How a meningioma can make you lose your train of thought while speaking

Authors:

Cheyenne Svaldi is a MA student in the Master’s of Neurolinguistics at the University of Groningen. She is currently doing her internship and thesis focusing on language issues in people with brain tumors.

Adrià Rofes holds a PhD in Cognitive Neuroscience and an MSc in Clinical Linguistics. Currently, he is assistant professor at the department of neurolinguistics at the University of Groningen

Kate Walsh. Photo: Wikimedia Commons

In a 2017 interview, the famous actress Kate Walsh – whom you may know from the TV show Grey’s anatomy – reported the following: “I started having more cognitive difficulties. It felt like aphasia [language problems], but it was not just not being able to find words; I would lose my train of thought, I was not able to finish sentences, and that is when I really got alarmed”. Interestingly, these language problems led to the discovery of a large meningioma in her brain and its successful removal (Walsh, 2017).

Meningiomas are common benign brain tumors that affect women two to three times more than men (Baldi et al., 2018). These are slow-growing tumors emerging from the meninges – thin layers of tissue that cover the brain and spinal cord (see Figure 1). Because they do not emerge from the brain itself, meningiomas put pressure on the brain and can go unnoticed for years. Indeed, sometimes they are only discovered by accident, when looking for other non-related symptoms (Baldi et al., 2018; Moradi et al., 2008). Importantly, these tumors can have negative consequences for your daily functioning, including some aspects of cognition and the way you speak (Bommakanti et al., 2016; Rijnen et al., 2019).

Figure 1 Drawing of a meningioma pressing the frontal lobe of the brain (Patient Resource LCC, n.d.)

When meningiomas are large or located near specific brain areas, some subtle symptoms may be noticeable. It is then possible to experience issues with thinking and remembering new information (Bommakanti et al., 2016; Meskal, Gehring, van der Linden, Rutten, & Sitskoorn, 2015) and also having a hard time focusing, for example, during a conversation (Campanella, Skrap, & Vallesi, 2016; Rijnen et al., 2019).

Specific to language, meningiomas tend to result in subtle changes, such as problems with finishing sentences and verbal fluency (e.g., naming as many animals as you can in one minute). While the underlying mechanism of these problems is not clear yet, it seems that the influence of cognitive problems can provide an explanation (Bommakanti et al., 2016; Campanella et al., 2016; Meskal et al., 2015; Rijnen et al., 2019). Indeed, several aspects of language, such as verbal fluency and forming sentences, are known to require cognitive functions such as attention and working memory (Murray, 2012; Hartsuiker & Barkhuysen, 2006). Hence, during a conversation, people with a meningioma may lose their train of thought and have problems remembering what has been said or finishing sentences. One question that is difficult to answer though is whether those language problems are purely linguistic or if they are the triggered by cognitive problems.

Kemper, Herman and Lian (2003) told us about the intricate intertwine between language and cognition. In their study, older adults were asked to listen to noise and speak at the same time. The combination of two simultaneous tasks, which limits working memory, caused older adults to use shorter sentences and pause more often. This experiment highlighted the importance of cognitive aspects, such as working memory when it comes to speaking. Also, it can be used to support the idea of people with meningiomas having cognitive problems that affect their language, instead of having language problems per se.

While this is not necessarily the only explanation for what happens in people with a meningioma, it suggests that further attention should be paid in studying the relation between language and cognition in this population. Similar to what Kate Walsh reported, we can definitively that the way you speak can tell you something about your brain, but also about other aspects of your cognitive system.

References

Baldi, I., Engelhardt, J., Bonnet, C., Bauchet, L., Berteaud, E., Grüber, A., & Loiseau, H. (2018). Epidemiology of meningiomas. Neurochirurgie, 64, 5-14.

Bommakanti, K., Somayajula, S., Suvarna, A., Purohit, A. K., Mekala, S., Chadalawadi, S. K., & Gaddamanugu, P. (2016). Pre-operative and post-operative cognitive deficits in patients with supratentorial meningiomas. Clinical neurology and neurosurgery, 143, 150-158.

Campanella, F., Skrap, M., & Vallesi, A. (2016). Speed-accuracy strategy regulations in prefrontal tumor patients. Neuropsychologia, 82, 1-10.

Hartsuiker, R. J., & Barkhuysen, P. N. (2006). Language production and working memory: The case of subject-verb agreement. Language and Cognitive Processes, 21, 181-204.

Kemper, S., Herman, R. E., & Lian, C. H. (2003). The costs of doing two things at once for young and older adults: Talking while walking, finger tapping, and ignoring speech of noise. Psychology and aging, 18, 181.

Meskal, I., Gehring, K., van der Linden, S. D., Rutten, G. J. M., & Sitskoorn, M. M. (2015). Cognitive improvement in meningioma patients after surgery: clinical relevance of computerized testing. Journal of Neuro-oncology, 121, 617-625.

Moradi, A., Semnani, V., Djam, H., Tajodini, A., Zali, A. R., Ghaemi, K., … & Madani-Civi, M. (2008). Pathodiagnostic parameters for meningioma grading. Journal of Clinical Neuroscience, 15, 1370-1375.

Murray, L. L. (2012). Attention and other cognitive deficits in aphasia: Presence and relation to language and communication measures. American Journal of Speech-Language Pathology, 21, 51-64.

Patient Resource LCC (n.d.). Meningioma.[Illustration]. Retrieved from https://www.patientresource.com/Brain_Cancer_Types.aspx

Rijnen, S. J., Meskal, I., Bakker, M., De Baene, W., Rutten, G. J. M., Gehring, K., & Sitskoorn, M. M. (2019). Cognitive outcomes in meningioma patients undergoing surgery: individual changes over time and predictors of late cognitive functioning. Neuro-oncology, 21, 911-922.

Walsh, K. (2017, September 18). Kate Walsh reveals she was diagnosed with a brain tumor two years ago (E. Dibdin, Interviewer). Cosmopolitan. Retrieved from https://www.cosmopolitan.com/entertainment/celebs/a12254273/kate-walsh-brain-tumor-cancer-diagnosis-recovery-interview/

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