Figure 3.

Schema of Longitudinal Trajectory of Cognitive Impairment Across Disease Trajectory.

The blue line represents environmental demands and expectations such as work, school, and family responsibilities. The green line depicts the patient’s current cognitive skills such as attention/concentration, processing speed, memory, and executive functioning. The gray space between environmental demands and cognitive skills is the cognitive gap. The gap is narrow at “Presumed pretumor baseline” because the patient is well equipped with cognitive skills to manage his or her environmental demands and expectations. During “Tumor development,” the gap widens as skills decline and demands increase. The gap widens further with “Tumor treatment” given that the impact of surgery, radiotherapy, and chemotherapy on cognitive skills and environmental demand increases with factors such as returning to work after treatment. The dotted green line reflects natural recovery of cognitive skills after surgery. With “Rehab,” the gap is narrowed by improving cognitive skills using the Triple A model. Concurrently, environmental demands and expectations are decreased through environmental interaction strategies such as work accommodation, school accommodation, and managing family and patient performance expectations.