P rognosis
Download
1 / 11

P rognosis - PowerPoint PPT Presentation


  • 102 Views
  • Uploaded on

P rognosis. Life expectancy from the time of diagnosis: Alzheimer Disease 5-10 years Vascular Dementia 4 years Dementia with Lewy Bodies 4 years. What is an advance directive??. DNR Living will DPOA HC. W eight loss. Anorexia and Weight Loss. Common in patients with dementia

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' P rognosis' - infinity


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
P rognosis
Prognosis

  • Life expectancy from the time of diagnosis:

    • Alzheimer Disease 5-10 years

    • Vascular Dementia 4 years

    • Dementia with Lewy Bodies 4 years


What is an advance directive
What is an advance directive??

DNR

Living will

DPOA HC


W eight loss

Weight loss


Anorexia and weight loss
Anorexia and Weight Loss

  • Common in patients with dementia

  • Especially AD

  • Possible causes

    • Forgetting to eat

    • Inability to prepare and eat foods

    • Impaired olfaction and taste

    • Behavior problems (restlessness, etc)

    • Depression

    • Comorbid medical illness

    • Medications (espACh-I, Antidepressants)

    • Inflammatory abnormalities (anorexia, procatabolic state)

Wang et al, J Neurol 2004, 251:314-320; Aziz NA et al, J Neurol 2008


Wang et al, J Neurol 2004, 251:314-320


Knittweis J, Medical Hypotheses, 1999


Strategies
Strategies

  • Diet- liberalize it! No special diets!

  • Environment

    • Eat with others

    • Pleasant, quiet

      setting

    • Music may help

Tamura BK et al. Nutrition and the Institutionalized Elderly. 2007


Strategies1
Strategies

Food Modifications

  • Single items, presented one

    at a time

  • Contrast color of food with the dish

  • Make food and setting look attractive

  • Make food portable for those who are restless

  • Sweet, hot/cold, juicy

    Eating Schedule

  • AD pts ate more at breakfast than other meals

  • Frequent, small meals

  • Eat with others

Tamura BK et al. Nutrition and the Institutionalized Elderly. 2007


Limited data on pharmacologic strategies
Limited Data on Pharmacologic Strategies

Nutritional supplements between meals

Micronutrients (MVI) probably not needed

Megestrol acetate (Megace)

Dronabinol (Marinol)

Methylphenidate (Ritalin)

Mirtazepine (Remeron)

Tamura BK et al. Nutrition and the Institutionalized Elderly. 2007


Feeding tubes
Feeding tubes

When are they

appropriate?


Improved survival
Improved Survival?

  • Observational studies:

    • NH patients show no survival advantage with tube feeding

    • 1 retrospective review of 41 consults for PEG

      • survival without PEG 60 days, with PEG 59 days

  • Mortality is high after G-tube placement

    • 6-28% in first 30 days

    • 60% mortality at 6 months, perhaps 90% at one year

Murphy LM. Arch Int Med, 2003; Dharmarajan TS. Am J Gastroenterology, 2001; Mitchell SL. Arch Int Med, 1997; Gillick MR. N Engl J Med. 2000


ad