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November 15, 2000

End-of-Life Care for Patients With Advanced Dementia

JAMA. 2000;284(19):2449-2450. doi:10-1001/pubs.JAMA-ISSN-0098-7484-284-19-jlt1115

To the Editor: Between 2.5 and 4 million US residents have a life-limiting neurological disorder, including Alzheimer disease or related dementia (ADRD),1 that will require end-of-life (EOL) care. Although several groups have provided evidence-based suggestions to improve EOL care in general,2 as well as desirable outcomes for end-stage dementia, the unique characteristics of ADRD3 create unique difficulties at the end of life. In particular, ADRD does not have a predictable time course and causes cognitive and functional impairments that, in turn, predispose to behavioral symptoms. It also destroys intellectual capacity, personality, and the ability to communicate one's wishes for care and produces intense physical, emotional, and financial burden on the family.