Neuropalliative Care in Dementia.

OBJECTIVE

Patients and their caregivers and families confronting dementia often face heavy burdens from difficult-to-control symptoms, uncertainty about the future, and a high risk of care partner burnout. This article explores common palliative care dilemmas in dementia care and reviews evidence-based approaches to management.

LATEST DEVELOPMENTS: Research has recently accumulated about epidemiologic trends and racial disparities in dementia prevalence. Dementia-specific advance directives are being explored to help improve the ability of patients and their families to plan for the future. Although major breakthroughs have been elusive in the treatment of many common symptoms of dementia, research has further delineated the risks and benefits of many commonly used medications to guide routine clinical practice and added a few new options. Regarding deprescribing to limit polypharmacy in patients with dementia, new data about the mortality benefits of cholinesterase inhibitors must be weighed against the potential benefits of simplification. Additionally, research on survival in dementia has provided a more sophisticated tool to individualize prognostication for each patient.

ESSENTIAL POINTS: Dementia is a common and often highly burdensome disease process for patients, their caregivers and families, and the community at large. Palliating symptoms and providing guidance surrounding advance care planning and prognostication should be integral components of the management plan for patients with dementia in all settings.