The frequency and clinical course of cognitive impairment in patients with terminal cancer

Pereira, José Carlos; Hanson, John; Bruera, Éduardo

doi:10.1002/(sici)1097-0142(19970215)79:4<835::aid-cncr21>3.3.co;2-d

Cited by 114 publications

(166 citation statements)

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“…116 Cognitive screening of cancer patients with a briefly administered instrument such as the Minimental State Examination helps to detect cognitive deficits that otherwise might be missed. 3 This instrument has been widely used, and its psychometric properties are well known. Furthermore, normal values have been calculated for age and educational level on the basis of a large population study.…”

Section: Assessment Of Cognitive Dysfunction In Opioid-treated Patientsmentioning

confidence: 92%

“…40 The impaired mental status was based on an impaired assessment on a brief modified portion of the Minimental State Examination. 41 The frequency of cognitive impairment on objective testing in patients with cancer on admission to a palliative care unit has been reported in the range of 20 -44%, 3,42-44 whereas 80 -90% show impairment before death. 4 -6 The average duration of cognitive impairment before death in a prospective study of patients with advanced cancer has been estimated (the sample was not an inception cohort) to be 16 days.…”

Section: Prevalence and Pattern Of Cognitive Effects Associated With mentioning

confidence: 99%

“…One concern is that minor cognitive deficits might herald the risk or onset of more profound deficits, and therefore this justifies the role of regular cognitive monitoring in these patients. 3 Another concern is that previous studies have demonstrated that cognitive impairment is missed in 46% of elderly general medical inpatients, 111 and similarly in 23-60% of cancer patients. 5,112 Misdiagnosis of delirium occurs in 5-40% of general medical referrals to psychiatric services for depression.…”

Section: Assessment Of Cognitive Dysfunction In Opioid-treated Patientsmentioning

confidence: 99%

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The panorama of opioid‐related cognitive dysfunction in patients with cancer

Lawlor

2002

Cancer

104

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BACKGROUNDOpioids have an essential role in the management of pain in cancer patients, particularly those with advanced disease. Cognitive dysfunction is a recognized complication of opioid use. However, misconceptions and controversy surround the nature and prevalence of its occurrence. A projected increase in the aging cancer population highlights the need for a better understanding of this phenomenon.METHODSA critical appraisal of the literature evidence in relation to the pattern, pathophysiology, assessment, impact, and management of cognitive dysfunction due to opioid use in cancer pain management is given.RESULTSStudies in cancer patients with less advanced disease reveal subtle evidence of cognitive impairment, largely related to initial dosing or dose increases. In advanced cancer, opioid‐induced cognitive dysfunction usually occurs in the form of delirium, a multifactorial syndrome. The presence of both cognitive impairment and delirium frequently is misdiagnosed or missed. Potential risk factors include neuropathic and incidental pain, opioid tolerance, somatization of psychologic distress, and a history of drug or alcohol abuse. Elevation of opioid metabolites with renal impairment may contribute to cognitive dysfunction. Recognition of opioid‐related cognitive dysfunction is improved by objective screening. Successful management requires either dose reduction or a change of opioid, in addition to addressing other reversible precipitants such as dehydration or volume depletion.CONCLUSIONSOpioid‐related cognitive dysfunction tends to be subtle in the earlier stages of cancer, whereas delirium, a more florid form with behavioral disturbance is likely to be present in the advanced cancer population. In patients with advanced disease, an optimal management approach requires careful clinical assessment, identification of risk factors, objective monitoring of cognition, maintenance of adequate hydration, and either dose reduction or switching to a different opioid. Cancer 2002;94:1836–53. © 2002 American Cancer Society.DOI 10.1002/cncr.10389

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Section: Assessment Of Cognitive Dysfunction In Opioid-treated Patientsmentioning

confidence: 92%

Section: Prevalence and Pattern Of Cognitive Effects Associated With mentioning

confidence: 99%

Section: Assessment Of Cognitive Dysfunction In Opioid-treated Patientsmentioning

confidence: 99%

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The panorama of opioid‐related cognitive dysfunction in patients with cancer

Lawlor

2002

Cancer

104

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“…Né anmoins, la maladie cancé reuse et ses traitements restent à l'origine d'une sé rie de ré actions cognitives, é motionnelles et comportementales qui concernent tant le patient que les membres de sa famille et ses proches ( [18,28,32,48,49]). Ces ré actions s'articulent autour des diffé rentes phases de la maladie cancé -reuse : les premiers symptô mes [2,75], les traitements [41,56], la rechute, la phase pré terminale et terminale [34,42,59,81]), la ré mission [17,24,33] et la gué rison [1,36].…”

Section: Motsclé S : Cancer-besoins Psychosociaux -Support Professionunclassified

The psychosocial needs of the cancer sufferer and his support: a nationwide Belgian study

Libert¹,

Merckaert²,

Étienne³

et al. 2006

Oncologie

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“…30 Causes include opioid analgesics, psychoactive drugs, sepsis, dehydration, renal failure and other metabolic abnormalities. 24 In some cases, simple interventions such as antibiotics, intravenous fluids and treating reversible metabolic abnormalities may be helpful.…”

Section: Deliriummentioning

confidence: 99%