Delirium and Cognitive Impairment

Abstract Cognitive syndromes are prevalent in palliative care settings. Delirium is the most common and often serious neuropsychiatric disorder found in palliative care settings. Delirium is characterized by abrupt onset, fluctuating disturbance in awareness, attention, cognition, and perception. Delirium is associated with increased morbidity and mortality, causing distress in patients, family members, and staff. Delirium is often underrecognized or misdiagnosed and inappropriately treated or untreated. Clinicians who care for patients with advanced cancer and at the end-of-life must be able to diagnose delirium accurately, undertake appropriate assessment of etiologies, and understand the benefits and risks of pharmacologic and nonpharmacologic interventions currently available. Dementia and other neurocognitive disorders can also be encountered in palliative care settings, have multifactorial etiologies ranging from cancer-treatments to brain metastases, and include neurodegenerative illnesses comorbidly, especially in the oldest old patient population. This chapter presents an overview of the assessment and management of delirium in cancer patients in palliative care settings. Other cognitive syndromes will be briefly described with a focus on the assessment and differential diagnosis. Professional issues, including communication challenges, ethical dilemmas, legal requirements, and service development agendas will be considered.