Neuropsychiatric symptoms at the end of life in dementia
DOI:
https://doi.org/10.62954/9eded190Keywords:
Dementia, neuropsychiatric symptoms, palliative care, end of life, geriatricsAbstract
Introduction: Neuropsychiatric symptoms (NPS) are frequent and complex manifestations in the terminal stages of dementia and represent a clinical challenge due to their impact on quality of life, caregiver burden, and end-of-life decision-making. Objective: The aim of this narrative review is to analyze recent evidence on the prevalence, classification, diagnostic approach, and comprehensive treatment of NPS in the context of terminal dementia. Materials and Methods: The main symptomatic domains (affective, psychotic, behavioral, and somatic-vegetative) are discussed, along with diagnostic tools such as the Neuropsychiatric Inventory (NPI) and other validated scales. Evidence-based, non-pharmacological interventions, and pharmacological options with risk-benefit considerations are also reviewed. Ethical aspects, such as advance directives, appropriate limitation of therapeutic effort, and palliative sedation, are addressed, recognizing the essential role of the geriatrician as the coordinator of the therapeutic plan and facilitator of interdisciplinary care. Results: NPS in terminal dementia require a proactive, empathetic, and evidence-based approach, with special attention to prognosis, continuous monitoring, and respect for patient dignity. Priority areas for future research include validation of prognostic tools and the effectiveness of culturally adapted interventions. Conclusion: Managing NPS is essential and requires a comprehensive, evidence-based approach. The role of the geriatrician is fundamental to ensuring quality care.
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