Case-Based Reasoning in the Care of Alzheimer's Disease Patients

Planning the ongoing care of Alzheimer s Disease AD pa tients is a complex task marked by cases that change over time mul tiple perspectives and ethical issues Geriatric interdisciplinary teams of physicians nurses and social workers currently plan this care with out computer assistance Although AD is incurable interventions are planned to improve the quality of life for patients and their families Much of the reasoning involved is case based as clinicians look to case histories to learn which interventions are e ective to document clinical ndings and to train future health care professionals There is great variability among AD patients and within the same patient over time AD is not yet well enough understood for universally e ective treatments to be available The case based reasoning CBR re search paradigm complements the medical research approach of nding treatments e ective for all patients by matching patients to treatments that were e ective for similar patients in the past The Auguste Project is an e ort to provide decision support for plan ning the ongoing care of AD patients using CBR and other thought processes natural to members of geriatric interdisciplinary teams Sys tem prototypes are used to explore the reasoning processes involved and to provide the forerunners of practical clinical tools The rst system pro totype has just been completed This prototype supports the decision to prescribe neuroleptic drugs to AD patients with behavioral problems It uses CBR to determine if a neuroleptic drug should be prescribed and rule based reasoning to select one of ve approved neuroleptic drugs for a patient The rst system prototype serves as proof of concept that CBR is useful for planning ongoing care for AD patients Additional prototypes are planned to explore the research issues raised