Changing pattern of agitated impaired mental status in patients with advanced cancer: Association with cognitive monitoring, hydration, and opioid rotation

Eduardo Bruera, John J. Franco, Marco Maltoni, Sharon Watanabe, Maria Suarez-Almazor

Research output: Contribution to journalArticle

Abstract

In late 1990, it became standard practice at the palliative care unit of the Edmonton General Hospital to regularly administer the Mini-Mental State Questionnaire (MMSQ) and to undertake opioid rotation and hydration upon detection of cognitive failure. We retrospectively reviewed the charts of 117 and 162 patients admitted in 1988-1989 and 1991-1992, respectively, to assess the impact of these maneuvers on the prevalence of agitated impaired mental status (IMS). All patients underwent regular cognitive assessment in 1991-1992 versus none in 1988-1989. Seventy-three percent of patients received hydration in the second period versus 32% in the first (P <0.01). The frequency of opioid rotation was also greater in the second period (41% versus 21%, P <0.001). The incidence of agitated IMS decreased from 26% in 1988-1989 to 10% in 1991-1992 (P <0.001). This was reflected by a lower mean dose of the major drug used to treat this condition, haloperidol (3.6 ± 2.4 versus 5.6 ± 3.8 mg/day, P <0.01), and less frequent use of other neuroleptics and benzodiazepines (0.12 versus 0.38 prescriptions per patient, P <0.01) in the second period. Our data suggest that routine cognitive monitoring, opioid rotation, and hydration may reduce the incidence of agitated IMS in terminal cancer patients.

Original languageEnglish
Pages (from-to)287-291
Number of pages5
JournalJournal of Pain and Symptom Management
Volume10
Issue number4
DOIs
Publication statusPublished - 1995

Keywords

  • cognitive monitoring
  • Delirium
  • hydration
  • neoplasms
  • opioid rotation
  • terminal care

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Nursing(all)
  • Neurology

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