LAUSR

Simple Summary The median age of diagnosis of dementia, as well as for many cancers, is above 60 years. Dementia should not exclude even frail, elderly patients from cancer treatment. Before beginning any treatment, the effects of the patient’s diet, medications and caregiver situation on neurological symptoms should be determined. Malnutrition, dehydration, alcohol consumption, and even loneliness can all accentuate or cause the “3Ds” of dementia, delirium and depression. Common drugs, especially if taken together, can cause cognitive difficulties resembling neurodegenerative diseases such as Alzheimer or Parkinson. These syndromes may be reversed by diet, social and caregiver changes, and stopping or lowering the dose of potentially inappropriate medications (PIMs). Brain scans and genetic analysis can be used to guide immunotherapies and tumor-antigen directed treatments. Discussion among the patient, caregivers and medical team is needed to assess cognition state and ability to accept diagnostic and therapeutic procedures. While surgery may be too dangerous for frail patients, radiation and many oral or infusion therapies, some discussed in this review, may be better tolerated. Abstract The likelihood of a diagnosis of dementia increases with a person’s age, as is also the case for many cancers, including melanoma and multiple myeloma, where the median age of diagnosis is above 60 years. However, patients diagnosed with dementia are less likely to be offered invasive curative therapies for cancer. Together with analysis of diet and medication history, advanced imaging methods and genetic profiling can now indicate more about syndromes causing the neurological symptoms. Cachexia, malnutrition, dehydration, alcohol consumption, and even loneliness can all accentuate or cause the “3Ds” of dementia, delirium and depression. Many common drugs, especially in the context of polypharmacy, can cause cognitive difficulties resembling neurodegenerative disease. These syndromes may be reversed by diet, social and caregiver changes, and stopping potentially inappropriate medications (PIMs). More insidious are immune reactions to many different autoantigens, some of which are related to cancers and tumors. These can induce movement and cognitive difficulties that mimic Alzheimer’s and Parkinson’s diseases and other ataxias associated with aging. Paraneoplastic neurological syndromes may be reversed by directed immunotherapies if detected in their early stages but are best treated by removal of the causative tumor. A full genetic workup should be done for all individuals as soon as possible after diagnosis, to guide less invasive treatments suitable for frail individuals. While surgical interventions may be contraindicated, genetic profile guided immunotherapies, oral treatments, and radiation may be equally curative in a significant number of cancers.