Personality Changes in Brain Tumor Patients

Core Clinical Features

• The National Comprehensive Cancer Network recommends considering brain tumors in patients with new-onset psychiatric symptoms, atypical presentations, or personality changes, even without focal neurological signs 1

Cognitive and Executive Dysfunction

• Up to 90% of primary brain tumor patients experience impaired executive functioning, including difficulty with planning, problem-solving, and decision-making capacity, before treatment, according to the Annals of Oncology 2, 3

Management Implications

• The National Comprehensive Cancer Network suggests obtaining brain MRI for any patient with new-onset psychiatric symptoms, atypical presentations, or personality changes, even without focal neurological signs 3
• The Annals of Oncology recommends assessing for cognitive impairment using validated neuropsychological testing to document baseline function 2, 3
• The Journal of the National Comprehensive Cancer Network recommends evaluating for depression and anxiety, as these significantly impact quality of life and survival, with depression prevalence of 21.7% in brain tumor patients 7
• The Journal of the National Comprehensive Cancer Network suggests using psychosocial interventions, including cognitive-behavioral therapy, which have strong evidence for reducing distress and improving quality of life 8
• The National Comprehensive Cancer Network advises using antidepressants cautiously, as they may unmask underlying mood instability; SSRIs are effective for depression but require monitoring for behavioral activation 7, 6