About 4 million people in the United States have Alzheimer disease (AD) and the number of incident cases is expected to more than double from 377,000 in 1995 to 959,000 in 2050. Patients, their families, and health care professionals struggle with a relentless and irreversible neurological syndrome that can last from 2 to 20 years. Alzheimer disease causes both cognitive and functional impairments that predispose the patient to behavioral symptoms, destroy intellectual capacity and personality, erase the ability to communicate one's wishes for care, and lead to life-threatening consequences. At the close of life, family members and clinicians face decisions regarding degrees of intensive medical care to be provided for treatment of the late-stage consequences of AD, including withdrawal of invasive interventions, initiation of hospice, and treatment of a range of progressive medical conditions. Physicians can assist patients with AD and their loved ones through the terminal phases of the illness by preparing them for the relentless progression of the disease and by supporting them through the intellectual and emotional conflicts accompanying the end of life.