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

Altered Mental Status in Cancer

John Y. Rhee
1   Division of Neuro-Oncology, Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
2   Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
3   Department of Neurology, Harvard Medical School, Boston, Massachusetts
,
Vihang Nakhate
1   Division of Neuro-Oncology, Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
3   Department of Neurology, Harvard Medical School, Boston, Massachusetts
4   Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
,
Christy Soares
5   Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
,
Zachary Tentor
2   Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
,
Jorg Dietrich
3   Department of Neurology, Harvard Medical School, Boston, Massachusetts
4   Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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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


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Artikel online veröffentlicht:
05. August 2024

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