RESUMO
Among the many losses that a patient with dementia inevitably experiences is loss of competency. The patient with a degenerative dementia experiences gradual and progressive impairment of multiple abilities, which may interfere with his or her competency in a number of realms, including medical or legal decision making, driving, and independent living. It is common for concerns about competency to arise while providing dementia care. Family members, other caregivers, members of the health care team, courts, and other physicians may trigger questions related to competency. The treating physician is in a unique position to address these concerns. The challenges of competency determination can be met with an understanding of the medical and legal principles behind the notion of competency. The physician's role in competency determinations is to assess capacity. Although determination of capacity often proves to be a demanding challenge for the physician, energy spent in this endeavor may result in preservation of the autonomy of the patient with dementia and overall improved quality of life at its end stages.
Assuntos
Atividades Cotidianas/psicologia , Condução de Veículo/psicologia , Demência/psicologia , Competência Mental/psicologia , Tomada de Decisões , Avaliação Geriátrica , Humanos , Testes Neuropsicológicos , Papel do Médico , Relações Médico-Paciente , Guias de Prática Clínica como AssuntoRESUMO
A previously healthy 46-year-old woman had the abrupt onset of aphasia and right hemiplegia from a large left-hemisphere infarct. At postmortem examination the cause of the infarct was dissection and occlusion of the intracranial carotid artery. No preexisting abnormality was found to account for the dissection. This uncommon cause of stroke and its pathogenesis are discussed.
Assuntos
Dissecção Aórtica/complicações , Doenças das Artérias Carótidas/complicações , Infarto Cerebral/etiologia , Artéria Carótida Interna/patologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Retinal nerve fiber layer (RNFL) photographs from 26 patients with Alzheimer's disease and 23 normal, age-matched, control subjects were reviewed for quality and abnormalities by two observers. A higher proportion of Alzheimer's patients showed RNFL abnormalities when compared to control subjects. There was some disagreement between the two observers regarding quality and frequency of abnormalities, reflecting suboptimal quality of the photographs obtained in patients with advanced Alzheimer's disease. Although these findings add to the clinical and histopathological evidence that ganglion cell degeneration occurs in Alzheimer's disease, the difficulty in obtaining and evaluating retinal nerve fiber layer photographs, especially in advanced cases, may limit the clinical usefulness of retinal nerve fiber layer analysis in such patients.