Download Strategies for Coping with Cognitive and Personality Changes

Strategies for Coping
with Cognitive and
Personality Changes
Brian Leahy, PhD, ABPP-CN
Alexian Brothers Neurosciences Institute
2014 Patient and Family Conference
Providing and Pursuing Answers: Advances in Brain Tumor Research, Treatment & Care
www.abta.org
1-800-886-ABTA (2282)
[email protected]
#ABTA2014
Introduction
• Patients with brain tumor can experience a wide
range of both direct and indirect changes in
thinking, emotions, and behavior.
• More than half of all patients with malignant brain
tumors experience some kind of cognitive or
behavioral change
• The presentation varies widely as a result of
interactions between the nature and location of
the tumor, the treatment undergone,
characteristics of the person, and factors in the
individual’s environment
FRONTAL LOBES
Primary Functions of the
Frontal Lobes
- Expressive Language
- Intentional Movement
- Behavioral Control
- Reasoning / Judgment
- Higher Level Attention
- Emotional Regulation
- Planning / Organization
- Aspects of Learning
and Memory
TEMPORAL LOBES
Primary Functions of the
Temporal Lobes
- Memory
- Verbal Comprehension
- Emotional Regulation
PARIETAL LOBES
Primary Functions of the
Parietal Lobes
- Somatoensory
Functions
- Attention / Neglect
- Complex Motor
Movements
OCCIPITAL LOBES
Primary Functions of the
Occipital Lobes
- Object Recognition
- Visual Perception
Other Structures
• Cerebellum – Motor Coordination
• Thalamus – Relay for senses including vision,
hearing and touch
• Hypothalamus / Pituitary – Hormones and body
regulation processes
• Brain Stem – Cranial nerves and organ regulation
Brain Networks
Though location is
important in
determining the effects
of a tumor, the brain is
highly complex and
interconnected with
about 100 billion
neurons and 100 trillion
connections. So
dysfunction in one area
can have far reaching
effects.
Stages of Adjustment
• Represent a typical process of adjustment
• Not necessarily maladaptive, though
remaining in a given stage for a prolonged
period can be
• Depression and anger are normal parts of
the process
• Not everyone goes through all stages in the
same order or rate, and stages can overlap
• Individual, disability, and environmental
factors impact this process
• Family members can go through a parallel
process
I. Initial Impact
• Shock
– The individual appears overwhelmed, stunned,
not yet fully grasped the situation
• Anxiety
– Panicked and confused, individual may be
overreactive and distraught
II. Defense Mobilization
• Bargaining
– Negotiating with a higher power to take the
condition away
• Denial
– Retreat from the consequences of the condition
– May be longer term than bargaining
III. Initial Realization
• Mourning / Grief
– Short term focus on the specific loss
• Depression
– Longer term and more generalized about loss of
worth and future implications
• Internalized Anger
– Self blame, feelings of guilt. Individuals may feel
bitter, remorseful, or easily embarrassed
IV. Retaliation
• Externalized Anger
– Blame others for negative feelings and
problems
– Can result in active aggression or passive
resistance
V. Reintegration
• Acknowledgement
– Intellectual acceptance of changes, beginning
changes in self concept
– Begin to identify with others with the same
condition
– May experience frustration and nervousness
• Acceptance and Final Adjustment
– Emotional acceptance, feeling satisfied and
content with one’s identity
– Incorporating the implications of the disability into
future plans and goals
Depression
• Occurs at very high rates in individuals with brain tumor
• Sadness can be a primary sign, but depression can
present in many different ways
– Apathy
– Social Withdrawal
– Diminished Self Care
– Loss of Pleasure / Interest
– Irritability / Anger
Physical and cognitive changes can also be early
signs (e.g., fatigue, sleep disturbance, changes in
appetite, concentration problems)
Neurobehavioral Changes
•
•
•
•
•
•
•
Apathy
Impulsive Behavior
Trouble Regulating Emotions
Inappropriate Social Behavior
Diminished Creativity / Imagination
Euphoria
Anger Outbursts
Evaluation for Cognitive and Behavioral
Issues
• First step is to recognize and understand
problems
• Family members may be the first to
recognize issues
• Report symptoms to your doctor
• Seek out services
• Neuropsychological Evaluation
• Psycholotherapy
• Neuropsychiatric Assessment
Psychotherapy
•
•
•
•
•
•
Cognitive Therapy
Behavioral Therapy
Psychodynamic Therapy
The Therapeutic Process
Efficacy of Psychotherapy
Predictors of Success
Managing Cognitive Symptoms
•
•
•
•
•
•
Identify Specific Cognitive Issues
Medical Care
Medications
Mental Health
Remediation
Compensation
Cognitive Assessment: Learning and Memory
Encoding /
Learning
- Basic Perception
(e.g., Vision, Hearing)
-Processing Speed
-Basic Attention
-Complex Attention
-Mental Organization
of Information
Retention
Retrieval /
Recognition
- Keeping
-Spontaneously
Information in
Recalling Information
Memory for Later
-Recalling Information
Access
with a Reminder
-Recognizing Information
that was Learned
Cognitive Rehabilitation
• Designed to help people regain as much of their
mental, physical and emotional abilities as possible
• Compensation techniques for the abilities that cannot
be fully regained
• Sessions are often combined with counseling to help
patients adjust to differences resulting from the tumor
• Performed by speech therapists, occupational
therapists, and psychologist
• Research indicates that compensatory techniques, not
just cognitive exercises are essential for success
Visuospatial and Language
•
•
•
•
•
Visual Scanning Training
Reading Exercises
Word Retrieval Exercise
Pragmatic Communication Training
Alternative Communication Strategies
Attention
• Break Tasks into Smaller Sessions
• Establish and Environment with Minimal
Distraction
• Focus on One Task at a Time
• Schedule to Minimize Fatigue
• Be Consistent
• Review for Accuracy
• Attention Exercises
Executive Functions
•
•
•
•
•
•
•
•
Formal Problem Solving Strategies
List Alternatives with Pros and Cons
Consistency for Complex Tasks
Set Aside Time to Plan Activities
Seek Assistance and Advice
Self Cueing / Monitoring
Advanced Preparation
Attention Exercises
Memory
•
•
•
•
•
•
•
•
•
•
Repeat Information
Mnemonic Devices
Verbal or Visual Cues
Written Checklists
Structured Daily Schedule / To Do List
Audible Alarm
PDA
Recording or Written Notes
Place Items in a Consistent Location
Memory Exercises
Emotions and Cognition
• Anxiety, depression, and other emotional
distress are distracting and make cognitive
symptoms worse
• Emotional distress can impact sleep,
medical compliance, nutrition, and other
areas that also impact cognition
• Cognitive deficits can contribute to
diminished self esteem and decreased
sense of control
THANK YOU
Any Questions?
2014 Patient and Family Conference
Providing and Pursuing Answers: Advances in Brain Tumor Research, Treatment & Care
www.abta.org
1-800-886-ABTA (2282)
[email protected]
#ABTA2014