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Memantine, which is FDA
approved for use in patients with moderate and severe Alzheimer's
disease, may provide modest benefits and has few adverse events.
Donepezil is FDA approved for severe Alzheimer's
disease. Galantamine and rivastigmine have not been approved for
late-stage disease, but they may be helpful.
A brief medication-free trial may be used to assess
whether a medication is still providing a benefit.
Depression may be less prevalent
and more difficult to diagnose, but if present, should be treated
vigorously, using strategies already described.
Psychotic symptoms and agitation are often present and
should be treated pharmacologically if they cause distress to the
patient or significant danger or disruption to caregivers or to
other residents of long-term care facilities, as already described.
Sleep disturbance should be treated as already described.
Ideally, discussions about
feeding tube placement, treatment of infection, cardiopulmonary
resuscitation, and intubation will have taken place when the patient
could participate. If they have not, it is important to raise these
issues with the family before a decision about one of these options
Hospice care can provide physical support for the patient
and emotional support for the family during the last months of life.
A physician must certify that the patient meets hospice criteria
for dementia for hospice benefits to be available.