PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PC-FACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at [email protected] PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PC-FACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at [email protected] Biggar N. Why religion deserves a place in secular medicine. J Med Ethics 2015;41:229-233. Earp BD. Does religion deserve a place in secular medicine? J Med Ethics 2015 Jun 23. [Epub ahead of print]. Smith KR. Religion, secular medicine and utilitarianism: a response to Biggar. J Med Ethics 2015 Jun 19. [Epub ahead of print]. Peters ME, Schwartz S, Han D, et al. Neuropsychiatric symptoms as predictors of progression to severe Alzheimer's dementia and death: the Cache County Dementia Progression Study. Am J Psychiatry 2015;172:460-465. Manzano J-GM, Gadiraju S, Hiremath A, et al. Unplanned 30-day readmissions in a general internal medicine hospitalist service at a comprehensive cancer center. J Oncol Pract 2015;11:410-415. Huang JS, Terrones L, Tompane T, et al. Preparing adolescents with chronic disease for transition to adult care: a technology program. Pediatrics 2014;133:e1639-1646. Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2015;6:CD011006. Brodaty H, Connors MH, Xu J, Woodward M, Ames D; PRIME study group. The course of neuropsychiatric symptoms in dementia: a 3-year longitudinal study. J Am Med Dir Assoc 2015;16:380-387. Spiritual care is part of palliative care;1-6 but when medicine intersects with religion, ethical conflicts arise. Despite the AMA’s7 and others’8 historical interest in medicine and religion, what place does religion have in today’s medical ethics? Biggar posits that secular medicine should not exclude religion by labeling it as irrational. Empirical data is not the only form of reasoning that can or should apply to medicine, nor will it create consensus on ethics and compassionate care issues—for example, whether a fetus is a person or when one can take a life. Wrong choices do not arise solely from insufficient or misinterpreted evidence; they also come from a misplaced emphasis on the “wrong things” and a lack of morality in decision- making. Thus, religion deserves a seat at the table of medical “negotiation.” Medicine without religion predisposes people to be careless of others. Earp states that Biggar equates “religion” with “moral philosophy” more than a set of beliefs. Earp says many dangers are inherent in allowing religion per se to influence medical decisions; different religions can come to opposite conclusions regarding patient treatment, which can have profound and fatal consequences. Citing potential treatment conundrums for rape victims, those on life support, and certain other groups, Earp argues against allowing religion to influence such decision-making. Additionally, worldviews other than Christianity support a moratorium on unnecessary killing. Smith presents utilitarianism as the most consistent application of moral theory and thus the best solution for medical ethics. Utilitarianism highly values happiness and maximizes desirable consequences accordingly. Religious morality is incompatible with today’s world because it is impossible to reason that one set of allegedly God-given precepts would be right while others are wrong. Religious dogma slows ethical progress; thus, religion has no place in secular medicine. Decision-making based on empirical thought and rational argument produces the most beneficent outcomes. For those who subscribe to specific faith traditions, religious beliefs may constitute important substrates for coping, meaning making, and decision-making. Technology may be morally neutral, but decisions about its use involve values, which are often informed by religious beliefs. It follows that religion affects medicine, but debate continues about its proper role? Shortcomings of all three commentaries include a near total focus on Christianity, excluding other faith traditions, and each neglects to differentiate between spirituality, organized religion, dogma, religious precepts, and (religious) philosophy. But perhaps the biggest missed opportunity circles back to why we care about religion in medicine to begin with: if palliative care seeks to assess and alleviate spiritual suffering, how can we expect to simultaneously excise spirituality’s role in complex decision-making? Despite disagreement about its rationality and appropriateness, religion continues to play an important role in medical decision-making. Hunter Groninger, MD, FACP, FAAHPM, MedStar Washington Hospital Center, Washington, DC. Biggar N. Why religion deserves a place in secular medicine. J Med Ethics 2015;41:229-233. Earp BD. Does religion deserve a place in secular medicine? J Med Ethics 2015 Jun 23. [Epub ahead of print]. Smith KR. Religion, secular medicine and utilitarianism: a response to Biggar. J Med Ethics 2015 Jun 19. [Epub ahead of print]. 1.Salsman JM, Pustejovsky JE, Jim HS, et al. A meta-analytic approach to examining the correlation between religion/spirituality and mental health in cancer. Cancer 2015 Aug 10. [Epub ahead of print].2.Selman L, Young T, Vermandere M, et al. Research priorities in spiritual care: an international survey of palliative care researchers and clinicians. J Pain Symptom Manage 2014;48:518-531.3.Kuczewski MG, McCarthy MP, Michelfelder A, et al. “I will never let that be ok again”: student reflections on competent spiritual care for dying patients. Acad Med 2014;89:54-59.4.Necek R. Moral and religious issues in health care. Przegl Lek 2012;69:271-274.5.Broeckaert B. Spirituality and palliative care. Indian J Palliat Care 2011;17 (Suppl): S39-S41.6.Sulmasy DP. Spirituality, religion, and clinical care. Chest 2009;135:1634-1642.7.Kim DT, Curlin FA, Wolenberg KM, Sulmasy DP. Back to the future: the AMA and religion, 1961–1974. Acad Med 2014;89:1603-1609.8.Curlin FA. Commentary: A case for studying the relationship between religion and the practice of medicine. Acad Med 2008;83:1118-1120. Alzheimer’s disease (AD) progresses inexorably,1 with heterogeneous manifestations that make treatment mostly reactive and palliative.2 In the absence of reliable prognostic biomarkers for this disease,3 can we use any other means to predict AD’s rate of progression? This longitudinal, population-based study screened 5,092 people for dementia, following 335 with possible or probable AD from January 1995 until October 2010. At 3- to 5-year intervals, the validated 10-domain Neuropsychiatric Inventory (NPI)4,5 was administered, documenting the type, frequency, and severity of symptoms participants reported having during the previous 30 days. NPI scores were analyzed as trichotomous variables (mild, moderate, severe) on Kaplan-Meier plots. Multiple Cox proportional hazard models controlled for variables including dementia onset-to-diagnosis time, APOE-4ε status, age, gender, educational status, and general health status. Mean age at symptom onset was 84.3 years (SD 6.4). Time from onset to diagnosis was 1.7 years (SD 1.3). Median time to progress to severe AD was 8.4 years (CI 7.6-9.2); median time to death 5.7 years (CI 5.4-6.1). Fifty-one percent of the sample had at least one neuropsychiatric symptom. Sixty-eight people (20%) developed severe AD during the study. The presence of (1) psychosis (delusions/hallucinations), (2) agitation/aggression, and (3) one neuropsychiatric symptom (e.g., disinhibition) predicted progression to severe dementia (P = 0.03, 0.004, and 0.001, respectively). Psychosis, agitation/aggression, affective changes, ≥1 mild and ≥1 clinically significant neuropsychiatric symptom predicted progression to death (P = 0.01, 0.004, 0.02, and ≤0.001, respectively). The use of psychotropic medications did not alter the results. Two hundred and seventy-three participants died by the end of the follow-up period. This longitudinal prospective study describes an intriguing link between the presence of neuropsychiatric symptoms and progression to advanced-stage AD and death. The study doesn’t provide data to use this association in prognostication. There may be unmeasured confounding variables, such as comorbidities, that cause symptom distress. Neurospychiatric symptoms in dementia, which may signal a need for palliative care consultation, are also associated with future disease progression. Laura C. Hanson, MD, MPH, FAAHPM, University of North Carolina—Chapel Hill, Chapel Hill, NC. Peters ME, Schwartz S, Han D, et al. Neuropsychiatric symptoms as predictors of progression to severe Alzheimer's dementia and death: the Cache County Dementia Progression Study. Am J Psychiatry 2015;172:460-465. 1.World Health Organization. Dementia. Fact sheet No. 362. March 2015. Available at: http://www.who.int/mediacentre/factsheets/fs362/en/. Accessed August 18, 2015.2.Nelson L, Tabet N. Slowing the progression of Alzheimer’s disease; what works? Ageing Res Rev 2015;23(Pt B):193-209.3.McGhee DJ, Ritchie CW, Thompson PA, et al. A systematic review of biomarkers for disease progression in Alzheimer's disease. PLoS One 2014;9:e88854.4.Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48(5 Suppl 6):S10-16.5.de Medeiros K, Robert P, Gauthier S, et al. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. Int Psychogeriatr 2010;22:984-994. Regulatory and other agencies use unplanned hospital readmission rates as a quality metric and risk stratification tool,1-4 but the unique case mix seen in cancer hospitals does not align with national data.5-6 Can readmission risk factors be predicted specifically for cancer hospitals? This retrospective, observational analysis reviewed unplanned 30-day admissions data on cancer patients discharged from a comprehensive cancer center between April 2012 and September 2012. Exclusion criteria included readmissions for planned treatments, nonelective surgeries, and patients who died during the index hospitalization. Readmissions to other hospitals were not tracked. Noncancer comorbidities were identified by extracting Elixhauser comorbidity measures recorded within one year prior to the observation period. The final cohort included 706 unique patients with 884 discharges. In this cohort, 47% of patients had metastatic disease and 50% of patients had ≥3 comorbidities. Two hundred unplanned admissions from 884 discharges (22.6%) were identified. Median time to readmission was 10 days. Factors associated with unplanned readmission were distant disease (OR 2.9; CI 1.4-6.2, P =0.004) and ≥3 comorbidities (OR 2.1; CI 1.4-3.0, P < 0.001). Discharge status was significant (P < 0.001), potentially indicating a patient subpopulation that may have been eligible for end-of-life care. (Those discharged to hospice were less likely to be readmitted.) Although 89% of the patients were age 45 or older, age did not affect the results (P = 0.038). Similarly, ethnicity, gender, and hospital and ICU lengths of stay did not affect the results. It is unknown whether the number of GI cancer cases (427 patients; 60.5%) drove any of the results. Quality and cost of care are driving forces for government healthcare planning. The Center for Medicare and Medicaid Services (CMS) addressed these themes with financial disincentives for readmissions within 30 days. Oncology hospitalizations are presently excluded, but preparation for this possibility is important. This study establishes baseline metrics for readmission in oncology patients. It is striking that readmissions are minimally higher in this group than across all other CMS baselines. Hospice admission was the one factor that effectively lowered readmission. This knowledge can serve as a trigger for palliative care involvement for patients with advanced disease at higher risk for hospital readmission (advanced disease, more comorbidities, younger age, gastric cancers); this knowledge can also provide a greater focus on hospice discussion with medically appropriate patients. In addition, readmissions related to GI cancer due to complications such as bowel obstruction, infection, ascites, and effusions might benefit from proactive planning for these complications. Lowering rates for readmissions for cancer hospitalizations will need further study, but hospice referral remains a good option for cancer patients with symptomatic disease. Charles S. Mills, MD, HMDC, FACP, FAAHPM, Elliot Health System, Manchester, NH. Manzano J-GM, Gadiraju S, Hiremath A, et al. Unplanned 30-day readmissions in a general internal medicine hospitalist service at a comprehensive cancer center. J Oncol Pract 2015;11:410-415. 1.Centers for Medicare and Medicaid Services. Specifications for the all-cause unplanned readmission measure for 30 days post discharge from inpatient rehabilitation facilities. May 2, 2013.2.Agency for Healthcare Research Quality. 30-day readmission rates to hospitals. From HCUP Statistical Briefs #153 and #154, 2012.3.NQF endorses all-cause unplanned readmissions measures [news release]. Washington, DC: National Quality Forum, April 24, 2012. Available at: http://www.qualityforum.org/News_And_Resources/Press_Releases/2012/NQF_Endorses_All-Cause_Unplanned_Readmissions_Measures.aspx. Accessed August 20, 2015.4.Baier RR, Gardner RL, Coleman EA, et al. Shifting the dialogue from hospital readmissions to unplanned care. Am J Manag Care 2013;19:450-453.5.Saunders ND, Nichols SD, Antiporda MA, et al. Examination of unplanned 30-day readmissions to a comprehensive cancer hospital. J Oncol Pract 2015;11: e177-181.6.Granda-Cameron C, Behta M, Hovinga M, Rundio A, Mintzer D. Risk factors associated with unplanned hospital readmissions in adults with cancer. Oncol Nurs Forum 2015;42:E257-268. Disease-specific apps offer great “reach” but frequently lack objective research to evaluate outcomes.1-4 Can a generic disease-management app help adolescents with chronic disease (ACDs) transition to an adult-oriented healthcare system? This randomized, 8-month, interventional trial (NCT01253733) studied whether a mobile app (MD2Me) would increase participants’ health-related self-efficacy. Eighty-one patients, age 14 to 22 years, with irritable bowel syndrome (IBS), cystic fibrosis (CF), or Type 1 diabetes (T1D) were recruited between October 2010 and March 2011 from a tertiary pediatric center. The treatment arm had access to a website containing disease management, communications, and lifestyle information, short texted reinforcements several times/week, disease management algorithms for e-queries, and e-communications with healthcare providers. Controls received monthly mail or e-mail messages and usual healthcare access. Both groups were assessed at baseline, 2 months, and 8 months for disease status, universal health status, health literacy, transition readiness, quality of life (QOL), and self-efficacy. Disease assessments were pediatric specific; transition readiness was adult specific. Median ages (IQRs) of subjects were: IBD and T1D 17 (16-18), CF 14 (13-16) (P =0.004). Seventy-five youths completed the study. Patient-initiated healthcare interactions were assessed 8 months before and throughout the study. Disease, functional, and QOL statuses did not differ between study arms (P = 0.18-0.86, 0.31, and 0.17, respectively). Although 74% of patients demonstrated adequate health literacy, only a third were performing any disease management skills necessary for adult-oriented healthcare. Compared with controls, MD2Me recipients showed significant improvements in disease management (P = 0.02), self-efficacy (P = 0.02) and the number of patient-initiated communications with their healthcare team (P < 0.0001). Most MD2Me recipients said the texting program (89%) and Web information (91%) were helpful. According to consensus guidelines, the process of transitioning ACD from child- to adult-based health care should begin by the age of 14.5 Adolescents account for a significant portion of children with complex chronic conditions (CCCs)6 as well as approximately one-third of patients served by pediatric palliative care (PPC).7,8 Adolescents served by PPC are likely to fall on the serious end of the CCC spectrum and may have unique physical, developmental, and communication needs9-11 that further potentiate barriers in transitions to adult-centered care. Validated interventions such as the MD2Me program to facilitate improved chronic disease self-management skills and patient-initiated communication are important low-cost, age-tailored tools than can be delivered independent of the clinical encounter. PPC services may consider adjunctive technology-based tools to support adolescents with chronic disease in improving short-term independence and empower patient-initiated communication as they transition from pediatric- to adult-based health care services. Christopher A. Collura, MD, FAAP, Mayo Clinic Children’s Center, Rochester, MN. Huang JS, Terrones L, Tompane T, et al. Preparing adolescents with chronic disease for transition to adult care: a technology program. Pediatrics 2014;133:e1639-1646. 1.Committee on Adolescent Health Care Services National Research Council, Institute of Medicine. Challenges in adolescent health care. Washington, DC: National Academies Press, 2007.2.US Department of Health and Human Services. Healthy people 2020. Available at: www.healthypeople.gox/2020/topicsobjectives2020/pdfs/HP2020objectives.pdf. Accessed September 22, 2015.3.Sawicki GS, Lukens-Bull K, Yin X, et al. Measuring the transition readiness of youth with special healthcare needs: validation of the TRAQ-Transition Readiness Assessment Questionnaire. J Pediatr Psychol 2011;36:160-171.4.Hibbard JH, Stockard J, Mahoney ER, et al. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res 2004;39(4 pt 1):1005-1026.5.American Academy of Pediatrics; American Academy of Family Physicians; American College of Physicians-American Society of Internal Medicine. A consensus statement of health care transitions for young adults with special health care needs. Pediatrics 2002;110(6 pt 2):1304-1306.6.Feudtner C, Kang TI, Hexem KR, et al. Pediatric palliative care patients: a prospective multicenter cohort study. Pediatrics 2011;28:109-117.7.Frizzola M, Miller EG. Referrals to a new pediatric palliative care team: details of the first 12 months of operation. J Pall Med 2014;17:585-588.8.Simon TD, Berry J, Feudtner C, et al. Children with complex chronic conditions in inpatient hospital settings in the United States. Pediatrics 2010;126:647-655.9.Wiener L, Weaver M, Bell CJ, et al. Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer. Clin Oncol Adolesc Young Adults 2015;5:1-18.10.Humphrey L, Dell ML. Identifying the unique aspects of adolescent and young adult palliative care: a case study to propel programmatic changes in pediatric hospitals. Semin Pediatr Neurol 2015;22:166-171.11.Ferrari A, Thomas D, Franklin AR, et al. Starting an adolescent and young adult program: some success stories and some obstacles to overcome. J Clin Oncol 2010;28:4850-4857. Depression affects compliance, quality of life (QOL), and mortality in cancer patients;1-5 depression related response to illness6.7 complicates decisions regarding pharmacological intervention.8.9 Can metaanalysis of randomized clinical trials (RCTs) shed light on benefits to antidepressants? This Cochrane review assessed antidepressant benefits in cancer. Information included databases (Cochrane Central Register, MEDLINE, EMBASE, and PsycINFO), FDA and drug registries, clinical trial registries, conference proceedings, and pharmaceutical websites. Randomized trials from 1946 through April 2014 included adults with cancer and depression, even if antidepressants were used for other indications. The primary outcome was response after 6-12 weeks using mean change in depression score. Secondary outcomes were early responses (≤4 weeks), social adjustment, health-related QOL, and acceptability (dropout rate). To eliminate potential carry-over effects in crossover trials, only data from the first phase were included. Four-hundred and seventy-nine patients were included in the primary outcome analysis, 592 in early efficacy, 175 in social adjustments, 305 in QOL, and 668 in acceptability. No significant differences were found in the primary outcome comparing antidepressants versus placebo (SMD -0.45; 95% CI -1.01-0.11). No antidepressant class outperformed another (SMD -0.08; 95% CI -0.34-0.18). Antidepressants did not improve social adjustment, QOL, early efficacy, or dropout rates. Cancer site and stage and psychiatric diagnosis did not affect results. Overall, study methodological quality was low, with an “unclear” or “high” risk for selection, attrition, and reporting biases. There was significant trial heterogeneity in the antidepressant versus placebo trials. This latest Cochrane review further muddies already murky water. An analysis of more than 50 years of randomized trials, it yielded fewer than 500 analyzable patients, confusingly wide confidence intervals, and the assertion by the authors that the quality of the available studies was so low that “we cannot draw reliable conclusions about the effects of antidepressants on depression in people with cancer.” For the clinician who seeks to conduct evidence-based practice, this is both confusing and hard to square against other recent rigorous reviews that conclude there are meaningful benefits of antidepressants in similar settings.10,11 The nullset results of this rigorous review do not help inform clinical practice. We must rely on clinical considerations and other studies to guide our decisions. Thomas Strouse, MD, UCLA David Geffen School of Medicine, Los Angeles, CA. Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2015;6:CD011006. 1.Sperner-Unterweger B. Depression in cancer patients. Wien Med Wochenschr 2015;165:297-303.2.Fujisawa D, Inoguchi H, Shimoda H, et al. Impact of depression on health utility value in cancer patients. Psychooncology 2015 Aug 17. [Epub ahead of print].3.Chabrier M, Bezy O, Mouret MA, Bay JO, Jalenques I. Impact of depressive disorders on adherence to oral anti-cancer treatment. Bull Cancer 2013;100:1017-1022.4.Bender CM, Gentry AL, Brufsky AM, et al. Influence of patient and treatment factors on adherence to adjuvant endocrine therapy in breast cancer. Oncol Nurs Forum 2014;41:274-285.5.Somerset W, Stout SC, Miller AH, Musselman D. Breast cancer and depression. Oncology (Williston Park) 2004;18:1021-1036.6.Saracino RM, Rosenfeld B, Nelson CJ. Towards a new conceptualization of depression in older adult cancer patients: a review of the literature. Aging Ment Health 2015;27:1-13.7.Park EM, Rosenstein DL. Depression in adolescents and young adults with cancer. Dialogues Clin Neurosci 2015;17:171-180.8.Osório FL, Lima MP, Chagas MH. Screening tools for psychiatry disorders in cancer setting: caution when using. Psychiatry Res 2015;229:739-742.9.Butow P, Price MA, Shaw JM, et al. Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines. Psychooncology 2015;24:987-1001.10.Rayner L, Price A, Evans A, et al. Antidepressants for depression in physically ill people. Cochrane Database SystRevs 2010;3:CD007503.11.Rayner L, Price A, Evans A, et al. Antidepressants for treatment of depression in palliative care: systematic review and meta-analysis. Palliat Med 2011;25:36-51. Despite similarities in dementias, symptom trajectories are uncertain.1-3 Can patients’ baseline characteristics and trending information predict symptom course? Seven hundred and seventy Australian patients with dementia or mild cognitive impairment from the Prospective Research in Memory clinics (PRIME) study were followed for 3 years to determine whether baseline characteristics or other factors predict trajectory of neuropsychological symptoms. Patients represented nine memory clinics, excluding nursing home residents. At baseline, 3 months, 6 months, and 12 months, and annually, patients were assessed with the 12-item Neuropsychiatric Inventory, Mini-Mental State Examination, Clinical Dementia Rating (CDR) scale, Functional Autonomy Measurement System, and a medication review. Complete data from ≥4 time points were required for analysis. Blom transformation compensated for skewing in linear mixed models. Baseline CDR controlled for disease severity. Five hundred and eleven patients were included in analyses. Total NPI score and symptoms increased significantly each year. At each time point, ≈90% of patients had ≥1 neuropsychiatric symptom; >50% had ≥4 symptoms. When the study ended, >75% of patients had ≥3 symptoms. Most symptoms increased significantly—but differentially—over time. Delusions, disinhibition, and euphoria increased the first year; apathy and anxiety increased during years 1 and 2. Symptom severity differed by type of dementia. Overall, Alzheimer’s disease (AD) was associated with milder neuropsychiatric symptoms (P = 0.02), while frontotemporal dementia was associated with higher symptomatology (P = 0.02). AD medications accelerated symptom onset (P = 0.02); atypical antipsychotics worsened symptoms (P < 0.01 to 0.03). Age did not affect the results. Palliative care for dementia patients is challenged to provide just-in-time prognostication, interventions, and support for varied symptoms over variable trajectories. This longitudinal Australian multisite study demonstrates, as predicted, the more severe symptomatology and trajectory of frontotemporal dementia, as opposed to the milder symptoms of AD. Symptoms also clustered somewhat by diagnosis, and predictably multiplied and worsened over this 3-year study. This and other longitudinal studies are limited to associations and cannot provide evidence for causality! Conclusions such as “AD medications accelerated symptom onset,” and “atypical antipsychotics worsened symptoms” truly represent the same reality as “analgesics accelerate pain onset” and “antiseizure medications are associated with the onset of seizures.” Dementia symptoms and course are significantly associated with type of dementia and might be influenced by both biological factors and psychological reactions to loss. Dan Handel, MD, Denver Health Medical Center, Denver, CO. Brodaty H, Connors MH, Xu J, Woodward M, Ames D; PRIME study group. The course of neuropsychiatric symptoms in dementia: a 3-year longitudinal study. J Am Med Dir Assoc 2015;16:380-387. 1.Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ 2015;350:h369.2.Peters ME, Schwartz S, Han D, et al. Neuropsychiatric symptoms as predictors of progression to severe Alzheimer's dementia and death: the Cache County Dementia Progression Study. Am J Psychiatry 2015;172(5):460-465.3.Cerejeira J, Lagarto L, Mukaetova-Ladinska E. Behavioral and psychological symptoms of dementia. Front Neurol 2012;3(Article 73):1e21. PC-FACS Feedback We appreciate your feedback. Help us help you—send your comments to [email protected] PC-FACS was created in 2005 by Founding Editor-in-Chief Amy P. Abernethy, MD, PhD, FACP, FAAHPM. The Academy is deeply grateful to Dr. Abernethy for creating this important publication and for her many contributions to the field of hospice and palliative medicine. PC-FACS is edited by Editor-in-Chief, Donna S. Zhukovsky, MD, FACP, FAAHPM, of the University of Texas M. D. Anderson Cancer Center, and Associate Editor-in-Chief, Mellar P. Davis, MD, FCCP, FAAHPM, of the Taussig Cancer Institute at Cleveland Clinic. All critical summaries are written by Lana Christian. AAHPM thanks the following PC-FACS Editorial Board members for their review of the critical summaries and preparation of the commentaries: Basic Science Egidio Del Fabbro, MD, Senior Section Editor Rony Dev, DO, MS Khurram J. Khan, MD Eric Prommer, MD, FAAHPM Eric Roeland, MD, FAAHPM Bioethics, Humanities, and Spirituality Francine Rainone, DO, PhD, MS, FAAHPM, Senior Section Editor Robert M. Arnold, MD, FAAHPM Valencia Clay, MD, FAAHPM Hunter Groninger, MD, FAAHPM Jessica A. Moore, DHCE, MA Alan J. Nixon, MB, BCh, BAO, CCFP(C), FAAHPM Gordon Wood, MD, MSci, FAAHPM Geriatrics and Care Transitions Paul Tatum, MD, MSPH, CMD, FAAHPM, Senior Section Editor David B. Brecher, MD, FAAFP, FAAHPM Laura C. Hanson, MD, MPH, FAAHPM Sandra Sanchez-Reilly, MD, MSc, AGSF, FAAHPM Eric Widera, MD, FAAHPM Hospice, Hospice and Palliative Medicine Interface, and Regulatory Issues Tommie W. Farrell, MD, Senior Section Editor Christopher Jones, MD Matthew G. Kestenbaum, MD Charles S. Mills, MD, HMDC, FACP, FAAHPM Joel S. Policzer, MD, FACP, FAAHPM Pediatrics Christina Ullrich, MD, MPH, FAAHPM, Senior Section Editor Rene D. Boss, MD, MHS Christopher A. Collura, MD, FAAP Marcia Levetown, MD, FAAP, FAAHPM Robert C. Macauley, MD, FAAP, FAAHPM Psychosocial Thomas B. Strouse, MD, Senior Section Editor Steven J. Baumrucker, MD, FAAFP, FAAHPM Myra Glajchen, DSW Stephanie M. Harman, MD, FACP Jane E. Loitman, MD, MBA, FAAHPM David Nowels, MD, MPH Symptom Assessment and Management Stephen J. Bekanich, MD, Senior Section Editor Amy P. Abernethy, MD, FACP, FAAHPM Michael A. Ashburn, MD, MBA, MPH James T. D'Olimpio, MD, FACP, FAAHPM Daniel L. Handel, MD Dana Lustbader, MD, FCCM, FCCP, FAAHPM Ad Hoc Reviewers Jeanne-Marie Maher, MD, FACP Lisa E. Thompson, MD Denise G. Waugh, MD, FACEP, FAAHPM PC-FACS is partially supported through an unrestricted educational grant from Purdue Pharma, LP. The views expressed herein are those of the individual authors and are not necessarily those of the Academy. Information included herein is not medical advice and is not intended to replace the judgment of a practitioner with respect to particular patients, procedures or practices. To the extent permissible under applicable laws, the Academy disclaims responsibility for any injury and / or damage to persons or property as a result of any actual or alleged libelous statements, infringement of intellectual property or other proprietary or privacy rights, or from use or operation of any ideas, instructions, procedures, products or methods contained in this publication. American Academy of Hospice and Palliative Medicine 8735 W. Higgins Road, Suite 300 Chicago, IL 60631, USA Phone: 847-375-4712 Fax: 877-734-8671 E-mail: Website: www.aahpm.org