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Determining Prognosis: Patients with End-Stage Neurologic Disease (Reading & Sharing)

The three major subgroups: Alzheimer’s disease and other dementia, cerebrovascular disease, and amyotrophic lateral sclerosis (ALS) and related motor neuron disorders.

Alzheimer’s disease and other dementia

    • Inability to ambulate without assistance (FAST 7-C)
    • inability to speak or communicate meaningfully with speech limited to approximately a half-dozen or fewer intelligible or different words (FAST 7-B)
    • Loss of ADL functions including bathing and dressing (FAST 6)
    • Incontinence of bowel and bladder (FAST 6)
    • one or more of the following comorbid conditions in last 3-6 months
      • Aspiration pneumonia
      • Pyelonephritis or upper urinary tract infection
      • Septicemia
      • Decubitus ulcers, usually multiple and stages II or IV
      • Fever, recurrent after antibiotics
      • An altered nutritional status as manifested by:
        • difficulty swallowing or refusal to eat such that sufficient fluid or caloric intake cannot be maintained and the patient refuses artificial nutritional support
        • OR
        • If the patient is receiving artificial nutritional support (NG or G-tube or parenteral hyperalimentation), there must be evidence of an impaired nutritional status as defined in the General Guidelines (greater or equal 10% loss of body weight)

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Alzheimer’s Disease (AD) /Reading & Sharing

Alzheimer’s Disease (AD) is the most common form of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life. AD accounts for 60% to 80% of dementia cases. According to a 2017 report, AD affects an estimated 6.08 million people in the United States. Although the disease is associated with old age, it could somewhat develop at any age (Bature, Guinn, Pang & Pappas, 2016). Approximately 200,000 people younger than 65 years with AD constitute the younger-onset US population with AD (Brookmeyer, Abdalla, Kawas & Corrada, 2017).

By definition, Alzheimer’s disease (AD) is a progressive neurodegenerative disease clinically characterized by impairment of cognitive and functional abilities as well as behavioral symptoms. It has been reported that individuals with AD experience a long asymptomatic (preclinical) phase in which neuropathological changes occur but cognitive ability is normal, followed by a symptomatic (prodromal or pre-dementia) phase of progressive cognitive decline before the onset of functional impairment and overt dementia. In addition, it has been discovered that cognitive impairment can be detected way before the onset of dementia symptoms (Dubois, Padovani, Scheltens, Rossi, Agnello & Saykin 2016).

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