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Dementia

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Neuropalliative Care

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Abstract

Dementia represents an umbrella term encompassing many distinct syndromes leading to cognitive and functional impairment. Symptom burden throughout the course of dementia is high and can escalate as the disease progresses. These symptoms are often difficult to assess in the patient with dementia and effective treatment options are often limited. Palliative care interventions, whether through a primary provider or a palliative specialist, should include a multifaceted approach, which evolves based on disease stage and individual need. Early identification of surrogate decision makers and advance care planning, anticipating care needs based on stage of disease, identifying and managing symptoms, caregiver support, and timely identification of hospice eligible patients are the cornerstones of effective treatment. While research continues to search for treatment options that alter disease course and effectively target cognitive and behavioral symptoms, other gaps in our understanding of disease also need attention. Prognostic uncertainty contributes to the aggressive and burdensome care that many patients experience at end-of-life, as well as low hospice utilization. The accuracy of the current Medicare guidelines in predicting 6-month mortality is limited and there is a need for more exploration and adoption of better predictive tools for prognostication.

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Author information

Authors and Affiliations

  1. Department of Medicine, Division of Geriatrics and Aging, University of Rochester Medical Center, Rochester, NY, USA

    Thomas V. Caprio MD, MPH, MS

  2. Department of Medicine, Division of Palliative Care, University of Rochester Medical Center, Rochester, NY, USA

    Nicole Kosier MD

Authors
  1. Thomas V. Caprio MD, MPH, MS
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  2. Nicole Kosier MD
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Corresponding author

Correspondence to Thomas V. Caprio MD, MPH, MS .

Editor information

Editors and Affiliations

  1. Assistant Professor, Department of Neurology, University of Washington Harborview Medical Center, Seattle, WA, USA

    Claire J. Creutzfeldt

  2. Professor of Neurology, Chief Neurology Supportive and Palliative Care Section, Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Benzi M. Kluger

  3. Professor and Edward A. and Alma Vollertsen Rykenboer Chair, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA

    Robert G. Holloway

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Caprio, T.V., Kosier, N. (2019). Dementia. In: Creutzfeldt, C., Kluger, B., Holloway, R. (eds) Neuropalliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-93215-6_6

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  • DOI: https://doi.org/10.1007/978-3-319-93215-6_6

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