Lee Michelle, Chodosh Joshua
David Geffen School of Medicine, UCLA, Division of Geriatric Medicine, Los Angeles, CA 90095, USA.
J Am Med Dir Assoc. 2009 Sep;10(7):466-71. doi: 10.1016/j.jamda.2009.03.014. Epub 2009 Jun 27.
Dementia is a common geriatric syndrome. It is unclear how best to predict survival among dementia patients, which leaves clinicians, patients, and families uncertain as to how to proceed with medical decisions and reassessing goals.
We performed a MEDLINE systematic review of studies that evaluated dementia prognosis and survival; 48 studies (cohort, cross-sectional, retrospective, and case-control studies) were included.
Increased age, male gender, decreased functional status, and medical comorbidities such as diabetes, cardiovascular disease, and malignancy were associated with a higher mortality rate in dementia patients. Patients' baseline education level showed no influence on survival. There was no consensus regarding the association among dementia type, baseline cognitive function, and neuropsychiatric symptoms with dementia prognosis.
Despite much data, we lack a unifying guideline for dementia prognostication. Moving forward, the creation of a risk score for dementia could be helpful for patients and families in reassessing goals of care and possible enrollment in services such as hospice or palliative care.
痴呆是一种常见的老年综合征。目前尚不清楚如何最好地预测痴呆患者的生存期，这使得临床医生、患者及其家属在如何进行医疗决策和重新评估目标方面感到不确定。
我们对评估痴呆预后和生存期的研究进行了MEDLINE系统评价；纳入了48项研究（队列研究、横断面研究、回顾性研究和病例对照研究）。
年龄增加、男性、功能状态下降以及糖尿病、心血管疾病和恶性肿瘤等合并症与痴呆患者较高的死亡率相关。患者的基线教育水平对生存期无影响。关于痴呆类型、基线认知功能和神经精神症状与痴呆预后之间的关联尚无共识。
尽管有大量数据，但我们仍缺乏统一的痴呆预后指南。展望未来，创建痴呆风险评分可能有助于患者及其家属重新评估护理目标，并可能有助于患者入住临终关怀或姑息治疗等服务机构。
