| Altered mental status in patients with cancer. | |
MedLine Citation:
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PMID: 11115238 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To identify the causes of an altered mental status in a cancer population. METHODS: We studied 140 confused patients with cancer (100 prospectively and 40 retrospectively) between January 1, 1991, and June 30, 1992, to determine clinical findings, causes, and outcome. RESULTS: All patients had non-central nervous system cancers. The most common primary cancer types were lung (20%), gastrointestinal tract (18%), leukemia and lymphoma (17%), and breast (11%). Median patient age was 73 years, and 49% were men. Disseminated systemic metastases were present in 50% of patients; 34% were confused at hospital admission and 66% developed confusion during hospitalization. Symptoms included lethargy or coma in 61% of patients, agitation in 44%, disorientation in 83%, lateralizing signs in 41%, delusions or hallucinations in 28%, and seizures in 9%. A single cause of the altered mental status was found in 33% of patients, whereas 67% had multiple causes. Drugs, especially opioids, were associated with altered mental status in 64% of patients, metabolic abnormalities in 53%, infection in 46%, and recent surgery in 32%. A structural brain lesion was the sole cause of encephalopathy in 15% of patients. Although delirium improved in 67% of patients, it was a poor prognostic factor for overall outcome. Thirty-day mortality was 25%, and 44% of patients died within 6 months, usually from progression of the underlying cancer. Prolonged delirium suggested infection or coagulopathy. Younger patients and those with hypoxemia or kidney or liver dysfunction were more likely to die (P<.05). CONCLUSION: Patients with cancer usually have multiple causes of delirium, many of which are treatable, with rapid improvement in their cognitive status. |
Authors:
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R Tuma; L M DeAngelis |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Archives of neurology Volume: 57 ISSN: 0003-9942 ISO Abbreviation: Arch. Neurol. Publication Date: 2000 Dec |
Date Detail:
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Created Date: 2000-12-18 Completed Date: 2001-01-04 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0372436 Medline TA: Arch Neurol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1727-31 Citation Subset: AIM; IM |
Affiliation:
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Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Age Factors Aged Delirium / etiology*, psychology, therapy Disease Progression Female Humans Male Middle Aged Neoplasms / complications*, psychology* Prognosis Prospective Studies Retrospective Studies |
| Comments/Corrections | |
Comment In:
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Arch Neurol. 2001 Aug;58(8):1310
[PMID:
11493178
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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