Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; Palliative and Supportive Institute, UPMC Health System, Pittsburgh, PA, United States.
Handb Clin Neurol. 2022;190:163-174. doi: 10.1016/B978-0-323-85029-2.00009-9.
Dementia is a progressive, irreversible illness and leading global cause of death defined by cognitive and subsequent functional decline. Current treatments have limited impact on mortality. In this chapter, we discuss the trajectory of dementia and its variability, markers associated with poorer prognosis (such as poor nutrition, pneumonia, comorbid conditions), the impact of hospitalization on prognosis, and current models of end-of-life palliative care/hospice eligibility (with the use of the Functional Assessment Staging tool and other markers). We then discuss strategies to discuss prognosis with patients and their healthcare proxies using a mental model (Ask, Discover, Anticipate, Provide, Track: ADAPT) and specific skills. Because of progression of dementia variability, prognosis is better discussed in terms of function. For patients with dementia, initiating advance care planning earlier in their disease course allows for more patient involvement (such as to identify a surrogate decision maker).
痴呆症是一种进行性、不可逆转的疾病，是全球主要的死亡原因，其特征是认知功能和随后的功能下降。目前的治疗方法对死亡率的影响有限。在本章中，我们讨论了痴呆症的轨迹及其可变性、与预后较差相关的标志物（如营养不良、肺炎、合并症）、住院对预后的影响，以及目前的临终姑息治疗/临终关怀资格模型（使用功能评估分期工具和其他标志物）。然后，我们讨论了使用心理模型（询问、发现、预期、提供、跟踪：ADAPT）和特定技能与患者及其医疗保健代理人讨论预后的策略。由于痴呆症的进展具有变异性，因此最好根据功能来讨论预后。对于痴呆症患者，在疾病早期开始进行预先护理计划可以让患者更多地参与（例如，确定替代决策人）。
