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November 1997

Persistent Vegetative State in Alzheimer Disease: Does 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.