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Cognitive failure in end of life

Ostgathe, Christoph; Gaertner, Jan; Voltz, Raymond

Current Opinion in Supportive and Palliative Care: September 2008 - Volume 2 - Issue 3 - p 187–191
doi: 10.1097/SPC.0b013e32830baebf
End-of-life management: Edited by Sam H. Ahmedzai and Gustavo De Simone

Purpose of review Cognitive failure is known to be common in patients with advanced illness and can lead to significant distress for the persons affected and their environment. To get an insight on the most recent advances concerning cognitive failure at the end of life, a literature review has been performed focusing on the syndrome in general palliative care as well as on palliative care in patients with dementia.

Recent findings Cognitive impairment is diagnosed in varying commonness in up to 56% of patients. Reviewed research focused in part on diagnosing distress of patients being cognitively impaired. Signs and behaviours for distress were identified and observed in a high number of patients. Additionally, with focus on the caretakers distress, it could be demonstrated that for example general anxiety disorders were significantly more common when a delirium was perceived.

Goals of care for the patients with end-stage dementia can be defined as quality of life, dignity and comfort. Prognostication of the disease trajectory in patients with end-stage disease remains difficult even when the reviewed research shows growing evidence on the risk factors and causes for death of these patients.

Summary An overall improvement in professional care independent of the place of care for patients with cognitive impairment and dementia is still claimed by professionals and primary caretakers. In addition to further research, the lack of palliative care expertise can possibly be resolved by more specific, supportive and educational initiatives.

Department of Palliative Medicine, University Hospital Cologne, Germany

Correspondence to Raymond Voltz, Kerpenerstrasse 62, 50924 Köln, Germany Tel: +49 221 478 3361; fax: +49 221 478 7579; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.