I have my approach to handling these difficult issues but I am
interested in hearing from other practitioners on how they discuss
these hopeless cases with families especially the difficult
(unrealistic) families.

I remember when there were no dementia medications at all. Patients
and families were simply told there is nothing we can do. Now we have
5 FDA approved medications although I have not written a prescription
for Cognex in over 10 years. We are able to provide some initial hope
to patients and their families. We are "doing something".

My problem is these medications are very expensive and I do not see
any significant benefit. Occasional a family member says they feel
there has been improvement and maybe they do not deteriorate at the
pre-medication level.