The Impact of Gliomas on Cognition and Capacity

Brain tumors, particularly gliomas, can have profound effects on cognitive functioning. The cognitive effects that can occur due to a glioma are not just due to the tumor itself, but also from the treatment modalities used. In-depth neuropsychiatric testing or screening is typically necessary to determine the extent of cognitive impairments and the rate of progression, especially given that physical functioning may be better than cognitive functioning. Given the high mortality rate and fast-growing nature of gliomas, patients often have to make significant and consequential decisions in relatively short periods of time, such as consent for treatments and personal planning (e.g., preparing a will, assigning power of attorney). In a postmortem context, forensic psychiatrists may have to make determinations regarding whether a person had capacity at the time many of these decisions were made. This article discusses some of the unique cognitive concerns that arise from gliomas and their impact on patient care and personal decision-making, both contemporaneously and in a postmortem context.