Anneser Johanna, Arenz Victoria, Borasio Gian Domenico
Palliative Care Team, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Service de Soins palliatifs et de support, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
Front Neurol. 2018 Apr 25;9:275. doi: 10.3389/fneur.2018.00275. eCollection 2018.
Neurological expertise in palliative care may be required not only for patients with primary neurological disorders but also for patients with non-neurological diseases suffering from burdensome neurological symptoms. The aim of this study was to determine the prevalence of neurological diagnoses and symptoms in palliative care patients, as well as the related burden and impact on everyday life.
We analyzed retrospectively the medical records of 255 consecutive patients from a tertiary medical center, at the time point of referral to an inpatient palliative care consultation service. In addition, 100 patients prospectively answered a questionnaire which included the assessment of neurological symptoms, as well as numeric rating scales for quality of life, symptom-specific burden, and restrictions in everyday life.
Forty-one patients (16%) suffered from a primary neurological disease. Most decisions regarding the termination of life-sustaining measures concerned this group (20/22, 91%). Neurological symptoms (excluding pain) were documented in 122 patients (48%) with an underlying non-neurological disease. In the questionnaire study, 98/100 patients reported at least one neurological or neuropsychiatric symptom, most frequently sleeping problems ( = 63), difficulty concentrating ( = 55), and sensory symptoms ( = 50). Vertigo/dizziness ( = 19) had the greatest impact on everyday life (7.57/10 ± 2.17) and the highest symptom-specific burden (7.14 ± 2.51). Difficulty concentrating (restrictions in everyday life/burden) and pain intensity were the only symptoms significantly correlated with quality of life ( = -0.36, = 0.009/ = -0.32; = 0.04; = -0.327, = 0.003).
Neurological diseases and symptoms are frequent among palliative care patients and are often associated with a high symptom burden, which may severely affect the patients' lives. It is thus of paramount importance to implement neurological expertise in palliative care.
姑息治疗中的神经学专业知识不仅可能是患有原发性神经疾病的患者所需要的，对于患有非神经疾病但遭受严重神经症状困扰的患者也是如此。本研究的目的是确定姑息治疗患者中神经学诊断和症状的患病率，以及相关负担和对日常生活的影响。
我们回顾性分析了一家三级医疗中心255例连续患者在转诊至住院姑息治疗咨询服务时的病历。此外，100例患者前瞻性地回答了一份问卷，其中包括对神经症状的评估，以及生活质量、症状特异性负担和日常生活限制的数字评分量表。
41例患者（16%）患有原发性神经疾病。大多数关于终止维持生命措施的决定涉及该组患者（20/22，91%）。122例患有潜在非神经疾病的患者记录了神经症状（不包括疼痛）。在问卷调查中，98/100例患者报告至少有一种神经或神经精神症状，最常见的是睡眠问题（=63）、注意力不集中（=55）和感觉症状（=50）。眩晕/头晕（=19）对日常生活的影响最大（7.57/10±2.17），症状特异性负担最高（7.14±2.51）。注意力不集中（日常生活限制/负担）和疼痛强度是仅与生活质量显著相关的症状（=-0.36，=0.009/=-0.32；=0.04；=-0.327，=0.003）。
神经疾病和症状在姑息治疗患者中很常见，并且通常与高症状负担相关，这可能严重影响患者的生活。因此，在姑息治疗中引入神经学专业知识至关重要。
