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Article CommentaryAnalysis and Commentary

The Impact of Gliomas on Cognition and Capacity

Jason Lee and Ryan Chaloner Winton Hall
Journal of the American Academy of Psychiatry and the Law Online June 2019, JAAPL.003841-19; DOI: https://doi.org/10.29158/JAAPL.003841-19
Jason Lee
Dr. Lee is a Psychiatry Resident, Cleveland Clinic Foundation, Cleveland, Ohio. Dr. Hall is Assistant Professor, University of Central Florida College of Medicine, Orlando, Florida, and Affiliate Assistant Professor, University of South Florida, Tampa, Florida.
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Ryan Chaloner Winton Hall
Dr. Lee is a Psychiatry Resident, Cleveland Clinic Foundation, Cleveland, Ohio. Dr. Hall is Assistant Professor, University of Central Florida College of Medicine, Orlando, Florida, and Affiliate Assistant Professor, University of South Florida, Tampa, Florida.
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Article Figures & Data

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    Table 1

    Pooled Median Survival in Months for Common Brain Tumors

    GradePrognosis, months
    Astrocytoma
        Grade I (pilocytic astrocytoma)Often cured with surgery
        Grade II (astrocytoma)48–180
        Grade III (anaplastic astrocytoma)18–36
        Grade IV (glioblastoma multiforme)4.25–12
    Oligodendroglioma
        Grade II (oligodendrogliomas)55.2–204
        Grade III (anaplastic oligoastrocytoma)42–120
    Primary CNS lymphoma17–84
    • Prognosis data are from References 12⇓⇓⇓⇓⇓⇓–19. CNS, central nervous system.

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    Table 2

    Testamentary Capacity Factors

    Understands what a will is
    Knows one's assets
    Knows one's natural heirs
    Decisions on how assets are distributed are not influenced by delusional beliefs
    Person is not a victim of undue influence
    • Source: Reference 57.

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    Table 3

    Karnofsky Performance Scale65, 66

    100: Normal; no complaints; no evidence of disease
    90: Able to carry on normal activity; minor signs or symptoms of disease
    80: Normal activity with effort; some signs or symptoms of disease
    70: Cares for self; unable to carry on normal activity or to do active work
    60: Requires occasional assistance, but is able to care for most of their personal needs
    50: Requires considerable assistance and frequent medical care
    40: Disabled; requires special care and assistance
    30: Severely disabled; hospital admission is indicated although death not imminent
    20: Very sick; hospital admission necessary; active supportive treatment necessary
    10: Moribund; fatal processes progressing rapidly
    0: Dead
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    Table 4

    Proposed Signs for Family Overreporting of Functioning in GBM (When Consistently Present)

    1. Frequent justification of improvement on minor physical findings that appears to be overemphasized or does not match other treatment reports
    2. Pervasive and overemphasized belief that person is special (e.g., a fighter), especially after significant documented decline
    3. Overreliance on spiritual beliefs for a cure, not just comfort for circumstances
    4. Unwavering focused on anecdotal reports of a cure and how the patient is similar to those reports
    5. Lack of acknowledgement of the meaning of words such as “palliative” (e.g., doctor's recommendation was potentially curative not just palliative)
    6. Lack of rational explanation for not applying similar past life experience to current situation (e.g., uncle's death from brain tumor does not apply)
    7. Repetitive overreliance on credentials of treating doctors (e.g., stating, “We got the best physicians, therefore he will get better [or was functioning better].”)
    8. Perceived extreme and consistent minimization of deficits, even after education to the contrary (e.g., stating, “He was always bad with names” in a person with aphasia)
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Journal of the American Academy of Psychiatry and the Law Online: 53 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 53, Issue 1
1 Mar 2025
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The Impact of Gliomas on Cognition and Capacity
Jason Lee, Ryan Chaloner Winton Hall
Journal of the American Academy of Psychiatry and the Law Online Jun 2019, JAAPL.003841-19; DOI: 10.29158/JAAPL.003841-19

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The Impact of Gliomas on Cognition and Capacity
Jason Lee, Ryan Chaloner Winton Hall
Journal of the American Academy of Psychiatry and the Law Online Jun 2019, JAAPL.003841-19; DOI: 10.29158/JAAPL.003841-19
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