5 Strategies to Protect Your Cognitive Function During Glioblastoma Treatment

1. Surgical Innovations

“Surgical advancements for glioblastoma are increasingly focused on maximizing tumor removal while safeguarding neurological, including cognitive, functions,” says Joseph Landolfi, DO, a neuro-oncologist and the division chief of neuro-oncology at Hackensack Meridian Health's JFK New Jersey Neuroscience Institute in Edison, New Jersey. “A personalized approach combining sophisticated techniques is crucial.”

Brain Mapping

Advanced brain mapping allows a highly specialized surgeon to remove as much of a tumor as possible while attempting to minimize complications. It may be the most effective surgical approach today, says Alyx Porter Umphrey, MD, a neurologist, a professor of neurology, and the director of the neuro-oncology section at Mayo Clinic Comprehensive Cancer Center in Phoenix.

Then your surgeon can carefully plan a surgical route that maximizes tumor removal while minimizing the risk of losing cognitive or neurological function, says Nitesh V. Patel, MD, a brain and tumor neurosurgeon and the co-director of the neurosurgical oncology program at Hackensack Meridian Health's Jersey Shore University Medical Center in Neptune, New Jersey.

Fluorescence-Guided Surgery

Awake Craniotomy

“If the surgeon gets too close to a critical area, they can immediately adjust,” Porter Umphrey says. “[This procedure] requires a coordinated team, including neurosurgeons, neuropsychologists, and anesthesiologists, all working together to maximize tumor removal without compromising cognition or quality of life.”

2. Advancements in Radiation

Radiation therapy typically destroys cancer cells with high-energy waves, and newer techniques have improved its precision while helping reduce damage to healthy tissue and some side effects.

“Modern radiation treatment for glioblastoma is highly precise and much more sophisticated than in the past,” says Ranjit S. Bindra, MD, PhD, a therapeutic radiologist, a pathologist, and the Harvey and Kate Cushing professor at Yale School of Medicine in New Haven, Connecticut.

By using advanced imaging to plan the target, doctors can now shape radiation carefully around the tumor and the area where the tumor was removed while letting less radiation touch nearby normal brain structures, Dr. Bindra says.

Advanced radiation options include the following:

• Photon Radiation These beams pass through your body, just like an X-ray, though in higher doses.

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   Intensity-modulated radiation therapy and volumetric modulated arc therapy are two types of photon radiation.

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• Proton Therapy Proton beams stop at the tumor — they don’t keep going like photon beams.

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   This allows protons to be more precise, protecting healthy tissue.

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   Proton beams often treat tumors deep in the brain.

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• Stereotactic Radiosurgery (SRS) This radiation therapy targets the tumor from many angles to gain more precision.

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   SRS usually treats small tumors or tumor tissue left over after surgery.

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• Radiation Tiles After your surgeon inserts these small devices, they emit radiation in the area the tumor is removed, Patel says. They may lower the chances of your cancer returning to that area.

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• Tumor-Treating Fields This treatment, which the U.S. Food and Drug Administration has approved to treat glioblastoma in people age 22 and older, involves wearing stickers or bandages on your shaved head for at least 18 hours a day.

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   Ceramic discs inside push electricity through your scalp, which can destroy cancer cells or stop them from multiplying. The discs use nonionizing radiation, which is lower-energy than traditional radiation therapy.

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3. Medications

“In practice, we often take a supportive, individualized approach,” Porter Umphrey says. “That can include medications to manage fatigue, depression, or anxiety, because improving those symptoms can indirectly help cognitive function.”

For example, psychostimulants such as methylphenidate (Ritalin, Concerta) can sometimes help with attention and fatigue, which could improve concentration and memory, Porter Umphrey says.

4. Cognitive Remediation and Rehabilitation

“During awake brain surgery, speech, occupational, and sometimes physical therapists may be present in the operating room,” Patel says. “They assist in real-time testing of language, movement, and other functions while the surgeon operates.”

• Memory training
• Exercises to improve attention and concentration
• Problem-solving tasks
• Organization exercises

5. Lifestyle Changes

Healthy lifestyle habits can help build resilience, manage side effects, and improve overall quality of life, Landolfi says.

“While medical treatments are the cornerstone of managing glioblastoma, a growing body of evidence suggests that certain lifestyle habits can play a significant supportive role in protecting cognitive function during active treatment,” he says.

Alongside your treatment, you can try these lifestyle habits to boost your brain health:

• Get active. Exercise keeps your brain healthy, lowers stress, and boosts your mood. Even light movement or regular walking can support brain health, Porter Umphrey says.

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• Eat healthy. Focus on a diet rich in fruits, vegetables, lean proteins, and healthy fats — similar to the Mediterranean diet — to support brain function, Landolfi says. Talk to your doctor and a registered dietitian before making significant dietary changes.
• Stay mentally engaged. Read, do puzzles, and get together with friends and family, Patel says. Keeping your brain active in this way can protect against cognitive decline.

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• Focus on quality sleep. Getting good sleep is vital for normal brain function and can improve your memory, attention, and mood.

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   You can improve your sleep by sticking to consistent sleep and wake times, avoiding screens before bed, and creating a cool, dark, cozy sleep environment.

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The Takeaway

• Glioblastoma and its treatment can cause cognitive issues and brain fog, but some treatment types can help you protect your concentration, memory, and brain function.
• Surgical techniques such as brain mapping, awake craniotomy, and fluorescence-guided surgery can help your surgeon avoid complications when removing the tumor.
• Advanced radiation techniques allow for precise treatment, shielding healthy brain tissue from radiation’s effects.
• Talk to your doctor and care team about medications, additional therapists, and lifestyle changes such as dietary and exercise adjustments that may help you maintain your cognitive function.