2024 年 41 巻 1 号 p. 15-18
Advance care planning is one of the most valuable to total care for Parkinson disease (PD). However it is very difficult to provide appropriate opportunity for patients and their family members to think about late–stage medical treatment and end–stage care. The difficulty is due to the variety of clinical course of individuals with PD, that is PD is never single pathogenic disease, but complexed or clustered pathogenesis. Impaired cognition is another reason of difficulty. Almost 30% of PD patients are already suffered from cognitive decline, and over 80% of PD patients are suggested to have dementia according to Sydney cohort study. Initiation of ACP should be set during preserved cognition for self–determination. Device aided therapy (DAT) is admitted for motor complication of PD and has possibility to change aPD and late–stage PD life. That is the reason why DAT should be involved in ACP of PD, although it is not sure that DAT improve mortality of PD.
One of the main causes of death of PD patients is pneumonia. During treatment pneumonia, tracheostomy and mechanical ventilation are considered due to severity of pneumonia and genera condition. Sever dysphagia frequently requires nasogastric tube or gastrostomy tube feeding to maintain nutritional status. Physician should explain air way and feeding pathway management of advanced stage and that will support patients to imagine ACP.
