| General indicators of deterioration in neurological diseases |
▸ Progressive deterioration in physical or cognitive function despite optimal therapy ▸ Complex symptoms ▸ Swallowing problems leading to respiratory complications ▸ Speech problems: dysarthria and progressive dysphasia
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| Specific clinical indicators for the disease groups |
| ALS/MND |
▸ Evidence of disturbed sleep related to respiratory muscle weakness in addition to signs of dyspnoea at rest ▸ Increased cognitive difficulties/barely intelligible speech ▸ Difficulty swallowing poor nutritional status/weight loss ▸ Needing assistance with ADLs ▸ Medical complications, eg, pneumonia, sepsis ▸ A low vital capacity (below 50% of predicted, hypercapnia)
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| Multiple sclerosis |
EDSS ≥8, 5 Presence of at least one of the following conditions:
▸ Significant complex symptoms and medical complications ▸ Dysphagia (swallowing difficulties) admissions with sepsis and poor nutritional status ▸ Communication difficulties, eg, dysarthria+fatigue ▸ Cognitive impairment ▸ Breathlessness
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| Movement disorders |
Hoehn and Yahr stage ≥4 No indication for neurosurgical procedures The presence of 2 or more of the following criteria:
▸ Drug treatment is less effective or an increasingly complex regime of drug treatments ▸ Reduced independence, need for help with daily living ▸ Recognition that the condition has become less controlled and less predictable with “off” periods ▸ Dyskinesias, mobility problems and falls ▸ Swallowing problems ▸ Psychiatric signs (depression, anxiety, hallucinations, psychosis)
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