6. Professor Liz Sampson, 2022,失智症安寧緩和醫療實務論壇
Dementia Palliative Care in Practice and Research Goals,
Challenges, Lessons Learnt and the Future
7. 阿茲海默失智症 - 典型病程
主觀及臨床可見認知障礙
臨床可見認知障礙
失智症
重度失智症
診斷 正常
主觀
認知障礙
MCI
Mild
AD
Mod.
AD
Mod. severe AD Severe AD
CDR分期 0 0.5 1 2 3
GDS/FAST分期 1 2 3 4 5 6 7
FAST substage a b c d e a b c d e f
病程/年 ~ 30-50 ~ 15 0 7 9 10.5 13
MMSE 29 29 25 19 14 5 0
AD=Alzheimer's disease, CDR=Clinical dementia rating, GDS=Global deterioration scale,
FAST=Functional assessment staging, MCI=Mild cognitive impairment, MMSE=Mini-mental state examination
Adapted from: Reisberg et. al. Alzheimer's Disease and Related Disorders. 1994; 8(suppl.): S1184-205
11. FAST 分期(Functional Assessment Staging)
• 共 16 個ordinal phases, 1–7f, (* occasionally or more frequently over the past weeks)
6a. Improperly putting on clothes without assistance/cueing * 穿
6b. Unable to bathe properly * 洗
6c. Inability to handle the mechanics of using the toilet * 拉
6d. Urinary incontinence * 小禁
6e. Bowel incontinence * 大禁
7a. Speech limited to 1–5 words 說不出
7b. All intelligible vocabulary lost 沒話講
7d. Unable to sit independently 坐不住
7e. Unable to smile 笑不出來
7f. Unable to hold head up 抬不起頭
7c. Non-ambulatory 走不動
• All stages must be
passed through
sequentially
J Am Med Assoc 2004; 291: 2734–2740
12.
13. FAST stage 7c characteristics
limited or more extensive assistance needed for
dressing and toileting
supervision or more assistance needed for bathing
urinary and fecal incontinence at least twice a week
rarely or never able to make themselves understood
• inability to ambulate without extensive
assistance
J Am Med Assoc 2004; 291: 2734–2740
36. 60% of hospitalised patients with
community-acquired pneumonia (CAP)
should be diagnosed as
aspiration pneumonia
silent aspiration during night
is a most important risk and/or cause of AP
“pneumonia is a friend of the aged”
37. van der Steen, J. T., Albers, G., Licht-Strunk, E., Muller, M. T.,
& Ribbe, M. W. (2011). A validated risk score to estimate
mortality risk in patients with dementia and pneumonia:
barriers to clinical impact. International
psychogeriatrics, 23(1), 31–43.
41. Treatment for oral frailty
Teeth and denture
Treatment of xerostomia
high quality protein:
1.0-1.5 g/k/day
Resistance training
Upright positioning in bed
early activity
J Nutr Health Aging. 2020;24(7):683-684
54. Professor Liz Sampson, 2022,失智症安寧緩和醫療實務論壇
Dementia Palliative Care in Practice and Research Goals, Challenges, Lessons Learnt and the Future
55. 無法防止嗆入 (口腔分泌物、逆流胃中食物)
非隨機試驗發現 – 用於有嗆咳的病人無法防止繼續嗆咳
JAMA 2007;298:2527-36
Dr. Kanthee Anantapong, 2022,失智症安寧緩和醫療實務論壇,
Providing nutrition and hydration to people with dementia –
clinical practice and challenges in decision-making