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Cognitive Impairment Associated With Carcinoid Syndrome

Pasieka, Janice L. MD, FRCSC, FACS*,†; Longman, R. Stewart PhD; Chambers, Anthony J. MS, FRACS*; Rorstad, Otto MD, PhD; Rach-Longman, Kathy PhD*; Dixon, Elijah MD, MclinEp, FRCSC*

doi: 10.1097/SLA.0b013e318288ff6d
Original Articles

Objectives: To evaluate the cognitive performance of patients with carcinoid syndrome (CS) compared with population norms and cancer patients with non-neuroendocrine (non-NET) liver metastases.

Background: The release of serotonin into the systemic circulation from metastatic small bowel neuroendocrine tumors (SB NET) causes CS. Many patients with CS followed in a multidisciplinary NET clinic seemed to exhibit a unique cognitive impairment. Because serotonin is known to influence a range of cognitive function, the question arouse as to whether cognitive impairment is another manifestation of CS.

Methods: Patients were recruited from the multidisciplinary NET and the hepatobilary cancer clinics at the cancer center. The CS group consisted of patients with proven SB NETs metastatic to liver; the cancer comparison group consisted of patients with liver metastases from non-NET cancer. All completed a self-reported cognitive questionnaire and a battery of 6 standardized neurocognitive tests. Both groups were compared to age/sex/educational-matched norms.

Results: Thirty-six patients with CS and 20 with non-NET metastases were enrolled. Patients with CS reported greater cognitive dysfunction in all cognitive domains than both norms and the comparison cancer group. On cognitive testing, patients with CS demonstrated weakness in initiation, processing speed, visual memory, cognitive efficiency, and delayed verbal recall compared with norms. Although the patients with non-NET cancer also demonstrated some cognitive dysfunction compared with norms, the patients with CS did significantly worse on delayed recall (P = 0.03) and marginally slower on speeded mental flexibility (P = 0.097) compared with patients with non-NET cancer.

Conclusion: This study confirmed our clinical observation that patients with CS suffer from cognitive impairment that is different from the non-NET cancer group and population norms.

Patients with carcinoid syndrome self-report significant cognitive impairment compared with patients with nonneuroendocrine cancer and population norms. On formal cognitive testing, patients with carcinoid syndrome have a distinct cognitive impairment compared with these 2 groups that should be addressed in the care and management of this rare disease.

*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.

Reprints: Janice L. Pasieka, MD, FRCSC, FACS, Department of Surgery and Oncology, University of Calgary and Tom Baker Cancer Center, North Tower FMC, 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada. E-mail:

Disclosure: The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.