Abstract
Dementia is characterized by overall progression over time and in most cases, causal therapy is not available. Patients in advanced stages of dementia have severe cognitive deterioration and depend on nursing support, and during terminal stages there is irreversible loss of autonomy and need of continual nursing.
Dementia should be considered as a serious life limiting condition with predictable and irreversible progression to terminal stages of the underlying disease. Physicians should early open discussion about prognostic aspects, anticipate the predictable worsening and together with the patient and his family search for therapeutic options that would be in accord with his values and preferences.
Advance directives may facilitate and improve care for dementia patients but they have to be drawn up early in the disease stage. During end-of-life stages patients can benefit from hospice care.
Initiation of terminal palliative care should respect patient's wishes, clearly stated in advance directives when available.