Management of severe Alzheimer's disease and end-of-life issues.

The quality of life of individuals with severe Alzheimer's disease requires attention to three main factors: (1) availability of meaningful activities, (2) optimal management of medical issues, and (3) appropriate treatment of psychiatric symptoms. Preservation of ambulation and comfort and avoidance of depression are significant interfaces between these three main factors. Formulation of an advance proxy plan is important for ensuring that the patient's previous wishes or best interests are considered when decisions about treatment strategies are made. Decisions regarding treatment strategies should take into consideration decreased effectiveness of several therapeutic approaches in this patient population. Hospice care is appropriate for the terminal stage of Alzheimer's disease, but palliative care also can be provided in other settings.