When most people hear the words dementia they think of a condition that causes memory loss and decreased brain functioning. Not many people are aware that it is an incurable progressive and terminal disease Dr Susan L Mitchell an Associate professor at Harvard Medical School say

"Dementia is a terminal illness; as the end of life approaches, the pattern in which patients with advanced dementia experience distressing symptoms is similar to patients dying of more commonly recognized terminal conditions, such as cancer."

However many people (physicians included) have a difficult time with Dr. Mitchells mind set of placing cancer and dementia into the same category.

For starters Dementia is a gradual loss of cognition and function that could take anywhere from 4-10 years until the patient shows sign of advanced end stage dementia.

On the slight chance that family members and physicians are able to acknowledge dementia as a progressive incurable disease many of them have no insight as to what their loved ones actually died from. As Neeraja discussed previously pneumonia is the most common “cause of death” seen on the death certificates of patients with dementia. When families see this listed they tend to think that it was the infection that caused the death and want to aggressively treat the infection in hopes that their loved ones will live longer. However it was the dementia that caused the apraxia dysphagia and decrease mobility that lead to an increased risk for infection and the end development of pneumonia.

We see our loved ones suffering in pain and immediately want to give them aggressive medications so that WE feel better. Family members feel uncomfortable watching their loved ones in pain while doing nothing about it. But there is no evidence that antibiotics promote any more comfort than just providing supportive care," she said. We can achieve the same amount of comfort by giving them oxygen, Tylenol to curve the fever, and medications to dry up the secretions. This is palliative care.

Holding off treatment is a very difficult decision to make but it is one that must be discussed before a patient reaches the end stage and can no longer make informed decisions about their care.

For
Most end stage patients die from pneumonia or other respiratory illnesses and most effective way to treat is antibiotics
Medications for pneumonia and palliative care medications are similar in their side effects
Antibiotics do not prolong life and the patients have the same mortality rate as those who do not take them.