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Prognostication for death in end stage dementia
Source: http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_150.htm Mortality Risk Index Score (Mitchell) Points Risk factor 1.9 Complete dependence with ADLs 1.9 Male gender 1.7 Cancer 1.6 Congestive heart failure 1.6 O2 therapy needed w/in 14 day 1.5 Shortness of breath 1.5 <25% of food eaten at most meals 1.5 Unstable medical condition 1.5 Bowel incontinence 1.5 Bedfast 1.4 Age > 83 y 1.4 Not awake most of the day Risk estimate of death within 6 months Score Risk % 0 8.9 1-2 10.8 3-5 23.2 6-8 40.4 9-11 57.0 = 12 70.0 |
Hospice Care Forum 11/12/13
Advanced dementia complications: Pneumonia (50% of adv dem die with pneumonia) Feeding/swallowing/nutrition Sepsis (50% pneumonia, 30% UTI, 20% skin) Neuropsychiatric Decubitus ulcers Advanced dementia symptoms dyspnea 46% pain 39% pressure ulcers 39% agitation 54% aspiration 41% Treatments: antipsychotics - if delusions or hallucinations antidepressants - good for agitation/aggression benzodiazepines - not a good first choice anticonvulsants Avoid hospital transfers Artificial Nutrition & hydration of no benefit Feeding tubes DO NOT decrease pneumonia, improve nutrition, heal pressure ulcers, or improve survival |
Alzheimer's disease:
Most common dementia (70%), women 1/5, men 1/10 Initial cognitive changes affect work, relationships, social Progressive decline variably over 8-10 yrs to death Selective memory loss, facts/events then motor/procedure Lose word finding, misplace items, trouble navigating Lack insight, lose motor tasks, lose abstract reasoning Agitation, wandering, psychosis |
Multi infarct dementia (15%)
Stepwise decline, imaging evidence Lewy Body dementia (5-10%) Dementia first then Parkinson motor disorder Parkinsons dementia (5%) Other demntias Frontotemporal lobe, metabolic, alcoholic |
Cochrane Review of Namenda
Some evidence of efficacy of memantine for dementia McShane R, Areosa Sastre A, Minakaran N Published Online: January 21, 2009 - See more at: http://summaries.cochrane.org/CD003154/some-evidence-of-efficacy-of-memantine-for-dementia#sthash.mNqbd9rd.dpuf Memantine has a small beneficial, clinically detectable effect on cognitive function and functional decline measured at 6 months in patients with moderate to severe Alzheimer's Disease (AD). In patients with mild to moderate dementia, the small beneficial effect on cognition was not clinically detectable in those with vascular dementia and barely detectable in those with AD. It is well tolerated. Slightly fewer patients with moderate to severe AD taking memantine develop agitation, but there is no evidence either way about whether it has an effect on agitation which is already present. |
Cochrane Review of cholinesterase inhibitors
The three cholinesterase inhibitors are efficacious for mild to moderate Alzheimer's disease. - See more at: http://summaries.cochrane.org/CD005593/cholinesterase-inhibitors-cheis-donepezil-galantamine-and-rivastigmine-are-efficacious-for-mild-to-moderate-alzheimers-disease#sthash.jEY1AnNc.dpuf |