Language and Personality Changes in Brain Tumor Patients

Issues related to patients' verbal expression, responses, and changes in personality?

Doctor: Hello.
I am one of the primary caregivers for the patient.
The patient has a tumor in the left temporal lobe measuring 7.69 cm, which was surgically removed and confirmed to be a glioblastoma multiforme in January 2018.
She has undergone standard treatment, including radiation therapy and oral chemotherapy.
In August 2019, there was a recurrence in the brain measuring 1×0.6-1×0.8 cm, so the oral chemotherapy was switched to intravenous administration of the second-line chemotherapy drug Avastin (bevacizumab).
At that time, we asked the doctor about potential future issues and what to watch for.
The doctor mentioned (the following is a summary from our medical notes taken at home, not a verbatim record): "This tumor will primarily affect her language abilities for now; if it grows larger, it may impact her mobility.
Just observe closely, and do not assign her important tasks." We mentioned that the patient was primarily responsible for driving and managing finances, and the doctor advised against her driving or riding a motorcycle, suggesting that if she must drive, she should have someone accompany her.
If she were to manage finances, she might make mistakes, such as writing incorrect amounts.
Around April 2020, the patient began experiencing sensations of the ceiling spinning when lying down to sleep, along with blurred vision (which improved after acupuncture).
When we consulted the doctor, it seemed to be a normal reaction following brain surgery.
Around this time, the patient also started having difficulties with language expression, such as being unable to articulate desired words, misplacing words, or expressing things incorrectly, without recognizing any issues with her communication.
For example, she would refer to driving as "I need to go turn the wheels." We continued to ask the doctor if this was normal, and the doctor reassured us that it was not a concern.
However, recently, we have noticed that her condition seems to be worsening, particularly in her language expression and responsiveness.
For instance, she has not disposed of expired food properly and instead presented it to others, while discarding her eTag card (when we asked her about it, she could only say it was thrown into a bag.
When we probed further, asking if it was the trash can or the recycling area, we had to repeat the question several times for her to choose one option.
It seems she needs time to articulate her thoughts or finds it challenging).
Additionally, her personality has shifted from being very proactive to being fearful of taking on more tasks or showing reluctance to engage in activities.
In October 2020, due to chemotherapy side effects, the patient developed hypertension and required antihypertensive medication.
However, during today's follow-up (March 30), the brain imaging appeared stable, and the insurance-covered medications were approved.
The doctor indicated that this suggests good control of the tumor.
We would like to ask the doctor two main questions regarding the noticeable changes in the patient's language expression and responsiveness since April 2020.
Although these changes do not resemble the early signs of dementia as seen before her surgery in January 2018, they are concerning to us.

1.
Could the changes in her responses be due to an undetected brain tumor in addition to the recurrence in August 2019 measuring 1×0.6-1×0.8 cm? (After the surgery in January 2018, the patient had regained her previous normal memory, responsiveness, and language abilities.) As primary caregivers, we also care for an 80-year-old patient with Alzheimer's disease, and the changes in the patient's language, responsiveness, and personality feel reminiscent of early-stage dementia.
Should we seek a neurologist's evaluation for potential dementia treatment?
2.
Are the changes in the patient's language, responsiveness, and personality a consequence of the brain surgery? If so, are they irreversible and will they continue to decline over time? What assistance can we, as caregivers, provide? Additionally, are there any relevant books or educational materials that could help us better understand the potential issues?

Yu, 30~39 year old female. Ask Date: 2021/03/31

Dr. Zhang Junwei reply Neurosurgery

The patient's clinical neurological function is closely related to the progression of the brain tumor (size, location, recurrence, etc.).
It is recommended to return to the outpatient clinic and have a thorough discussion with your attending physician.

Reply Date: 2021/03/31

More Info

Understanding language and personality changes in patients with brain tumors, particularly those who have undergone surgery, is crucial for caregivers and healthcare providers alike. The case you presented highlights several important aspects of post-operative care and the potential cognitive and behavioral changes that can occur in patients with brain tumors, especially glioblastomas.

Firstly, it is essential to recognize that brain tumors, particularly those located in the temporal lobe, can significantly affect cognitive functions, including language and memory. The temporal lobe is responsible for processing auditory information and is also critical for language comprehension and production. When a tumor is present, it can disrupt these functions, leading to symptoms such as word-finding difficulties, confusion, and changes in personality. In your case, the patient’s experiences of struggling to find words, misplacing terms, and exhibiting changes in behavior are consistent with the effects of a tumor on the brain's language centers.

Regarding your first concern about whether the changes in the patient's behavior and cognition could be due to an undetected tumor, it is indeed a possibility that should be explored. Recurrence of a tumor can lead to new or worsening symptoms. Regular follow-ups with a neurologist or oncologist are crucial to monitor for any signs of tumor progression or recurrence. Imaging studies, such as MRI scans, can help determine if there are any new growths or changes in the existing tumor that might be contributing to the observed cognitive decline.

Your second concern about whether these changes are permanent or a result of the surgery is also valid. Surgical intervention can lead to various neurological deficits, depending on the extent of the surgery and the areas of the brain affected. Some patients experience improvements over time, while others may have lasting deficits. The degree of recovery can vary widely among individuals. Cognitive rehabilitation therapy may be beneficial in helping the patient regain some of the lost functions. Engaging in speech therapy can specifically address language difficulties, while occupational therapy can assist with daily living skills.

As caregivers, there are several strategies you can employ to support the patient:
1. Create a Structured Environment: Establishing a routine can help the patient feel more secure and reduce confusion. Use visual aids, reminders, and checklists to assist with daily tasks.

2. Encourage Communication: Be patient and give the patient ample time to express themselves. Avoid interrupting or finishing their sentences, as this can lead to frustration.

3. Monitor Safety: Given the patient’s difficulties with judgment and decision-making, it is wise to limit their responsibilities, especially those that could pose safety risks, such as driving or managing finances.

4. Seek Professional Help: Regular consultations with healthcare professionals, including neurologists, speech therapists, and psychologists, can provide valuable support and guidance tailored to the patient’s needs.

5. Educate Yourself: Understanding the effects of brain tumors and their treatment can empower you as a caregiver. Look for resources such as books, support groups, and educational materials from reputable organizations like the American Brain Tumor Association or the National Brain Tumor Society.

In conclusion, the changes you are observing in the patient are not uncommon in individuals with brain tumors, particularly following surgery. It is essential to maintain open communication with healthcare providers and seek appropriate interventions to support the patient’s cognitive and emotional well-being. Regular monitoring and a proactive approach to care can significantly enhance the quality of life for both the patient and the caregivers.

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