Multiple sclerosis (MS) is the most frequent inflammatory demyelination disorder of the central nervous system. The clinical picture reflects the pathological mechanism of inflammation, demyelination, and axon degeneration.
Specific challenges in MS patients:
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Stroke is the 3rd leading cause of death in the United States, making the need for hospice care for many victims essential.
A stroke takes time to manifest its full effect, and some early symptoms might be transitory. The physician might consider a referral to hospice if the patient remains comatose or has a severely reduced level of consciousness (obtundation) with abnormal muscle contraction (myoclonus) for 3 days or longer.
Patients who survive 4 weeks and regain significant function during that time are more likely to need active rehabilitation than palliative care.
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ALS is a rapidly progressing degenerative neuromuscular disease with an unknown origin, results in muscle weakness, disability, respiratory insufficiency, and eventually death. The median survival duration for patients is approximately 3 years, yet 10% will survive for > 10 years.
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Parkinson’s disease is a fairly common disease of the central nervous system. It is a chronic, progressive neurodegenerative disease defined by the classic trial of tremor, rigor 僵直, and akinesis 运动消失 (There is a slow progression of motor skill complications, including resting tremors, excessive slowness in activity, and rigidity). Classic signs include pill-rolling movements in the hands, loss of facial expression, difficulty initiating movements, and gait changes. Because of its slow progression, patients may initially present with generalized weakness, aching, fatigue, and malaise. A slight tremor of an extremity may also be noted. Symptoms result from an imbalance between dopamine-activated and acetylcholine-actived neural pathways in the basal ganglia and are generally found in people older than 65 years. Parkinson-like symptoms can also be caused by medication toxicity, head trauma, or other degenerative conditions.
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Neurological disorders are among the leading causes of morbidity and death worldwide. While strokes is the 3rd leading cause of death, after heart disease and cancer, in the United States, other neurological disease, such as Parkinson’s disease, amyotrophic lateral sclerosis 肌萎缩性侧索硬化 (ALS), and multiple sclerosis 多发性硬化症 (MS), have a more chronic course that leads to protracted disability, morbidity, and ultimately, death.
End-stage disease progression of neurologic disorders varies but there are some commonalities:
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