ABSTRACT
This chapter focuses on the palliative care of adults with the more common progressive neurodegenerative diseases and their caregivers. In addition, stroke will be discussed in some detail due to its high morbidity and prevalence. Despite the different disease trajectories, many more patients die from Parkinson's disease than amyotrophic lateral sclerosis (ALS) each year and just as many die from multiple sclerosis as from ALS. The disease progression of most neurodegenerative disorders cannot be significantly altered; it is, therefore, all the more important that appropriate palliation of the attendant symptoms and psychological distress is given. Around 25% of stroke patients experience poststroke pain syndromes such as headaches, central poststroke pain, hemiplegic shoulder pain, painful spasticity, and tension headaches. Spasticity can lead to pain, spasms, reduced mobility, and limited range of motion as well as contractures. The potential for tracheostomy should be a routine part of advanced care planning, emphasizing the risk of locked-in syndrome.
