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Dementia

  • Thomas V. CaprioEmail author
  • Nicole Kosier
Chapter

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.

Keywords

Dementia Palliative care Dementia with Lewy body Alzheimer’s disease Behavioral and psychological symptoms of dementia 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine, Division of Geriatrics and AgingUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Department of Medicine, Division of Palliative CareUniversity of Rochester Medical CenterRochesterUSA

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