Effect of fever-management strategy on the progression of dementia of the Alzheimer type.
This study was undertaken to determine if the progression of dementia of the Alzheimer type (DAT) is accelerated by an intercurrent infection and if management strategy (aggressive or palliative care) would modify this effect. A prospective cohort study compared the progression of DAT in patients in three 25-bed dementia special care units that provide a hospice option for care. There were three groups of patients, as follows: (a) developed a fever and received aggressive care (FAC, n = 30), (b) developed a fever and received palliative care (FPC, n = 19), and (c) did not develop a fever (NF, n = 46). The presence of a fever episode did not have an effect of its own on DAT progression. Over a 3-month period, DAT severity increased in most patients, but more so in FAC patients. Thus aggressive medical treatment of infections did not affect the underlying disease process and was associated with an acceleration of the progression of severity of DAT. Providing palliative care is recommended because it prevents patients from undergoing invasive diagnostic workups and treatments, does not accelerate the progression of DAT, and conserves scarce health care resources.
Hurley
A C
AC
Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.
Volicer
B J
BJ
Volicer
L
L
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000544:Alzheimer Disease / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004992:Ethics, Medical; D005260:Female; D005334:Fever / Q000209:etiology / Q000628:therapy*; D006291:Health Policy; D006801:Humans; D007262:Infusions, Intravenous; D008134:Long-Term Care; D008297:Male; D009483:Neuropsychological Tests; D010166:Palliative Care; D011446:Prospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents