It is increasingly common to describe the advanced stages of dementia with the words "end-of-life". While the question of how should treatment for dementia be conducted at these stages is a troubling one in the clinical setting, when it is considered, it would be necessary to sort out the problem. Firstly, the author has repeatedly criticized the concept of "core symptoms" and "peripheral symptoms" in dementia and the crudity of lumping psychological symptoms together with behavioral impairment under the term "Behavioral and Psychological Symptoms of Dementia" (BPSD). This is because we believe that such concepts are not only causing misunderstanding of psychiatric care in dementia, but are also causing a mismatch in the choice of treatment methods. Although this is a personal opinion, when the matching of symptomatology and treatment is considered, symptoms can be divided into a higher cerebral dysfunction group centered around cognitive impairment, a psychological symptom group (mental function impairment group+physiological impairment group), and a behavioral impairment group, and we consider the treatment of dementia to be the treatment of such symptom groups with the addition of treatment of physical complications. On the other hand, at a stage when no disease-modifying therapies currently exist, all anti-dementia treatments are symptomatic therapies. Since the symptoms of dementia change over its course, symptomatic therapies that become less needed should be discontinued or modified. A flexible "treatment exit strategy" in response to this kind of situation would also be necessary, yet uniform discontinuation of anti-dementia medications in the advanced stages of dementia would be considered crude. When risks and benefits are considered, we have to determine in which cases of advanced stages of dementia the risks of treatment are considerable enough to warrant dose reductions or treatment discontinuation, and in which cases the benefits are still dominant enough to choose continuation of treatment. Based on such a point of view, we examined a treatment exit strategy.
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