Neurologic illness trajectories

Four illness trajectories have been proposed to conceptualize how function declines as diseases advance to death: (A) a short decline as with cancer; (B) an episodic decline as with heart failure; (C) a prolonged decline as with dementia; (D) a crisis that may result in early death (often after a decision to withdraw life sustaining treatments) or survival with a high degree of disability as with stroke. These frameworks allow patients, family members, providers, and health care planners to prepare for next steps as they confront the limits of modern medicine and to develop compassionate health care systems that allow patients to live, age, and die with self-respect and grace.