Cognitive Disorders and Delirium (PDQ�)
Cognitive disorders and delirium are conditions in which the patient experiences a confused mental state and changes in behavior.
People who have
Sleeping and waking.
Delirium occurs frequently in patients with cancer, especially in patients with advanced cancer.
Delirium usually occurs suddenly and the patient's
This summary is about cognitive disorders in adults with
Causes of Cognitive Disorders and Delirium
Cognitive disorders and delirium may be complications of cancer and cancer treatment, especially in people with advanced cancer.
In patients with
Organfailure. Electrolyteimbalances: Electrolytes are important minerals(including salt, potassium, calcium, and phosphorous) that are needed to keep the heart, kidneys, nerves, and muscles working correctly. Infection. Symptomscaused by the cancer but that occur apart from the localor distantspread of the tumor ( paraneoplastic syndromes), such as inflammationof the brain. Medication side effects: Patients with cancer usually take many medications. Some drugshave side effects that include delirium and confusion. The effects of these drugs usually go away after the drug is stopped.
Withdrawal from drugs that depress (slow down) the
central nervous system(brain and spinal cord).
Risk factors for delirium include having a serious disease and having more than one disease.
Other conditions besides having cancer may place a patient at risk for developing delirium.
Advanced canceror other serious illness.
Having more than one disease.
disorder, such as dementia.
Low levels of albumin (
protein) in the blood. Infection.
Taking medications that affect the mind or behavior.
dosesof pain medication.
Early identification of risk factors may help
Effects of Cognitive Disorders and Delirium on the Patient, Family, and Health Care Providers
Cognitive disorders and delirium can be upsetting to the patient's family and caregivers.
Cognitive disorders and delirium may affect physical health and communication.
Patients with cognitive disorders or delirium are more likely to fall, be
The confused mental state of these patients may hinder their communication with family members and the health care providers.
Diagnosis of Cognitive Disorders and Delirium
Possible signs of cognitive disorders and delirium include sudden personality changes, impaired thinking, or unusual anxiety or depression.
A patient who suddenly becomes
The symptoms of delirium are similar to symptoms of depression and dementia.
Early symptoms of delirium are similar to symptoms of anxiety, anger, depression, and
Patients with delirium often go in and out of consciousness. Patients who have dementia usually remain alert.
Delirium may occur suddenly. Dementia appears gradually and gets worse over time.
Sleeping and waking problems are more common with delirium than with dementia.
In elderly patients who have
In patients aged 65 or older who have survived cancer for more than 5 years, the risk for cognitive disorders and dementia is increased, apart from the risk for delirium.
Treatment of Delirium
Patient and family concerns are addressed when deciding the treatment of
Treatment of the Symptoms of Delirium by Changing the Patient's Surroundings
Controlling the patient's surroundings may help reduce mild symptoms of delirium. The following changes may be effective:
Putting the patient in a quiet, well-lit room with familiar objects.
Placing a clock or calendar where the patient can see it.
Having family present.
Limiting changes in caregivers.
To prevent a patient from harming himself or herself or others, physical restraints also may be necessary.
Treatment of the Causes of Delirium
Treatment may include the following:
Stopping or reducing
medicationsthat cause delirium.
fluidsinto the bloodstream to correct dehydration.
drugsto correct hypercalcemia(too much calciumin the blood).
Treatment of the Symptoms of Delirium with Medication
Drugs called antipsychotics may be used to treat the symptoms of delirium. Drugs that
Delirium and Sedation
The decision to use drugs to sedate the patient who is near death and has symptoms of delirium, pain, and difficult breathing presents ethical and legal issues for both the doctor and the family. When the symptoms of delirium are not relieved with
Health care professionals who have experience in
palliative caremake repeated assessments of the patient?s responseto treatments. The family is always included.
The need to use drugs that sedate the patient is evaluated by a
multidisciplinaryteam of health care professionals.
sedationshould be considered.
A multidisciplinary team of health care professionals will work with the family to ensure that the family's views are assessed and understood. The family may need support from the health care team and
mental healthprofessionals while palliative sedation is used.
Current Clinical Trials
Check NCI?s list of cancer clinical trials for U.S. supportive and palliative care trials about cognitive/functional effects that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Get More Information From NCI
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
The NCI's LiveHelp� online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
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Changes to This Summary (08/19/2011)
Editorial changes were made to this summary.
Questions or Comments About This Summary
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PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).