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Related Experiment Videos

Persistent vegetative state in Alzheimer disease. Does it exist?

L Volicer1, S A Berman, P B Cipolloni

  • 1Geriatric Research Education Clinical Center, E. N. Rogers Memorial Veterans Hospital, Bedford, Mass., USA.

Archives of Neurology
|November 18, 1997
PubMed
Summary

Neurologists found it difficult to consistently diagnose persistent vegetative state (PVS) in Alzheimer disease patients. This diagnostic challenge suggests Alzheimer disease rarely progresses to PVS.

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Area of Science:

  • Neurology
  • Neurodegenerative Diseases
  • Clinical Diagnostics

Background:

  • Alzheimer disease (AD) is a progressive neurodegenerative disorder.
  • Persistent vegetative state (PVS) is a clinical condition characterized by severe brain damage.
  • The applicability of PVS diagnostic criteria to AD patients is not well-established.

Purpose of the Study:

  • To assess the utility of established persistent vegetative state diagnostic criteria in patients with Alzheimer disease.
  • To evaluate inter-rater reliability in diagnosing PVS among neurologists evaluating AD patients.

Main Methods:

  • Eighty-eight institutionalized patients with possible or probable Alzheimer disease were screened.
  • Patients unable to feed themselves, respond to commands, walk, or maintain continence were selected for further evaluation.

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  • A subset of 12 patients underwent independent neurological examinations, followed by a standardized evaluation after a consensus meeting.

    • Main Results:

    • Initial examinations showed significant disagreement among neurologists regarding PVS diagnosis in Alzheimer disease patients.
    • A second evaluation, after a consensus meeting to standardize procedures, still resulted in low diagnostic agreement.
    • Only one neurologist diagnosed PVS in 6 patients during the second evaluation, highlighting diagnostic variability.

    Conclusions:

    • The considerable diagnostic disagreement indicates challenges in applying PVS criteria to Alzheimer disease.
    • Alzheimer disease is unlikely to progress to a persistent vegetative state in most cases.
    • Further research is needed to refine diagnostic approaches for severe neurological impairment in Alzheimer disease.