fridge.’”

Treatments Associated With Progressive Neurocognitive Dysfunction

Several factors may contribute to progressive neurocognitive dysfunction, Weiss emphasized, which may differ from patient to patient. She explained that occasionally, the tumor may cause this impairment, while treatments can contribute, too.

Treatments, including surgery, radiation and chemotherapy, are associated with neurocognitive dysfunction.

“Once [patients] have surgery, [doctors] can measure cognitive changes in a person. For most people, it's not severe. But it's measurable,” Weiss said. “Certainly, though, the radiation and the chemotherapy are felt to have an impact. We worry more about radiation than chemotherapy, although in other diseases, it is most certainly true that people who've never had radiation anywhere near the brain, or at all, will talk about chemo brain or chemo fog. And they’ll say it’s life-long.”

Changes in gene expressions may also play a role in patients’ cognitive function, she mentioned.

“Up and downregulated expression of various genes that are associated in other disease states with inflammation, memory issues, things like that,” Weiss explained. “The closer you get to the tumor, the higher [the gene expression changes] are, they get lower and lower.”

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