Impact of brain tumors on patients' affective and psychological world
The most common types of intracranial tumours are gliomas and meningiomas. They have very different biological behaviours and therefore different impacts on cognitive functions. Moreover the cognitive effects of the surgical procedure have not yet been completely clarified, both in the immediate but also in the long term. While some of these aspects have been investigated in the past 10-15 years for basic sensory/motor and mainly language skills, the effects on most of the “higher level” cognitive skills are still unclear, especially those linked to emotion and behavioural regulation. Patients affected by brain tumours may show several emotional and behavioural regulation changes, but little evidence is available from lesion studies as to what specific brain regions are most likely linked to alterations to different aspects of mentalization processes.
Both behavioural and anatomical data will be presented on the mentalization abilities of patients operated for the removal of a brain tumour. Results show that temporo/insular lesions seem to affect tasks requiring basic (less mentalized) perception of emotions and intentions, with emotion recognition being maximally impaired by anterior temporal and amygdala lesionsand ‘basic’ Theory of Mind (perceptual recognition of intentions) being mostly impaired by posteriortemporoparietal lesions. Tasks relying on higher-level mentalizationwere maximally affected by prefrontallesions, with alexithymia being mostly associated with anterior/medial lesions and the lower “self-maturity” measure with lateral prefrontal ones.
From a more “neurosurgical” perspective, patients affected by Meningioma were unimpaired in all occasions. High Grade Glioma (HGG: aggressive gliomas) patientswere in general impaired already before the intervention and were unaffected by surgery, which is aimed to the removal of the compact, necrotic part of the lesion only. Low Grade Gliomas (LGG: slowly growing gliomas) were instead unaffected before surgery but showed a significant deficit immediately after surgery (with good recovery within 4 months) probably due to the more aggressive surgical strategy, aimed at obtaining the total excision of the tumour. This pattern was however not evident in more abstract/mentalized tasks which are likely less prone to “focal” surgical damage.
A final section will be dedicated to the discussion of the long-term psychological impact of being diagnosed a brain tumour, in particular LGG, with the presentation of data from a long term follow-up of the cognitive, psychological and emotional well-being of patients operated for LGG.