Advanced Dementia: Brain-State Characteristics and Clinical Indicators of Early Mortality

Area of Science:

• Neurology
• Gerontology
• Clinical Medicine

Background:

• Advanced dementia necessitates reliable prognostic predictors for ethical decision-making and family preparation.
• Current predictors for survival in advanced dementia are limited, particularly regarding brain activity and clinical comorbidities.

Purpose of the Study:

• To review and discuss the prognostic utility of clinical assessments and objective measures of pathological brain states in advanced dementia.
• To identify predictors of accelerated mortality in patients with advanced dementia.

Main Methods:

• Review of clinical assessments and objective measures of pathological brain states.
• Analysis of electroencephalography (EEG) measures and clinical indicators for forecasting mortality.
• Identification of risk factors associated with early mortality in terminal-stage dementia.

Main Results:

• Pressure ulcers and paroxysmal slow-wave EEG parameters are consistent risk factors for accelerated mortality in terminal-stage dementia.
• Immobility, malnutrition, and comorbid systemic diseases are highly associated with early mortality risk.
• EEG parameters correlate with cognitive impairment severity and disease progression.

Conclusions:

• Brain-state electroencephalography (EEG) measures and clinical indicators hold potential for forecasting early mortality in advanced dementia.
• Quantitative parameters of disease progression can aid in estimating mortality risk in advanced dementia patients.
• Identifying reliable predictors facilitates preparation for end-of-life care in advanced dementia.