Document Detail

Altered mental status in patients with cancer.
MedLine Citation:
PMID:  11115238     Owner:  NLM     Status:  MEDLINE    
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.
R Tuma; L M DeAngelis
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of neurology     Volume:  57     ISSN:  0003-9942     ISO Abbreviation:  Arch. Neurol.     Publication Date:  2000 Dec 
Date Detail:
Created Date:  2000-12-18     Completed Date:  2001-01-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372436     Medline TA:  Arch Neurol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1727-31     Citation Subset:  AIM; IM    
Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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MeSH Terms
Age Factors
Delirium / etiology*,  psychology,  therapy
Disease Progression
Middle Aged
Neoplasms / complications*,  psychology*
Prospective Studies
Retrospective Studies
Comment In:
Arch Neurol. 2001 Aug;58(8):1310   [PMID:  11493178 ]

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