Dementia: Helping Caregivers and Family Members Cope.

Physicians who care for patients with dementia also must provide support for patient caregivers and family members. Caregiver burden requires attention from the health care team because most caregivers of patients with dementia report high levels of emotional stress. This burden is more severe when patients have comorbid conditions, behavioral and psychological symptoms of dementia, and more severe functional impairments. A functional assessment of activities of daily living can be done using standardized screening tools. Driving is a specific instrumental activity of daily living that can become dangerous in dementia; decisions about stopping driving often are complicated by patient resistance and loss of independence. Clinicians will be faced with questions regarding patient decision-making capacity, which is the ability to comprehend information and use reason to communicate an informed choice. As complex decision-making capacity is likely to diminish with dementia progression, discussing advance directives and designation of a surrogate decision-maker early in the disease course is paramount. Dementia remains an incurable progressive disease; therefore, management often is directed toward maintaining quality of life, managing symptoms, and palliating suffering. Patients with dementia may become eligible for hospice when they lose speech, locomotion, or consciousness.