Neurólogos y demencias avanzadas, ¿estamos preparados para los mejores cuidados?

Abstract

Objective: To analyze whether neurologists identify dementias in advanced stages and whether this implies a change in the orientation of patient management. Method: We reviewed the clinical records of patients diagnosed with dementia according to ICD- 9 with the following terms and died at the Torrejón hospital between January and December 2016: Alzheimer´s disease, fronto temporal dementica, vascular dementia, lewy body dementia, Parikinson´s disease and mixed dementia. We analyzed whether the records contained sufficient data to determine the phase of the dementia according to the GDS-FAST scales, if the annotations made it possible to determine if the patients met NPHCO dementia’s termination criteria and if there were allusions to specific schedules in situations of high complexity, such as dysphagia/aphagia or infections. Results: 52 histories were found. Staging of dementia: the FAST or GDS scale could be defined in 46 stories. Terminality: in no case could it be completed if the patients fulfilled criteria of terminality. Medical income or events in the previous 6-12 months. Mention was made of income or medical incidents in 16 patients (31 out of 52 had medical incidents). Nutritional status: the question was asked about the presence of dysphagia in 30. Mention of weight: weight was recorded in 13 patients. The existence of a blood test was specified in 2. Approach on the predictable phases: Information about upcoming was written down in 4 patients. Advance directives: there is a single patient. Verbalization on planning in certain clinical scenarios (probe or not, advanced palliative management ...). Found in 2 patients. Conclusions: Neurologists do not perform a rigourous data collection aimed at identifying terminality situation and, therefore, open the door to palliative management, so palliative care can be hardly offered.