Alzheimer’s Disease and Related Disorders

Alzheimer’s disease is a degenerative brain disease of unknown cause that is the most common form of dementia. It results in progressive memory loss, impaired thinking, disorientation, and changes in personality and mood, that leads in advanced cases to a profound decline in cognitive and physical functioning, and that is marked by the degeneration of brain neurons especially in the cerebral cortex and by the presence of neurofibrillary tangles and plaques containing beta-amyloid.

Patients will be considered to be in the terminal stage of Alzheimer’s disease if they meet the following criteria: 1 plus either 2 or 3 MUST be present:

1. Stage 7 on the Functional Assessment Staging (FAST) Scale – A, B & C criteria are very important indicators of end stage Alzheimer’s disease.

Additional criteria lend additional support to terminal status:

  • Incontinence
  • Inability to communicate meaningfully (1 to 5 words a day)
  • Non-ambulatory (unable to ambulate and bear weight)
  • All intelligible vocabulary lost
  • Unable to sit up independently
  • Unable to smile
  • Unable to hold head up

2. Presence of co-morbid disease distinct from the terminal illness will impact functional impairment.  The combined effects of Alzheimer’s and any co-morbid condition should support a prognosis of 6 months or less.

  • COPD
  • CHF
  • Cancer
  • Liver Disease
  • Renal Failure
  • Neurological Disease

3. Patients should have had one of the following secondary conditions within the past 12 months:

  • Delirium
  • Recurrent or intractable infections, such as pneumonia or other URI
  • Pyelonephritis or other urinary tract infection
  • Septicemia
  • Decubitus ulcers, multiple, stage 3-4
  • Fever, recurrent after antibiotics
  • Inability to maintain sufficient fluid and calorie intake demonstrated by either of the following: 10% weight loss during the previous six months OR Serum albumin < 2.5 gm/dl
  • Aspiration pneumonia

If a patient meets the medical criteria above, they are by definition eligible to receive hospice services.  Some patients may not meet the criteria, but may still be eligible for hospice care due to comorbidities or rapid functional decline.  Contact your local Compassus program for further information.