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Published on: October 18, 2011
Cognitive impairment associated with carcinoid syndrome
Janice L Pasieka1, R Stewart Longman, Anthony J Chambers
1*Department of Surgery, Division of General Surgery and Surgical Oncology, University of Calgary and Tom Baker Cancer Center, Calgary, Alberta, Canada †Department of Medicine, Division of Endocrinology, University of Calgary and Tom Baker Cancer Center, Calgary, Alberta, Canada; and ‡Department of Psychology, Foothills Hospital, Calgary, Alberta, Canada.
Annals of Surgery
|March 13, 2013
Summary
Patients with carcinoid syndrome (CS) experience significant cognitive impairment, particularly in memory and processing speed, compared to general populations and other cancer patients. This cognitive dysfunction appears to be a distinct manifestation of CS.
Area of Science:
- Neuroscience
- Oncology
- Endocrinology
Background:
- Carcinoid syndrome (CS) results from systemic serotonin release by metastatic small bowel neuroendocrine tumors (SB NET).
- Clinical observations suggest a unique cognitive impairment in CS patients.
- Serotonin's known influence on cognition prompts investigation into CS-related cognitive deficits.
Purpose of the Study:
- To assess cognitive performance in patients with carcinoid syndrome (CS).
- To compare CS cognitive function against population norms.
- To compare CS cognitive function against liver metastases from non-neuroendocrine (non-NET) cancers.
Main Methods:
- Recruited patients from multidisciplinary NET and hepatobiliary cancer clinics.
- CS group: patients with SB NETs metastatic to the liver.
- Comparison group: patients with liver metastases from non-NET cancer.
- Administered self-reported cognitive questionnaires and a battery of 6 standardized neurocognitive tests.
- Compared both groups against age/sex/education-matched population norms.
Main Results:
- Thirty-six CS patients and 20 non-NET cancer patients were enrolled.
- CS patients reported greater cognitive dysfunction across all domains than norms and the non-NET cancer group.
- Cognitive testing revealed deficits in initiation, processing speed, visual memory, cognitive efficiency, and delayed verbal recall in CS patients compared to norms.
- CS patients performed significantly worse on delayed recall (P=0.03) and marginally slower on speeded mental flexibility (P=0.097) compared to non-NET cancer patients.
Conclusions:
- This study confirms that patients with carcinoid syndrome exhibit cognitive impairment.
- The observed cognitive impairment in CS is distinct from that seen in non-NET cancer patients and general population norms.
- Cognitive dysfunction is a significant manifestation of carcinoid syndrome.
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