Managing behavioural and cognitive changes associated with brain cancer Diane Whiting

Hosted by Cure Brain Cancer Foundation

Managing behavioural and

cognitive changes associated with brain cancer

Diane Whiting

Senior Clinical Psychologist

Brain Injury Rehabilitation Unit

Liverpool Hospital

1 May 2014

How are we different?

n Behavioural changes – what we say or do n Emotional changes – how we feel n Cognitive changes – how we think

Behavioural Changes n  Fatigue n  Aggression/ anger management (eg shouting, swearing,

insults, threats, hitting, scratching, throwing objects) n  Inappropriate behaviour (personal hygiene, sexual or

rude comments, boundary crosses) n  Perseveration (inappropriate repetitive thoughts or

actions) n  Adynamia (lack of drive / motivation / initiative, passivity,

inactivity)

Behavioural interventions

Positive Lifestyle - EASE n  Eating - Eating the right foods in the right portions helps

to keep up our energy, control weight and create a sense of balance and well-being

n  Activity - Remaining active helps us to enjoy life, and achieve personal goals

n  Sleep - Poor sleep can lead to feelings of tiredness and irritability, as well as making it harder to deal with the demands of daily living

n  Exercise - Exercise can generate a sense of wellbeing, reduce boredom, and get rid of tension and stress

Cognitive (thinking) changes

n  Psychologists have six main terms for cognitive disorders, these include:

1.  Memory 2.  Attention or concentration 3.  Speed of Information Processing 4.  Executive Functioning 5.  Language Skills 6.  Perceptual Abilities

Memory changes

n  People say my long term memory is fine it is my short term memory that is the problem!

n  Difficulties learning new information (attention) n  Difficulties keeping that new information in your

head (encoding) n  Difficulties finding where you put that information

in your head (retrieval)

Helping Memory Problems

n Use lists n  ‘A place for everything, and everything in

it’s place’ n Post it notes n Mobile phone n A diary, calendar, whiteboard

Attention/Concentration

n  Think of how we are all attending here today – listening, focussing, filtering out other information

n  People can often focus on one thing at a time, but have real difficulty ‘multi tasking’

n  Fatigue, emotion, physical illness makes it much worse

Coping with Attention/Concentration Problems

n  Recognise the problem exists, listen to other people who are there to help

n  Organise your environment n  Build in rewards e.g. 30 mins study, 10 mins

rest… n  Time important tasks to occur when you are

most awake and alert n  Minimise other distractions e.g. when doing a

task, turn off the TV

Speed of Information Processing

n  Like an old computer or like a dial up internet system that takes ‘forever’

n  Like a computer, we need to ‘take in, process, act upon or make decisions…..a computer may do this slowly (it might need new memory) or, you need to upgrade it’s capacity

Speed of Information Processing: Addressing the problem

n  Limit the amount of information n Allow yourself more time n Pace yourself n Only do one task at a time

Executive Functioning

Examples: n  Can’t think abstractly any more, quite concrete,

or literal. n  Can’t get myself organised anymore, get lost in

paper work or chaos. n  Can’t remember or stick to sequences, get

distracted on route, end up doing something different.

n  Can’t learn from my mistakes, always repeat them, time and time again.

n  Can’t do more than one thing at a time

Executive Functions

Think of it as a manager – or a good executive

n planning n goal setting, n monitoring, n abstract thinking, n problem solving, n multitasking

Coping with Executive Problems

n  Listen to your family/friends/relatives…allow them to aid your insight, you may simply not be aware

n  Ask for help, tell people that this is affected, and ask them to help you.

n  Practise training exercises/games which help to develop flexibility

n  Get organised, use lists, note where the problems are, brain storm how to get round them and practise these skills.

n  Get professional help where possible.

The Key

n  Work out with family what the main issues are, then PLAN how to get round these problems – consider making a list of problems and tackling one area/problem rather than trying to do the entire list.

n  Be RECEPTIVE to your family’s observations. n  Families, be AWARE that patients may not know there is

a problem – go carefully to gain cooperation and avoid confrontation.

n  Create STRUCTURE – this really helps

In summary: How do we cope?

n Use your support networks – don’t be too proud or afraid to ask for help

n Be selfish – don’t take on other people’s problems, put yourself first

n  Limit other stressors (if possible) n Try to maintain normal routines as closely

as you can

Other resources or places to access help n Allied health professionals at your hospital n GP for referral under the Mental Health

Plan to a psychologist n NSW Cancer Institute Fact Sheets

¨ http://www.cancerinstitute.org.au/cancer_inst/publications/index.html#factsheets