Understanding cognition in older patients with cancer.
Cancer and neurocognitive disorders, such as dementia and delirium, are common and serious diseases in the elderly that are accompanied by high degree of morbidity and mortality. Furthermore, evidence supports the under-diagnosis of both dementia and delirium in older adults. Complex questions exist regarding the interaction of dementia and delirium with cancer, beginning with guidelines on how best measure disease severity, the optimal screening test for either disorder, the appropriate level of intervention in the setting of abnormal findings, and strategies aimed at preventing the development or progression of either process. Ethical concerns emerge in the research setting, pertaining to the detection of cognitive dysfunction in participants, validity of consent, disclosure of abnormal results if screening is pursued, and recommended level of intervention by investigators. Furthermore, understanding the ways in which comorbid cognitive dysfunction and cancer impact both cancer and non-cancer-related outcomes is essential in guiding treatment decisions. In the following article, we will discuss what is presently known of the interactions of pre-existing cognitive impairment and delirium with cancer. We will also discuss identified deficits in our knowledge base, and propose ways in which innovative research may address these gaps.
University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: mskaruturi@mdanderson.org.
Meghan
M
Karuturi
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
Melisa L
ML
Wong
The Ottawa Hospital Cancer Center, Ottawa, Canada.
Tina
T
Hsu
Duke University, Durham, NC, USA.
Gretchen G
GG
Kimmick
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Stuart M
SM
Lichtman
University of Texas Health Science Center at Houston, Houston, TX, USA.
Holly M
HM
Holmes
Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA; Aging Brain Center, Hebrew SeniorLife, Boston, MA, USA.
Sharon K
SK
Inouye
University of Chicago, Chicago, IL, USA.
William
W
Dale
University of Rochester Medical Center, Rochester, NY, USA.
Kah P
KP
Loh
University of North Carolina, Chapel Hill, NC, USA.
Mary I
MI
Whitehead
University of North Carolina, Chapel Hill, NC, USA.
Allison
A
Magnuson
Comprehensive Cancer Center, City of Hope, Duarte, CA, USA.
Arti
A
Hurria
University of North Carolina, Chapel Hill, NC, USA.
Michelle C
MC
Janelsins
University of North Carolina, Chapel Hill, NC, USA.
Supriya
S
Mohile
D000368:Aged; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D003693:Delirium / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003704:Dementia / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D008495:Medical Oncology / Q000379:methods; D000073216:Mental Status and Dementia Tests; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D015995:Prevalence; D012720:Severity of Illness Index
Cognition; Competency; Confusion assessment method (CAM); Decision-making capacity; Delirium; Dementia; Mild cognitive impairment; Prevention; Screening; Treatment