Altered Mental Status in Cancer

John Y. Rhee; Vihang Nakhate; Christy Soares; Zachary Tentor; Jorg Dietrich

doi:10.1055/s-0044-1788806

Seminars in Neurology, Table of Contents

Semin Neurol 2024; 44(06): 652-669
DOI: 10.1055/s-0044-1788806

Review Article

Altered Mental Status in Cancer

John Y. Rhee

¹Division of Neuro-Oncology, Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts

²Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts

³Department of Neurology, Harvard Medical School, Boston, Massachusetts

,

Vihang Nakhate

¹Division of Neuro-Oncology, Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts

³Department of Neurology, Harvard Medical School, Boston, Massachusetts

⁴Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts

,

Christy Soares

⁵Department of Neurology, Emory University School of Medicine, Atlanta, Georgia

,

Zachary Tentor

²Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts

,

Jorg Dietrich

³Department of Neurology, Harvard Medical School, Boston, Massachusetts

⁴Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts

› Author Affiliations

Abstract

Patients with cancer experience high rates of alterations in mental status. The mechanisms for altered mental status (AMS) in this population are manifold. The cancer itself may cause AMS through direct invasion of the central nervous system or as metastatic leptomeningeal spread. However, cancer patients are also vulnerable to tumor-associated complications such as seizures, cerebral edema, strokes, or cancer treatment-related complications such as infections, direct neural injury from radiation or chemotherapy, edema, or dysregulated autoimmune response from immunotherapies. Both during treatment and as sequelae, patients may suffer neurocognitive complications from chemotherapy and radiation, medications or opportunistic infections, as well as toxic–metabolic, nutritional, and endocrine complications. In this review, we describe a clinical approach to the cancer patient presenting with AMS and discuss the differential drivers of AMS in this patient population. While common etiologies of AMS in noncancer patients (toxic–metabolic or infectious encephalopathy, delirium) are also applicable to cancer patients, we additionally provide a cancer-specific differential diagnosis that warrants special consideration in the cancer patient with AMS.

Keywords

altered mental status - neurologic toxicity - cancer

Full Text

References

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