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November 1997

Persistent Vegetative State in Alzheimer DiseaseDoes It Exist?

Author Affiliations

From the Geriatric Research Education Clinical Center, E. N. Rogers Memorial Veterans Hospital, Bedford, Mass (Drs Volicer, Cipolloni, and Mandell); Departments of Pharmacology and Psychiatry (Drs Volicer and Mandell) and Neurology (Drs Cipolloni and Mandell), Boston University School of Medicine, Boston, Mass; and Louisiana State University, Shreveport, La (Dr Berman).

Arch Neurol. 1997;54(11):1382-1384. doi:10.1001/archneur.1997.00550230051016

Objective:  To determine if the published criteria for diagnosis of the persistent vegetative state could be applied to patients suffering from Alzheimer disease.

Design and Methods:  Eighty-eight institutionalized patients with a diagnosis of possible or probable Alzheimer disease were evaluated for the presence of persistent vegetative state. Initial screening excluded patients who were able to do any of the following: feed themselves, respond to command, walk, or maintain continence of bowel and bladder. A sample of 12 of 28 patients unable to perform any of these functions was examined independently by 3 of us.

Results:  During the first examination, 2 patients were diagnosed as being in a vegetative state by 2 of us and 3 additional patients by 1 of us. One of us did not diagnose any patient as being in a vegetative state. A second evaluation of the same patients was performed 2 months later, after holding a consensus meeting to standardize the evaluation procedure. During the second evaluation, the vegetative state was diagnosed in 6 patients but only by 1 of us.

Conclusion:  The diagnostic disagreement between the neurologists indicates that Alzheimer disease may only rarely progress to the persistent vegetative state.