Percutaneous endoscopic gastrostomy (PEG) is an accepted technique for long-term enteral feeding. Its use has increased because of its relative technical simplicity and low complication rate. As a result, the demands for gastrostomy insertion have risen and now encompass indications where the long-term outcomes are uncertain. One example of this, are patients with end-stage dementia who may be unable or unwilling to eat. For this reason, dementia has become one of the most common indications for gastrostomy feeding. This article reviews the current evidence relating to PEG feeding in dementia as well as work from the authors' own group. The purpose of this review is to provide the reader with an overview of the published literature and suggest a practical approach for this difficult clinical situation. The changes which the authors have implemented and described (including audit data), may be something which any practising healthcare professional in this field may choose to incorporate into their own clinical practice.