identification of behavior changes in brain tumor · 2019. 5. 30. · diagnosing behavior changes...

Identification of Behavior Changes In Brain TumorBrihastami Sawitri, Azimatul Karimah

azimatul.karimah@fk.unair.ac.idbrihastami-s@fk.unair.ac.idPresented on Seminar Brain Tumor, April 27, 2019

Background

• Neurobehavioral symptoms

• affect the patient’s ability to engage with clinical decision-making

• affect survival

• affect patients’ direct social environment (spouses, family members etc)

• It is important to pay attention to symptom management and quality of life.

• Behavioral problems are often very difficult to detect in clinical neuro-oncologicalpractice

• Changes in behavior is either difficult to recognize, to treat, or are understudiedin scientific literature.

Diagnosing Behavior Changes in Brain Tumor

• Starts from having the clinical suspicion.

• Madhusoodanan et al recommended that neuroimaging be considered in the following conditions:• New onset psychosis,• new onset mood/memory symptoms,

occurrence of new or atypical symptoms,

• new onset personality changes, and anorexia without body dysmorphic symptoms.

Sign & Symptoms based on Tumor Location

Behavior Signs of Frontal Tumors

• A lack of interest• Mood swings and changes in

ethical standards.• Difficulty on Problem solving• a lack of concentration.• short-term memory (memory of

recent events) may diminish.• difficult to express thoughts in

words or writing.

Boele et al, 2015; Armstrong TS., et al, 2015

FRONTAL LOBE SYNDROM

Mediofrontal(apathy/abulia)

OFC

(disinhibition & impulsiveness)

DLPFC(Executivefunction)

Frontal Systems Behavior Scale

• a 46-item behavior rating instrument that measures impairments across behavioral and cognitive domains of executive impairment.

• Respondents rate the items on two response sets (before the injury/illness; after the injury/illness)

• 5 point Likert-type scale (1 D almostnever, to 5 D almost always)

Behavior Signs of Parietal Tumors

• Decrease awareness of sensation against the body Difficulty recognizing body position or body parts

• Confusion of the left and right sides of the body

• Losing language sentences that contain a comparison or a cross-referencemay not be understood

• Losing arithmetic ability.

• The loss of recognition of left-right or up-down positioning can make it difficult toadd, multiply or comprehend material presented in side-by side columns.

Armstrong TS., et al, 2015

Behavior Signs of Temporal Tumors

• A dreamy “deja vu” state.

• Time disorientation

• Difficulty in remembering recent events.

• Auditory hallucination or psychosis

• Glioma : acute psychosis, agitation, and suicidal/homicidal ideations with paranoia

• Not only because of the tumor, but also from the epilepsy• Mood disturbance (manic or hypomanic)

Boele, 2015; Armstrong TS., et al, 2015

Armstrong TS., et al, 2015

Behavior Signs of Occipital Tumors

• Visual hallucinations may cause a temporary “dreamy” state.

• Facial expressions may not seem familiar.

Armstrong TS., et al, 2015

Behavior Signs of Hypothalamic and Pituitary Tumors• Appetite and the desire for food disturbance

• Hormone disturbance sleep disturbances and emotional changes.

• Sexual development may be delayed or advanced or sexual desire may change.

Emotional Effects being diagnosed Brain Tumor

• Losing sense of security and control frightening, uncertainty

• Stress response Decreased appetite, depression, irritability, fatigue,sleeplessness, temporary memory problems and restlessness

After surgery, more likely to underestimate their psychological problems

negative impact (changes emotional functioning, interpersonalrelationships, neurocognitive functioning, and coping skills)

- distressing for partners

- a major impact on the outcome of rehabilitation after treatment

Armstrong TS., et al, 2015

Emotional and Social Dysfunction Questionnaire

• To measure of emotional and social dysfunction developed among neurosurgical patients with CNS disorders.

• Respondents rate all items on a 10-cm visualanalog scale (anchors “no problem” and “bigproblems”).

The Overt Behavior Scale

• To measure nine categories of challenging behaviors among brain-injured populations

• All behavioral levels are scored as simply present (1) or absent (0) (severity score).

• The OBS can be completed by clinicians and relatives and also has a patient self-report version. The OBS global caseness represents the presence of the most severe behaviors in each of the nine categories.

Karnofsky Performance Scale

• Widely used in the neuro oncology field.

• Clinicians rate patients into an ascending series of categories ranging from full functionality (KPS score D 100) through to death (KPS score D 0).

Some case reports of Behavior changes in Brain Tumor

Madhusoodanan S et al, 2015

Madhusoodanan S et al, 2015

Madhusoodanan S et al, 2015

Madhusoodanan S et al, 2015

Madhusoodanan S et al, 2015

Madhusoodanan S et al, 2015

Conclusion

• Behavior and psychological changes in brain tumor are frequently underestimated

• To diagnose psychiatric disorder in brain tumor, clinician should have suspiciousness toward the symptoms

• Each lobe contribute to particular psychiatric symptoms

• Psychometric helps to screen and measure the severity of psychological aspect of brain tumor.

Referensi

• Andrewes DG, Kaye A, Aitken S, Parr C, Bates L, Murphy M, 2003. The ESDQ: A New Method of Assessing Emotional and Social Dysfunction in Patients Following Brain Surgery. Journal of Clinical and Experimental Neuropsychology, Vol.25, No.2, p173-189

• Armstrong TS., et al, 2015. About Brain Tumor. American Brain Tumor Association

• Boele FW, Rooney AG, Grant R, Klein M, 2015. Psychiatric symptoms in glioma patients:from diagnosis to management Neuropsychiatric Disease and Treatment 2015:11 1413–1420

• Madhusoodanan S et al, 2015. Psychiatric aspects of brain tumors. World J Psychiatr 2015 September 22; 5(3): 273-285

• Simpson GK, Koh ES, Whiting D, et al, 2015. Frequency, clinical correlates, and ratings of behavioral changes in primary brain tumor patients: a preliminary investigation. Frontiers in Oncology, April 2015 | Volume 5 | Article 78

• Oxford Textbook of Palliative Medicine, Oxford University Press. 1993;109.

Azimatul Karimah azimatul.karimah@fk.unair.ac.id,

uci.nugroho@gmail.com +62-81-55-44444-06

Uci Nugroho

Terimakasih,

Brihastami-s@fk.unair.ac.id0818 322 841

Terimakasih,Brihastami-s@fk.unair.ac.id0818322841