VU University Medical Center, EMGO Institute for Health and Care Research, Department of Nursing Home Medicine, and Department of Public and Occupational Health, The Netherlands.
J Alzheimers Dis. 2010;22(1):37-55. doi: 10.3233/JAD-2010-100744.
Death with dementia is increasingly common. Although prognostication is difficult, it is an incurable life-limiting illness for which palliative care for the patient is often appropriate. Dementia patients are otherwise at risk of overtreatment with burdensome and possibly non-beneficial interventions and undertreatment of symptoms. Although recent studies indicate encouraging trends of improved palliative care, little evidence supports effectiveness of specific treatments. As of January 2010, at least 45 studies, almost all performed after 2000, have reported on treatment, comfort, symptom burden, and families' satisfaction with care. Over half (25; 56%) of these studies were in US settings, and most were small or retrospective. Few randomized trials and prospective observational studies have been performed so far, but several promising studies have been completed recently or are underway in various countries. Guidelines for care and treatment, still mostly consensus-based, support the benefits of advance care planning, continuity of care, and family and practitioner education. Assessment tools for pain, prognosis, and family evaluations of care have been developed and some have been shown to be effective in clinical practice. With increasing numbers of well-designed, large-scale studies, research in the next decade may result in better evidence-based guidelines and practice.
痴呆患者死亡的情况越来越常见。尽管预后困难，但痴呆是一种无法治愈的、限制生命的疾病，通常适合对患者进行姑息治疗。否则，痴呆患者可能面临过度治疗的风险，包括使用负担沉重且可能无益的干预措施，以及对症状的治疗不足。尽管最近的研究表明姑息治疗有令人鼓舞的改善趋势，但几乎没有证据支持特定治疗的有效性。截至 2010 年 1 月，至少有 45 项研究报告了治疗、舒适度、症状负担以及家庭对护理的满意度，其中近 90%是在 2000 年以后进行的。这些研究中超过一半（25 项；56%）在美国进行，且大多数规模较小或为回顾性研究。到目前为止，很少有随机试验和前瞻性观察性研究，但是最近在不同国家完成或正在进行一些有前途的研究。护理和治疗指南，仍然主要基于共识，支持预先护理计划、护理的连续性以及家庭和从业者教育的益处。已经开发出用于评估疼痛、预后和家庭护理评估的工具，并且已经证明一些工具在临床实践中是有效的。随着越来越多的精心设计的大规模研究，未来十年的研究可能会产生更好的基于证据的指南和实践。
