Abstract

Patients with head and neck cancer are treated through surgery, radiotherapy (RT), and chemotherapy (CT). Carotid artery damage and neurotoxicity were previously observed in these patients. This study estimated the dementia risk associated with different treatment modalities in a head and neck cancer population with long-term follow-up. Taiwan's National Health Insurance claims database and a cancer registry database from the Collaboration Center of Health Information Application were linked for the present analysis. Patients with head and neck cancer, treated from January 1, 2002 to December 31, 2010, were included in the study. The follow-up duration was the period from the index date to December 31, 2012. Inclusion criteria were head and neck cancer; an age >20 years; and having undergone surgery, CT, concurrent CT, or surgery with adjuvant treatment. Exclusion criteria were another cancer diagnosed before the head and neck cancer, death or being diagnosed with dementia within 2 years after the treatment of the head and neck cancer, stroke before the index date, distant metastasis, in situ carcinoma, sarcoma, head and neck cancer recurrence, an unknown sex, and an age 65 years and having undergone RT with or without CT were risk factors (P6660 cGy exhibited a 1.69-fold (95% CI 0.97-2.95, P=0.063) higher dementia risk compared with those who received a total radiation dose
Original languageEnglish
Pages (from-to)e1983
JournalMedicine (United States)
Volume94
Issue number45
DOIs
Publication statusPublished - 2015

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Head and Neck Neoplasms
Dementia
Drug Therapy
Radiotherapy
Databases
Information Centers
Carcinoma in Situ
National Health Programs
Taiwan
Carotid Arteries
Sarcoma
Registries
Neoplasms
Therapeutics
Stroke
Radiation
Neoplasm Metastasis
Recurrence
Health
Population

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Dementia Risk in Irradiated Patients with Head and Neck Cancer. / Chen, Jin-Hua; Yen, Yu-Chun; Liu, Shing Hwa; Lee, Fei-Peng; Lin, Kuan Chou; Lai, Ming-Tang; Wu, Chia-Che; Chen, Tsung Ming; Yuan, Sheng Po; Chang, Chia Lun; Wu, Szu-Yuan.

In: Medicine (United States), Vol. 94, No. 45, 2015, p. e1983.

Research output: Contribution to journalArticle

@article{12a2eb5139bb464b84586bf4c2dd55fe,
title = "Dementia Risk in Irradiated Patients with Head and Neck Cancer",
abstract = "Patients with head and neck cancer are treated through surgery, radiotherapy (RT), and chemotherapy (CT). Carotid artery damage and neurotoxicity were previously observed in these patients. This study estimated the dementia risk associated with different treatment modalities in a head and neck cancer population with long-term follow-up. Taiwan's National Health Insurance claims database and a cancer registry database from the Collaboration Center of Health Information Application were linked for the present analysis. Patients with head and neck cancer, treated from January 1, 2002 to December 31, 2010, were included in the study. The follow-up duration was the period from the index date to December 31, 2012. Inclusion criteria were head and neck cancer; an age >20 years; and having undergone surgery, CT, concurrent CT, or surgery with adjuvant treatment. Exclusion criteria were another cancer diagnosed before the head and neck cancer, death or being diagnosed with dementia within 2 years after the treatment of the head and neck cancer, stroke before the index date, distant metastasis, in situ carcinoma, sarcoma, head and neck cancer recurrence, an unknown sex, and an age 65 years and having undergone RT with or without CT were risk factors (P6660 cGy exhibited a 1.69-fold (95{\%} CI 0.97-2.95, P=0.063) higher dementia risk compared with those who received a total radiation dose",
author = "Jin-Hua Chen and Yu-Chun Yen and Liu, {Shing Hwa} and Fei-Peng Lee and Lin, {Kuan Chou} and Ming-Tang Lai and Chia-Che Wu and Chen, {Tsung Ming} and Yuan, {Sheng Po} and Chang, {Chia Lun} and Szu-Yuan Wu",
note = "Export Date: 29 March 2016 CODEN: MEDIA 通訊地址: Wu, S.-Y.; Taipei Medical University, Institute of Toxicology, College of Medicine, Hsing-Long Rd, Taiwan; 電子郵件: szuyuanwu5399@gmail.com 參考文獻: (2011) Taiwan Cancer Registry Report, 2011 Edition, , http://www.hpa.gov.tw/BHPNet/Web/Stat/StatisticsShow.aspx?No201404160001, Health Promotion Administration MoHaW; Chen, Y.J., Chang, J.T., Liao, C.T., Head and neck cancer in the betel quid chewing area: Recent advances in molecular carcinogenesis (2008) Cancer Sci, 99, pp. 1507-1514; Marcial, V.A., Pajak, T.F., Kramer, S., Radiation Therapy Oncology Group (RTOG) studies in head and neck cancer (1988) Semin Oncol, 15, pp. 39-60; Fu, K.K., Cooper, J.S., Marcial, V.A., Evolution of the Radiation Therapy Oncology Group clinical trials for head and neck cancer (1996) Int J Radiat Oncol Biol Phys, 35, pp. 425-438; Dorresteijn, L.D., Kappelle, A.C., Boogerd, W., Increased risk of ischemic stroke after radiotherapy on the neck in patients younger than 60 years (2002) J Clin Oncol, 20, pp. 282-288; Hsiao, K.Y., Yeh, S.A., Chang, C.C., Cognitive function before and after intensity-modulated radiation therapy in patients with nasopharyngeal carcinoma: A prospective study (2010) Int J Radiat Oncol Biol Phys, 77, pp. 722-726; Gavrilovic, I.T., Hormigo, A., Yahalom, J., Long-term follow-up of high-dose methotrexate-based therapy with and without whole brain irradiation for newly diagnosed primary CNS lymphoma (2006) J Clin Oncol, 24, pp. 4570-4574; Connell, C.M., Janevic, M.R., Gallant, M.P., The costs of caring: Impact of dementia on family caregivers (2001) J Geriatr Psychiatry Neurol Winter, 14, pp. 179-187; Toseland, R.W., McCallion, P., Gerber, T., Predictors of health and human services use by persons with dementia and their family caregivers (2002) Social Sci Med, 55, pp. 1255-1266; Battistin, L., Cagnin, A., Vascular cognitive disorder. A biological and clinical overview (2010) Neurochem Res, 35, pp. 1933-1938; Rosendorff, C., Beeri, M.S., Silverman, J.M., Cardiovascular risk factors for Alzheimer's disease (2007) Am J Geriatr Cardiol, 16, pp. 143-149; Epstein, N.U., Xie, H., Ruland, S.D., Vascular risk factors and cardiovascular outcomes in the Alzheimer's disease neuroimaging initiative (2012) Am J Alzheimer Dis Other Dementias, 27, pp. 275-279; Mendenhall, W.M., Million, R.R., Elective neck irradiation for squamous cell carcinoma of the head and neck: Analysis of time-dose factors and causes of failure (1986) Int J Radiat Oncol Biol Phys, 12, pp. 741-746; Mendenhall, W.M., Million, R.R., Cassisi, N.J., Squamous cell carcinoma of the head and neck treated with radiation therapy: The role of neck dissection for clinically positive neck nodes (1986) Int J Radiat Oncol Biol Phys, 12, pp. 733-740; Lindberg, R., Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts (1972) Cancer, 29, pp. 1446-1449; Chao, K.S., Wippold, F.J., Ozyigit, G., Determination and delineation of nodal target volumes for head-and-neck cancer based on patterns of failure in patients receiving definitive and postoperative IMRT (2002) Int J Radiat Oncol Biol Phys, 53, pp. 1174-1184; Stewart, F.A., Heeneman, S., Te Poele, J., Ionizing radiation accelerates the development of atherosclerotic lesions in ApoE-/-mice and predisposes to an inflammatory plaque phenotype prone to hemorrhage (2006) American J Pathol, 168, pp. 649-658; Schiller, N.K., Kubo, N., Boisvert, W.A., Effect of gammairradiation and bone marrow transplantation on atherosclerosis in LDL receptor-deficient mice (2001) Arterioscler Thromb Vasc Biol, 21, pp. 1674-1680; Manka, D., Forlow, S.B., Sanders, J.M., Critical role of platelet Pselectin in the response to arterial injury in apolipoprotein-Edeficient mice (2004) Arterioscler Thromb Vasc Biol, 24, pp. 1124-1129; Weintraub, N.L., Jones, W.K., Manka, D., Understanding radiationinduced vascular disease (2010) J Am Coll Cardiol, 55, pp. 1237-1239; Schultz-Hector, S., Trott, K.R., Radiation-induced cardiovascular diseases: Is the epidemiologic evidence compatible with the radiobiologic data (2007) Int J Radiat Oncol Biol Phys, 67, pp. 10-18; Zhao, W., Diz, D.I., Robbins, M.E., Oxidative damage pathways in relation to normal tissue injury (2007) Br J Radiol, 80, pp. S23-31. , (Spec No 1); Atkinson, J.L., Sundt, T.M., Jr., Dale, A.J., Radiation-associated atheromatous disease of the cervical carotid artery: Report of seven cases and review of the literature (1989) Neurosurgery, 24, pp. 171-178; Fonkalsrud, E.W., Sanchez, M., Zerubavel, R., Serial changes in arterial structure following radiation therapy (1977) Surg Gynecol Obstet, 145, pp. 395-400; Di Nisio, M., Soesan, M., Otten, H.M., Endothelial damage of the internal carotid artery after chemoradiotherapy of the neck for a Hodgkin lymphoma (2007) Thromb Haemost, 97, pp. 315-316; Gujral, D.M., Chahal, N., Senior, R., Radiation-induced carotid artery atherosclerosis (2014) Radiother Oncol, 110, pp. 31-38; Vigliani, M.C., Duyckaerts, C., Hauw, J.J., Dementia following treatment of brain tumors with radiotherapy administered alone or in combination with nitrosourea-based chemotherapy: A clinical and pathological study (1999) J Neuro-oncol, 41, pp. 137-149; DeAngelis, L.M., Delattre, J.Y., Posner, J.B., Radiation-induced dementia in patients cured of brain metastases (1989) Neurology, 39, pp. 789-796; Levendag, P.C., Nowak, P.J., Van Der Sangen, M.J., Local tumor control in radiation therapy of cancers in the head and neck (1996) Am J Clin Oncol, 19, pp. 469-477; Schiff, P.B., Harrison, L.B., Strong, E.W., Impact of the time interval between surgery and postoperative radiation therapy on locoregional control in advanced head and neck cancer (1990) J Surg Oncol, 43, pp. 203-208; McCready, R.A., Hyde, G.L., Bivins, B.A., Radiation-induced arterial injuries (1983) Surgery, 93, pp. 306-312; Katras, T., Baltazar, U., Colvett, K., Radiation-related arterial disease (1999) Am Surg, 65, pp. 1176-1179; Jurado, J.A., Bashir, R., Burket, M.W., Radiation-induced peripheral artery disease (2008) Catheterization Cardiovasc Intervent, 72, pp. 563-568; Cella, L., Liuzzi, R., Conson, M., Dosimetric predictors of asymptomatic heart valvular dysfunction following mediastinal irradiation for Hodgkin's lymphoma (2011) Radiother Oncol, 101, pp. 316-321; Carlson, R.G., Mayfield, W.R., Normann, S., Radiation-associated valvular disease (1991) Chest, 99, pp. 538-545; Heidenreich, P.A., Hancock, S.L., Lee, B.K., Asymptomatic cardiac disease following mediastinal irradiation (2003) J Am Coll Cardiol, 42, pp. 743-749; Lee, C.C., Su, Y.C., Ho, H.C., Increased risk of ischemic stroke in young nasopharyngeal carcinoma patients (2011) Int J Radiat Oncol Biol Phys, 81, pp. e833-838; Huang, Y.S., Lee, C.C., Chang, T.S., Increased risk of stroke in young head and neck cancer patients treated with radiotherapy or chemotherapy (2011) Oral Oncol, 47, pp. 1092-1097; Plummer, C., Henderson, R.D., O'Sullivan, J.D., Ischemic stroke and transient ischemic attack after head and neck radiotherapy: A review (2011) Stroke, 42, pp. 2410-2418; Scott, A.S., Parr, L.A., Johnstone, P.A., Risk of cerebrovascular events after neck and supraclavicular radiotherapy: A systematic review (2009) Radiother Oncol, 90, pp. 163-165; Chong, V.F., Khoo, J.B., Chan, L.L., Neurological changes following radiation therapy for head and neck tumours (2002) Eur J Radiol, 44, pp. 120-129; Cheung, M., Chan, A.S., Law, S.C., Cognitive function of patients with nasopharyngeal carcinoma with and without temporal lobe radionecrosis (2000) Arch Neurol, 57, pp. 1347-1352; Cmelak, A., Li, S., Marur, S., E1308: Reduced-dose IMRT in human papilloma virus (HPV)-associated resectable oropharyngeal squamous carcinomas (OPSCC) after clinical complete response (cCR) to induction chemotherapy (IC) (2014) J Clin Oncol, 32, p. 55. , Suppl[abstr LBA6006]",
year = "2015",
doi = "10.1097/MD.0000000000001983",
language = "English",
volume = "94",
pages = "e1983",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "45",

}

TY - JOUR

T1 - Dementia Risk in Irradiated Patients with Head and Neck Cancer

AU - Chen, Jin-Hua

AU - Yen, Yu-Chun

AU - Liu, Shing Hwa

AU - Lee, Fei-Peng

AU - Lin, Kuan Chou

AU - Lai, Ming-Tang

AU - Wu, Chia-Che

AU - Chen, Tsung Ming

AU - Yuan, Sheng Po

AU - Chang, Chia Lun

AU - Wu, Szu-Yuan

N1 - Export Date: 29 March 2016 CODEN: MEDIA 通訊地址: Wu, S.-Y.; Taipei Medical University, Institute of Toxicology, College of Medicine, Hsing-Long Rd, Taiwan; 電子郵件: szuyuanwu5399@gmail.com 參考文獻: (2011) Taiwan Cancer Registry Report, 2011 Edition, , http://www.hpa.gov.tw/BHPNet/Web/Stat/StatisticsShow.aspx?No201404160001, Health Promotion Administration MoHaW; Chen, Y.J., Chang, J.T., Liao, C.T., Head and neck cancer in the betel quid chewing area: Recent advances in molecular carcinogenesis (2008) Cancer Sci, 99, pp. 1507-1514; Marcial, V.A., Pajak, T.F., Kramer, S., Radiation Therapy Oncology Group (RTOG) studies in head and neck cancer (1988) Semin Oncol, 15, pp. 39-60; Fu, K.K., Cooper, J.S., Marcial, V.A., Evolution of the Radiation Therapy Oncology Group clinical trials for head and neck cancer (1996) Int J Radiat Oncol Biol Phys, 35, pp. 425-438; Dorresteijn, L.D., Kappelle, A.C., Boogerd, W., Increased risk of ischemic stroke after radiotherapy on the neck in patients younger than 60 years (2002) J Clin Oncol, 20, pp. 282-288; Hsiao, K.Y., Yeh, S.A., Chang, C.C., Cognitive function before and after intensity-modulated radiation therapy in patients with nasopharyngeal carcinoma: A prospective study (2010) Int J Radiat Oncol Biol Phys, 77, pp. 722-726; Gavrilovic, I.T., Hormigo, A., Yahalom, J., Long-term follow-up of high-dose methotrexate-based therapy with and without whole brain irradiation for newly diagnosed primary CNS lymphoma (2006) J Clin Oncol, 24, pp. 4570-4574; Connell, C.M., Janevic, M.R., Gallant, M.P., The costs of caring: Impact of dementia on family caregivers (2001) J Geriatr Psychiatry Neurol Winter, 14, pp. 179-187; Toseland, R.W., McCallion, P., Gerber, T., Predictors of health and human services use by persons with dementia and their family caregivers (2002) Social Sci Med, 55, pp. 1255-1266; Battistin, L., Cagnin, A., Vascular cognitive disorder. A biological and clinical overview (2010) Neurochem Res, 35, pp. 1933-1938; Rosendorff, C., Beeri, M.S., Silverman, J.M., Cardiovascular risk factors for Alzheimer's disease (2007) Am J Geriatr Cardiol, 16, pp. 143-149; Epstein, N.U., Xie, H., Ruland, S.D., Vascular risk factors and cardiovascular outcomes in the Alzheimer's disease neuroimaging initiative (2012) Am J Alzheimer Dis Other Dementias, 27, pp. 275-279; Mendenhall, W.M., Million, R.R., Elective neck irradiation for squamous cell carcinoma of the head and neck: Analysis of time-dose factors and causes of failure (1986) Int J Radiat Oncol Biol Phys, 12, pp. 741-746; Mendenhall, W.M., Million, R.R., Cassisi, N.J., Squamous cell carcinoma of the head and neck treated with radiation therapy: The role of neck dissection for clinically positive neck nodes (1986) Int J Radiat Oncol Biol Phys, 12, pp. 733-740; Lindberg, R., Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts (1972) Cancer, 29, pp. 1446-1449; Chao, K.S., Wippold, F.J., Ozyigit, G., Determination and delineation of nodal target volumes for head-and-neck cancer based on patterns of failure in patients receiving definitive and postoperative IMRT (2002) Int J Radiat Oncol Biol Phys, 53, pp. 1174-1184; Stewart, F.A., Heeneman, S., Te Poele, J., Ionizing radiation accelerates the development of atherosclerotic lesions in ApoE-/-mice and predisposes to an inflammatory plaque phenotype prone to hemorrhage (2006) American J Pathol, 168, pp. 649-658; Schiller, N.K., Kubo, N., Boisvert, W.A., Effect of gammairradiation and bone marrow transplantation on atherosclerosis in LDL receptor-deficient mice (2001) Arterioscler Thromb Vasc Biol, 21, pp. 1674-1680; Manka, D., Forlow, S.B., Sanders, J.M., Critical role of platelet Pselectin in the response to arterial injury in apolipoprotein-Edeficient mice (2004) Arterioscler Thromb Vasc Biol, 24, pp. 1124-1129; Weintraub, N.L., Jones, W.K., Manka, D., Understanding radiationinduced vascular disease (2010) J Am Coll Cardiol, 55, pp. 1237-1239; Schultz-Hector, S., Trott, K.R., Radiation-induced cardiovascular diseases: Is the epidemiologic evidence compatible with the radiobiologic data (2007) Int J Radiat Oncol Biol Phys, 67, pp. 10-18; Zhao, W., Diz, D.I., Robbins, M.E., Oxidative damage pathways in relation to normal tissue injury (2007) Br J Radiol, 80, pp. S23-31. , (Spec No 1); Atkinson, J.L., Sundt, T.M., Jr., Dale, A.J., Radiation-associated atheromatous disease of the cervical carotid artery: Report of seven cases and review of the literature (1989) Neurosurgery, 24, pp. 171-178; Fonkalsrud, E.W., Sanchez, M., Zerubavel, R., Serial changes in arterial structure following radiation therapy (1977) Surg Gynecol Obstet, 145, pp. 395-400; Di Nisio, M., Soesan, M., Otten, H.M., Endothelial damage of the internal carotid artery after chemoradiotherapy of the neck for a Hodgkin lymphoma (2007) Thromb Haemost, 97, pp. 315-316; Gujral, D.M., Chahal, N., Senior, R., Radiation-induced carotid artery atherosclerosis (2014) Radiother Oncol, 110, pp. 31-38; Vigliani, M.C., Duyckaerts, C., Hauw, J.J., Dementia following treatment of brain tumors with radiotherapy administered alone or in combination with nitrosourea-based chemotherapy: A clinical and pathological study (1999) J Neuro-oncol, 41, pp. 137-149; DeAngelis, L.M., Delattre, J.Y., Posner, J.B., Radiation-induced dementia in patients cured of brain metastases (1989) Neurology, 39, pp. 789-796; Levendag, P.C., Nowak, P.J., Van Der Sangen, M.J., Local tumor control in radiation therapy of cancers in the head and neck (1996) Am J Clin Oncol, 19, pp. 469-477; Schiff, P.B., Harrison, L.B., Strong, E.W., Impact of the time interval between surgery and postoperative radiation therapy on locoregional control in advanced head and neck cancer (1990) J Surg Oncol, 43, pp. 203-208; McCready, R.A., Hyde, G.L., Bivins, B.A., Radiation-induced arterial injuries (1983) Surgery, 93, pp. 306-312; Katras, T., Baltazar, U., Colvett, K., Radiation-related arterial disease (1999) Am Surg, 65, pp. 1176-1179; Jurado, J.A., Bashir, R., Burket, M.W., Radiation-induced peripheral artery disease (2008) Catheterization Cardiovasc Intervent, 72, pp. 563-568; Cella, L., Liuzzi, R., Conson, M., Dosimetric predictors of asymptomatic heart valvular dysfunction following mediastinal irradiation for Hodgkin's lymphoma (2011) Radiother Oncol, 101, pp. 316-321; Carlson, R.G., Mayfield, W.R., Normann, S., Radiation-associated valvular disease (1991) Chest, 99, pp. 538-545; Heidenreich, P.A., Hancock, S.L., Lee, B.K., Asymptomatic cardiac disease following mediastinal irradiation (2003) J Am Coll Cardiol, 42, pp. 743-749; Lee, C.C., Su, Y.C., Ho, H.C., Increased risk of ischemic stroke in young nasopharyngeal carcinoma patients (2011) Int J Radiat Oncol Biol Phys, 81, pp. e833-838; Huang, Y.S., Lee, C.C., Chang, T.S., Increased risk of stroke in young head and neck cancer patients treated with radiotherapy or chemotherapy (2011) Oral Oncol, 47, pp. 1092-1097; Plummer, C., Henderson, R.D., O'Sullivan, J.D., Ischemic stroke and transient ischemic attack after head and neck radiotherapy: A review (2011) Stroke, 42, pp. 2410-2418; Scott, A.S., Parr, L.A., Johnstone, P.A., Risk of cerebrovascular events after neck and supraclavicular radiotherapy: A systematic review (2009) Radiother Oncol, 90, pp. 163-165; Chong, V.F., Khoo, J.B., Chan, L.L., Neurological changes following radiation therapy for head and neck tumours (2002) Eur J Radiol, 44, pp. 120-129; Cheung, M., Chan, A.S., Law, S.C., Cognitive function of patients with nasopharyngeal carcinoma with and without temporal lobe radionecrosis (2000) Arch Neurol, 57, pp. 1347-1352; Cmelak, A., Li, S., Marur, S., E1308: Reduced-dose IMRT in human papilloma virus (HPV)-associated resectable oropharyngeal squamous carcinomas (OPSCC) after clinical complete response (cCR) to induction chemotherapy (IC) (2014) J Clin Oncol, 32, p. 55. , Suppl[abstr LBA6006]

PY - 2015

Y1 - 2015

N2 - Patients with head and neck cancer are treated through surgery, radiotherapy (RT), and chemotherapy (CT). Carotid artery damage and neurotoxicity were previously observed in these patients. This study estimated the dementia risk associated with different treatment modalities in a head and neck cancer population with long-term follow-up. Taiwan's National Health Insurance claims database and a cancer registry database from the Collaboration Center of Health Information Application were linked for the present analysis. Patients with head and neck cancer, treated from January 1, 2002 to December 31, 2010, were included in the study. The follow-up duration was the period from the index date to December 31, 2012. Inclusion criteria were head and neck cancer; an age >20 years; and having undergone surgery, CT, concurrent CT, or surgery with adjuvant treatment. Exclusion criteria were another cancer diagnosed before the head and neck cancer, death or being diagnosed with dementia within 2 years after the treatment of the head and neck cancer, stroke before the index date, distant metastasis, in situ carcinoma, sarcoma, head and neck cancer recurrence, an unknown sex, and an age 65 years and having undergone RT with or without CT were risk factors (P6660 cGy exhibited a 1.69-fold (95% CI 0.97-2.95, P=0.063) higher dementia risk compared with those who received a total radiation dose

AB - Patients with head and neck cancer are treated through surgery, radiotherapy (RT), and chemotherapy (CT). Carotid artery damage and neurotoxicity were previously observed in these patients. This study estimated the dementia risk associated with different treatment modalities in a head and neck cancer population with long-term follow-up. Taiwan's National Health Insurance claims database and a cancer registry database from the Collaboration Center of Health Information Application were linked for the present analysis. Patients with head and neck cancer, treated from January 1, 2002 to December 31, 2010, were included in the study. The follow-up duration was the period from the index date to December 31, 2012. Inclusion criteria were head and neck cancer; an age >20 years; and having undergone surgery, CT, concurrent CT, or surgery with adjuvant treatment. Exclusion criteria were another cancer diagnosed before the head and neck cancer, death or being diagnosed with dementia within 2 years after the treatment of the head and neck cancer, stroke before the index date, distant metastasis, in situ carcinoma, sarcoma, head and neck cancer recurrence, an unknown sex, and an age 65 years and having undergone RT with or without CT were risk factors (P6660 cGy exhibited a 1.69-fold (95% CI 0.97-2.95, P=0.063) higher dementia risk compared with those who received a total radiation dose

U2 - 10.1097/MD.0000000000001983

DO - 10.1097/MD.0000000000001983

M3 - Article

VL - 94

SP - e1983

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

IS - 45

ER -