Abstract
North American data show that in the year 2000 around 4.5 million people had a diagnosis of dementia and more than a half were at moderate or severe stages of the disease. There is inevitable cognitive and functional decline caused by all etiologies of irreversible dementia as well as many behavioral symptoms that compromise the quality of life of both patients and caregivers. Few published studies have investigated issues concerning severe dementia such as predictors of mortality and life expectancy, nutrition, end of life issues and palliative care in terminal dementia, as well as best pharmacological and non-pharmacological treatments. Due to the complexity that characterizes advanced dementia, it is important that this discussion starts as early as possible allowing some decisions to be taken, preferably when the patients can still express their opinion.
Key words:
dementia; Alzheimer's disease; severe
Resumo
Dados Norte-Americanos apontam que o contingente de portadores de DA no ano 2000 era de cerca de 4,5 milhões de pessoas e são esperados em torno de 13 milhões para o ano 2050 sendo mais da metade em fase moderada e grave da doença. Além do declínio cognitivo e funcional, são muito comuns diferentes sintomas comportamentais, que muito diminuem a qualidade de vida de pacientes e cuidadores. São escassos os estudos para o desenvolvimento de fármacos, conhecimento de medidas não-farmacológicas, estudos epidemiológicos que averiguam fatores que interferem na história natural da doença, formas de abordar o fim de vida, além de questões como nutrição e linguagem. O longo curso desta doença de prognóstico temporal incerto traz consideráveis dúvidas quanto às decisões a serem tomadas. A visão do conforto e proporcionalidade das ações e do princípio do não-malefício podem servir de guia para a tomada de decisão.
Palavras-chave:
demência; doença de Alzheimer; grave
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Publication Dates
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Publication in this collection
Jul-Sep 2010
History
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Received
09 Apr 2010 -
Accepted
20 June 2010