• Vol. 32 No. 6, 778–784
  • 15 November 2003

A Palliative Care Approach to End-stage Neurodegenerative Conditions



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Introduction: Neurodegenerative conditions, such as Alzheimer’s disease, Parkinson’s disease and motor neurone disease, are progressive and incurable conditions that ultimately lead to a state of total functional incapacitation and death. These conditions are “terminal” and, therefore, should be managed with a palliative care approach. This article highlights some of the issues in caring for patients with end-stage neurodegenerative conditions from a palliative perspective.

Methods: This review is based on evidence from pre-existing medical literature on the above subject and the authors’ personal experiences and observations.

Conclusion: Patients with end-stage neurodegenerative conditions have needs similar to that of advanced cancer patients. Therefore, the principles and practice of palliative care should be applied to such patients. This may also mean that palliative care training should be undertaken in nursing homes, where a large number of such patients are located.

A syndrome of total functional dependence, poor mobility, lack of meaningful communication and incontinence of bowels and bladder appears to be the final common pathway for many neurodegenerative conditions such as the dementias, Parkinson’s disease (PD) and motor neurone disease (MND). In the United States, the National Hospice Organisation (NHO) has outlined a set of criteria for hospice care in end-stage dementia, where patients who are non-ambulant without assistance, require assistance in all activities of daily living, unable to communicate meaningfully and have bladder and bowel incontinence qualify for palliative care funding.

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