ABSTRACT
Vascular dementia (VaD) is the most prevalent form of secondary dementia and the second most common of all dementias. The present paper aims to define guidelines on the basic principles for treating patients with suspected VaD (and vascular cognitive impairment - no dementia) using an evidence-based approach. The material was retrieved and selected from searches of databases (Medline, Scielo, Lilacs), preferentially from the last 15 years, to propose a systematic way to assess cognition, function and behavior, and disease severity staging, with instruments adapted for our milieu, and diagnosis disclosure. The present proposal contributes to the definition of standard diagnostic criteria for VaD based on various levels of evidence. It is noteworthy that only around half of the population of patients with vascular cognitive impairment present with dementia, which calls for future proposals defining diagnostic criteria and procedures for this condition.
A demência vascular (DV) é a forma de demência secundária mais prevalente e a segunda entre todas as demências. O presente artigo visa estabelecer diretrizes dos princípios básicos para o atendimento de pacientes com suspeita de DV (e comprometimento cognitivo vascular - não demência), fundamentadas em evidência. O material foi obtido e selecionado a partir de busca em bases de dados (Medline, Scielo, Lilacs), preferencialmente dos últimos 15 anos, para propor a sistemática da avaliação cognitiva, funcional e comportamental, além do estadiamento da gravidade, com instrumentos adaptados para o nosso meio, e a revelação do diagnóstico. A presente proposta contribui para a definição dos padrões de diagnóstico da DV através de evidência comprovada em vários níveis. É ressaltado que apenas cerca da metade da população dos pacientes com comprometimento cognitivo vascular apresenta quadro de demência, o que torna necessária, futuramente, uma proposta visando o estabelecimento de critérios e elaboração diagnóstica dessa condição.
Subject(s)
Humans , Activities of Daily Living , Aging , Dementia, Vascular , NeuropsychologyABSTRACT
<b>Purpose</b>: Doctors were reluctant to disclose a cancer diagnosis to patients in the 1980' s. Clinical pharmacists strive to reduce adverse events caused by chemotherapy and manage pain control and symptoms. We tracked changes in the quality and quantity of information on cancer patients provided by medical staff over 17 years in Kanazawa University Hospital. <b>Methods</b>: We questioned doctors and nurses about the same items in 1988, 1996 and 2005 and compared their replies. <b>Results</b>: Most doctors working on a gastroenterology ward did not reveal cancer diagnoses to patients in 1988 even for early stage cancer, but 70% of doctors did reveal early stage cancer diagnoses in 1996. In contrast, almost full disclosure was achieved irrespective of the stage of cancer progression in 2005. However, medical staff are now confronted with new issues including how long chemotherapy should be continued and planning strategy for the relief of pain and symptoms associated with cancer progression. <b>Conclusion</b>: Our 17-year investigation indicates that doctors provide a more detailed diagnosis in response to increased medical knowledge among patients, and pharmacists need to actively offer up their own opinions about continuation of chemotherapy or palliative care for managing pain and symptoms.