Brauner D J, Muir J C, Sachs G A
The University of Chicago Hospitals, Department of Medicine, 5841 S Maryland, MC 6098, Chicago, IL 60637, USA.
JAMA. 2000 Jun 28;283(24):3230-5. doi: 10.1001/jama.283.24.3230.
Physicians increasingly are called on to provide primary care for the growing population of people with Alzheimer-type dementia. However, little attention has been paid to the care of nondementia illnesses in this group of patients. To illustrate how presence of dementia can alter the risk-benefit ratio of treatment of a common medical problem, we present a case study in which a patient with dementia developed disastrous adverse effects to a drug commonly used to treat osteoporosis. This case and 2 composite vignettes illuminate how presence of dementia should influence the decision-making process for treatment of nondementia illnesses. We address issues such as decreased decision-making capacity, problems with reporting adverse effects, decreased cognition leading to problems with treatment adherence, and the role of screening and basic questions about acceptable burdens of treatments in patients with limited prognosis. We suggest ways to improve communication with patients with dementia in an effort to minimize complications and improve care, as well as policy changes to include patients with dementia in clinical trials. JAMA. 2000;283:3230-3235
越来越多的医生被要求为不断增加的阿尔茨海默病型痴呆患者提供初级护理。然而，对于这组患者中无痴呆疾病的护理却很少受到关注。为了说明痴呆的存在如何改变常见医疗问题治疗的风险效益比，我们呈现一个病例研究，其中一名痴呆患者对一种常用于治疗骨质疏松症的药物产生了灾难性的不良反应。这个病例以及2个综合案例说明了痴呆的存在应如何影响无痴呆疾病治疗的决策过程。我们讨论了诸如决策能力下降、不良反应报告问题、认知能力下降导致治疗依从性问题，以及在预后有限的患者中筛查的作用和关于可接受治疗负担的基本问题等。我们提出了改善与痴呆患者沟通的方法，以尽量减少并发症并改善护理，以及政策变革，将痴呆患者纳入临床试验。《美国医学会杂志》。2000年；283:3230 - 3235
