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Advanced Dementia's Course

The final stages of dementia are characterized by pneumonia, fevers, eating problems, and extremely high mortality, according to a prospective observational study in the New England Journal of Medicine.

Researchers followed over 300 patients with advanced dementia (and their healthcare proxies). Almost a quarter died within 6 months, and half within the course of the 18-month study. Infections and eating problems were common, heralding high mortality: the adjusted 6-month mortality rate for those suffering at least one episode of pneumonia was 47%; for a febrile episode, 44%; and for eating problems, 39%.

In the last 3 months of life, about 40% experienced burdensome interventions (e.g., parenteral therapy, hospitalizations, and tube feedings). Patients whose proxies believed their patients had less than 6 months to live were much less likely to undergo such interventions.

The authors write: "These findings can be used to inform families and care providers that infections and eating problems should be expected and that their occurrence often indicates that the end of life is near."

LINK(S):

NEJM article (Free abstract; full text requires subscription)

NEJM editorial (Subscription required)

Journal Watch General Medicine summary (Free)

Published in Physician's First Watch October 15, 2009