Palliative and supportive care of patients with dementia

Dementia is a major public health issue, as its prevalence is constantly rising worldwide. Most underlying causes of dementia, either neurodegenerative or vascular in nature, currently continue to be untreatable and fatal. The plethora of cognitive, behavioral and motor symptoms of dementia create a great burden for quality of life of patients, who are in need of timely and adequate palliative care (PC) and support. Advance directives constitute a fundamental part of PC, and application of advance directives is the most efficient way to reassure patients about their wishes and preferences concerning anticipated deterioration of their condition in the future, and possible loss of capacity. The concept of PC in neurology in general, and in dementia, is relatively new and continues to evolve, and gives rise to multiple issues that should be addressed by research. This is a review of the current data on the main principles, methods and burdens of PC in dementia. Specifically, the review discusses the appropriate time frame for PC provision, the most important everyday problems that people with dementia encounter, the multiple ethnic, social, religious and legal issues associated with PC, and the obstacles to implementation of advance directives. Provision of timely, well-organized PC in demented patients is of great importance. As neurologists will be the main providers of PC for patients with dementia in the near future, relevant research and their training in the field are essential.