Dementia natural history, complications and prognosis: Difference between revisions
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==Overview== | |||
The natural course is of progressive decline with some plateaus. Some data exist showing that current medications slow the rate of progression or temporarily improve cognition, but overall the current treatment options do not provide solid evidence of improving cognitive function. Cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists should be discontinued if there are intolerable adverse effects or there is poor compliance. Family education and referral to resources such as the Alzheimer's Association are vital, as patient care requires coordination between physician, caregiver, family, friends, social worker, psychologist, and community supports | |||
==Natural History== | |||
The history should focus on identifying the time course of cognitive decline and its relationship to basic and instrumental activities of daily living. Prior history of stroke should be ascertained, as well as its timing relative to the onset of cognitive symptoms. Factors that concerns the diagnosis of dementia include Stepwise deterioration, Nocturnal confusion, Personality change, Depression, Somatic complaints, Emotional incontinence (pseudobulbar affect),Hypertension, and Associated atherosclerosis<ref name="pmid9339696">{{cite journal |vauthors=Moroney JT, Bagiella E, Desmond DW, Hachinski VC, Mölsä PK, Gustafson L, Brun A, Fischer P, Erkinjuntti T, Rosen W, Paik MC, Tatemichi TK |title=Meta-analysis of the Hachinski Ischemic Score in pathologically verified dementias |journal=Neurology |volume=49 |issue=4 |pages=1096–105 |date=October 1997 |pmid=9339696 |doi=10.1212/wnl.49.4.1096 |url=}}</ref> | |||
==Complications== | |||
Complications of dementia include | |||
*[[Urinary tract infection (UTI)]] | |||
*[[weight loss]] | |||
*Institutionalization<ref name="pmid19327073">{{cite journal |vauthors=Teno JM, Mitchell SL, Skinner J, Kuo S, Fisher E, Intrator O, Rhodes R, Mor V |title=Churning: the association between health care transitions and feeding tube insertion for nursing home residents with advanced cognitive impairment |journal=J Palliat Med |volume=12 |issue=4 |pages=359–62 |date=April 2009 |pmid=19327073 |pmc=2700356 |doi=10.1089/jpm.2008.0168 |url=}}</ref> | |||
*[[pneumonia]]<ref name="pmid25133863">{{cite journal |vauthors=Mitchell SL, Shaffer ML, Loeb MB, Givens JL, Habtemariam D, Kiely DK, D'Agata E |title=Infection management and multidrug-resistant organisms in nursing home residents with advanced dementia |journal=JAMA Intern Med |volume=174 |issue=10 |pages=1660–7 |date=October 2014 |pmid=25133863 |pmc=4188742 |doi=10.1001/jamainternmed.2014.3918 |url=}}</ref> | |||
*[[Falls]] and their complications | |||
*Elder [[abuse]]<br /> | |||
==Prognosis== | |||
The prognosis of dementia is poor even with treatment. One study mentions that patients with dementia were less likely to have interventions such as PEG tubes, hospitalization, catheterizations, parenteral therapy, and venipunctures when their proxy's estimate of their life expectancy was shorter rather than greater than six months | |||
Advanced Dementia Prognostic Tool (ADEPT) is a 12-item additive score that includes information on patient age, gender, level of functional dependence, nutritional status, and presence or absence of various symptoms and medical conditions, such as congestive heart failure and shortness of breath.<ref name="pmid21045099">{{cite journal |vauthors=Mitchell SL, Miller SC, Teno JM, Kiely DK, Davis RB, Shaffer ML |title=Prediction of 6-month survival of nursing home residents with advanced dementia using ADEPT vs hospice eligibility guidelines |journal=JAMA |volume=304 |issue=17 |pages=1929–35 |date=November 2010 |pmid=21045099 |pmc=3017367 |doi=10.1001/jama.2010.1572 |url=}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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{{WS}} | |||
[[Category:Needs content]] | [[Category:Needs content]] | ||
[[Category:Neurology]] | |||
[[Category:Psychiatry]] | |||
Latest revision as of 17:56, 8 October 2020
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Dementia Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: ,Sabeeh Islam, MBBS[2]
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Dementia Microchapters |
Overview
The natural course is of progressive decline with some plateaus. Some data exist showing that current medications slow the rate of progression or temporarily improve cognition, but overall the current treatment options do not provide solid evidence of improving cognitive function. Cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists should be discontinued if there are intolerable adverse effects or there is poor compliance. Family education and referral to resources such as the Alzheimer's Association are vital, as patient care requires coordination between physician, caregiver, family, friends, social worker, psychologist, and community supports
Natural History
The history should focus on identifying the time course of cognitive decline and its relationship to basic and instrumental activities of daily living. Prior history of stroke should be ascertained, as well as its timing relative to the onset of cognitive symptoms. Factors that concerns the diagnosis of dementia include Stepwise deterioration, Nocturnal confusion, Personality change, Depression, Somatic complaints, Emotional incontinence (pseudobulbar affect),Hypertension, and Associated atherosclerosis[1]
Complications
Complications of dementia include
- Urinary tract infection (UTI)
- weight loss
- Institutionalization[2]
- pneumonia[3]
Prognosis
The prognosis of dementia is poor even with treatment. One study mentions that patients with dementia were less likely to have interventions such as PEG tubes, hospitalization, catheterizations, parenteral therapy, and venipunctures when their proxy's estimate of their life expectancy was shorter rather than greater than six months
Advanced Dementia Prognostic Tool (ADEPT) is a 12-item additive score that includes information on patient age, gender, level of functional dependence, nutritional status, and presence or absence of various symptoms and medical conditions, such as congestive heart failure and shortness of breath.[4]
References
- ↑ Moroney JT, Bagiella E, Desmond DW, Hachinski VC, Mölsä PK, Gustafson L, Brun A, Fischer P, Erkinjuntti T, Rosen W, Paik MC, Tatemichi TK (October 1997). "Meta-analysis of the Hachinski Ischemic Score in pathologically verified dementias". Neurology. 49 (4): 1096–105. doi:10.1212/wnl.49.4.1096. PMID 9339696.
- ↑ Teno JM, Mitchell SL, Skinner J, Kuo S, Fisher E, Intrator O, Rhodes R, Mor V (April 2009). "Churning: the association between health care transitions and feeding tube insertion for nursing home residents with advanced cognitive impairment". J Palliat Med. 12 (4): 359–62. doi:10.1089/jpm.2008.0168. PMC 2700356. PMID 19327073.
- ↑ Mitchell SL, Shaffer ML, Loeb MB, Givens JL, Habtemariam D, Kiely DK, D'Agata E (October 2014). "Infection management and multidrug-resistant organisms in nursing home residents with advanced dementia". JAMA Intern Med. 174 (10): 1660–7. doi:10.1001/jamainternmed.2014.3918. PMC 4188742. PMID 25133863.
- ↑ Mitchell SL, Miller SC, Teno JM, Kiely DK, Davis RB, Shaffer ML (November 2010). "Prediction of 6-month survival of nursing home residents with advanced dementia using ADEPT vs hospice eligibility guidelines". JAMA. 304 (17): 1929–35. doi:10.1001/jama.2010.1572. PMC 3017367. PMID 21045099.