Current opinion in supportive and palliative care
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Cognitive failure is known to be common in patients with advanced illness and can lead to significant distress for the persons affected and their environment. To get an insight on the most recent advances concerning cognitive failure at the end of life, a literature review has been performed focusing on the syndrome in general palliative care as well as on palliative care in patients with dementia. ⋯ An overall improvement in professional care independent of the place of care for patients with cognitive impairment and dementia is still claimed by professionals and primary caretakers. In addition to further research, the lack of palliative care expertise can possibly be resolved by more specific, supportive and educational initiatives.
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Curr Opin Support Palliat Care · Sep 2008
ReviewManagement of dyspnea in advanced motor neuron diseases.
Patients with amyotrophic lateral sclerosis or motor neuron disease (ALS/MND) invariably develop respiratory muscle weakness and most die from pulmonary complications. Little evidence is available that identifies optimal management approaches for caring for the dying patient. This review discusses the state of the art on dyspnea in advanced ALS/MND and its treatment. ⋯ In ALS/MND, loss of function relentlessly progresses, and subsequent death occurs mostly in a predictable manner. Therefore, the end of life care is heavily influenced by the type and quality of care provided from the earliest stages. Most patients with ALS/MND develop dyspnea, agitation, anxiety and air hunger in the final phase. Noninvasive positive pressure ventilation has become the standard of care for patients with ALS/MND and advanced respiratory insufficiency. A multidisciplinary approach is strongly recommended.