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Dear Jonathan and Suzanne, Sorry to hear about your mom's recent exacerbations of symptoms! You mentioned, your brother in Calf. (is he mom's primary CG?) feels she is "in the end stage." Evidently she has had an increase in symptoms in recent weeks and at this time seems to have a lot of dementia. In my experience and to my knowledge, there doesn't seem to be any descrete "end stage" associated with the disease, but rather perhaps a culmination of physical & psychological factors weakening the immune system and inviting onset of various other potentially fatal illnesses. I could be all wet here, but I was under the impression Parkinson's is *not* a "fatal disease," per se. So that might be some comfort or reassurance. Or maybe not. As to the dementia, though, after reading your post my immediate reaction was to think of my father's experience in taking just a truckload of different medications, and the possible interactions of these drugs... My Dad has very definitely experienced significant dementia and even psychosis at various times, due to the drug interactions of medications he's taken. Several have made him hallucinate. In most cases he has become very aware of these side effects rather quickly, and subsequently discontinued the med. A few, however, have made him seem to "really be losing it," without anybody really noticing -- until his behaviors became quite bizarre. After being withdrawn from some new med some Dr may have prescribed (without knowing the clinical hx, etc), Dad has rather quickly and consistently returned to whatever state of "normal" is possible for someone with advanced PD. As with an "end stage" therefore, I have the idea that dementia per se is not symptomatic or characteristic of PD, but may frequently be associated with multiple drug interactions. Talk with your Mom's physicians and try to get a handle on their understanding of the possible adverse effects of some of the meds she's on, when taken in combination. Now allow me to reveal my cynicism for a moment: I'd bet your mom sees at least 3 or 4 different Docs, all "specialists" in one area or another. I'd bet half of them don't have the faintest idea what the others are prescribeing, or how any new medications they might initiate may interact with those Mom is already taking. in considering your mom's "dementia," that would be the *first thing* I'd want to investigate! Good luck. And I hope your mom feels more functional soon! Roger