What Are The Main Types Of Dementia
Alzheimers disease is the most common cause of dementia, accounting for around 2 out of every 3 of cases in older people. Vascular dementia is another common form, while dementia with Lewy bodies and frontotemporal dementia are less common.
It is possible to have more than one type of dementia at the same time. Alzheimers is sometimes seen with vascular dementia or dementia with Lewy bodies. You might hear this called mixed dementia.
The symptoms of dementia vary depending on the disease, or diseases, causing it. You can read more about the symptoms associated with different types of dementia on the Alzheimers Society website .
End Of Life Dementia Care And Covid
Older adults and people with serious underlying medical conditions are at higher risk for severe illness from COVID-19. Older adults also have the highest rates of dementia. Given the risks that older adults face from both COVID-19 and dementia, its important to understand how to protect yourself and your loved one. Find more information about dementia and COVID-19 from the CDC.
When a dementia like Alzheimers disease is first diagnosed, if everyone understands that there is no cure, then plans for the end of life can be made before thinking and speaking abilities fail and the person with Alzheimers can no longer legally complete documents like advance directives.
End-of-life care decisions are more complicated for caregivers if the dying person has not expressed the kind of care he or she would prefer. Someone newly diagnosed with Alzheimers disease might not be able to imagine the later stages of the disease.
Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
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Support Family And Loved Ones
It is vital that the persons family and loved ones are aware that the person may be in the last few days or hours of life. Share information in a gentle and sensitive manner, drawing on those staff who have the strongest relationships with the person and their family. Giving family members space to explore their feelings and concerns is a critical part of good end-of-life care.
Often, family and loved ones want to be present when the person dies. They should know that changes can happen suddenly and the person may die, for example, when they have just popped out of the room to use the bathroom.
Sometimes, family members may not want to be present at the death. Family and relatives should never feel that they should stay, but always give them the opportunity to stay and to be involved in care as they wish.
Caring For Someone With Dementia Towards The End Of Life
Please be aware – this information is for healthcare professionals. We also have information for the public.
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People with dementia may experience problems with thinking, memory, behaviour and mobility. It can be difficult to recognise when someone with dementia is nearing the end of their life. You can support the person by communicating with them and helping them with any symptoms they have. If possible, its a good idea to plan the persons care in advance to help understand what they want from their care.
On this page:
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Is Alzheimers A Terminal Illness
This question has a fair amount of subtlety. I have treated it at greater length HERE. But, suffice it to say that there are broad and narrow conceptions for what a âterminal illnessâ is.
On the broad conception, a terminal illness is merely one that reduces your life expectancy and that you will you will have at the time of your death. Alzheimerâs surely fits this general description.
On the narrow definition, a terminal illness is one that you are expected to die from very soon â maybe within twelve or twenty-four months. A person recently diagnosed with mild-cognitive impairment or early-stage Alzheimerâs may have eight to ten years to live. So, on this narrow definition, âAlzheimerâsâ â by itself â may not be a terminal illness. However, we could say that late-stage Alzheimerâs could plausibly be construed as a terminal illness. Because, by the time a person enters Alzheimerâs advanced, end, or late stage, it may well be that their life expectancy has been reduced to one or two years.
For a more in-depth discussion of this issue, click HERE.
Understanding Lewy Body Dementia
Lewy body dementia symptoms are so similar to those of other forms of dementia that LBD can be misdiagnosed. This might make more sense when you consider that there are many types of dementia.
It may help to think of dementia as one large “umbrella” that slowly robs people of their ability to think, talk, remember, and use their bodies. Many diseases crowd underneath this umbrella, including:
- Alzheimers disease
- Struggle with incontinence
With dementia with Lewy bodies, cognitive changes may appear earlier than, about the same time, or shortly after any physical changes surface.
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Caring For A Person With Late
If you are caring at home for someone who is in the later stages of dementia the Aged Care Assessment Team can help with advice and referrals for all aspects of care. You can contact your nearest ACAT by calling the number listed in the Age Page of your telephone directory. Your doctor or hospital can also help you to contact your local ACAT.
Can You Die From Dementia
The answer to Can dementia kill you? is complicated.
Dementia in and of itself rarely causes someone to pass away. It isnt an acute disease that immediately and heavily affects someones life, like a heart attack or stroke. If you have a loved one showing early signs of dementia, youll still have time to enjoy them.
Instead, as we mentioned above, dementia can slowly progress over time from mild to severe symptoms. As dementia progresses, it can start to affect different parts of the brain and an individuals ability to perform daily tasks. In more advanced stages, a person with dementia may be unable to walk or eat independently. Eventually, the individual will pass away either from age or complications as a result of dementia.
But is immediately dying from dementia likely? No, people who start to show signs of dementia can live joyfully for many more years with the proper care and patience from loved ones.
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Provide Support For Family And Friends
Keep any family or friends informed about what is happening in a gentle, sensitive and supportive way. This will help reassure them that the person is getting the care they need. You could consider signposting them to appropriate services, such as an Admiral Nurse or local Alzheimers Society. It can also help to give them an opportunity to talk about what is happening.
What Happens In The Later Stages Of Dementia
- Progressive loss of memoryThis can be a particularly disturbing time for family and carers as the person with dementia may fail to recognise close family members.
- Increased loss of physical abilitiesMost people with dementia gradually lose their ability to walk, wash, dress and feed themselves. Other illnesses such as stroke or arthritis may also affect them. Eventually the person will be confined to a bed or a chair.
- Increased difficulty communicatingA person with dementia will have increasing difficulty in understanding what is said or what is going on around them. They may gradually lose their speech, or repeat a few words or cry out from time to time. But continuing to communicate with them is very important. Remember, although many abilities are lost as dementia progresses, some – such as the sense of touch and ability to respond to emotions – remain.
- Problems eatingIt is common for people in the later stages of dementia to lose a considerable amount of weight. People may forget how to eat or drink, or may not recognise the food they are given. Some people become unable to swallow properly. Providing nutrition supplements may need to be considered. If a person has swallowing difficulties, or is not consuming food or drink over a significant period of time and their health is affected, nutrition supplements may be considered for consumption other than by mouth.
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Alma And Silvias Story
Alma had been forgetful for years, but even after her family knew that Alzheimers disease was the cause of her forgetfulness, they never talked about what the future would bring. As time passed and the disease eroded Almas memory and ability to think and speak, she became less and less able to share her concerns and wishes with those close to her.
This made it hard for her daughter Silvia to know what Alma needed or wanted. When the doctors asked about feeding tubes or antibiotics to treat pneumonia, Silvia didnt know how to best reflect her mothers wishes. Her decisions had to be based on what she knew about her moms values, rather than on what Alma actually said she wanted.
Quality of life is an important issue when making healthcare decisions for people with dementia. For example, medicines are available that may delay or keep symptoms from becoming worse for a little while. Medicines also may help control some behavioral symptoms in people with mild-to-moderate Alzheimers disease.
However, some caregivers might not want drugs prescribed for people in the later stages of Alzheimers. They may believe that the persons quality of life is already so poor that the medicine is unlikely to make a difference. If the drug has serious side effects, they may be even more likely to decide against it.
What Are The Signs That Someone With Dementia Is Dying
It is difficult to know when a person with dementia is coming to the end of their life. However, there are some symptoms that may indicate the person is at the end of their life including:
- limited speech
- needing help with everyday activities
- eating less and swallowing difficulties
- incontinence and becoming bed bound.
When these are combined with frailty, recurrent infections and/or pressure ulcers, the person is likely to be nearing the end of their life. If the person has another life limiting condition , their condition is likely to worsen in a more predictable way.
When a person gets to within a few days or hours of dying, further changes are common. These include:
- deteriorating more quickly
- irregular breathing
- cold hands and feet.
These are part of the dying process, and its important to be aware of them so that you can help family and friends understand what is happening.
When a person with dementia is at the end of life its important to support the person to be as comfortable as possible until they die
For more information, see our page, Signs that someone is in their last days or hours.
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Dying From Dementia With Late
The death of your loved one can be a hard concept to wrap your head around and accept. But knowing what to expect can help you when your loved one has late-stage dementia. It might help to understand what’s coming in the future so you can prepare emotionally and practically.
This article explains how dementia progresses and what happens during late-stage dementia.
Recognizing Approaching End Of Life
People with advanced dementia suffer from a number of distressing symptoms . In their last 12 months, nursing homes residents with dementia suffer most common from restrictions in mobility, pain, and sleeping disorder. Further frequent symptoms at the end-of-life could be identified problems with eating, trouble with breathing, apathy and anxiety. Contrary to this sleep disturbances, challenging behavior, agitation and depressive episodes occurred less frequently . Increases in distressing symptoms such as febrile infections and problems with eating and swallowing may be indicators for death in the next six months . Clinical complications such as respiratory infections are associated with highest symptom burden . Other results showed increased mortality coinciding with low body weight or low Body Mass Index . Prognostic assessment tools all include at least one criterion related to nutritional status, such as reduced appetite, inadequate food intake, malnutrition, or weight loss .
Physicians associated unexpected death with suffering and poor quality of life . Expecting death within the coming months showed positive effects on quality of end-of-life care. Prognosis estimation under six months was associated with fewer burdensome interventions in people with dementia . Among people with dementia explicitly expected to die a lower symptom burden was noticed and all of them received morphine .
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Common Symptoms And Complications Treatment Options
As the disease progresses people with dementia become more and more dependent on other persons for almost all daily activities, care and treatment, t suffering considerable limitations in the last year . As shown above people with advanced dementia suffer a range of complex needs and symptoms, and symptom burden is similar to people with cancer or frailty . People with advanced dementia rarely express their needs and burdensome symptoms spontaneously, relying on their caregiversâ sensitive perception and interpretations of their verbal and nonverbal signs.
Special Prerequisites Of Palliative Care In Advanced Dementia
Originally, palliative care emerged in the UK for cancer patients in response to insufficient care for the terminally ill. Eventually conditions other than cancer were acknowledged as being in need of palliative care. Independent of specific diagnosis palliative care should be provided for people with life-threatening disease and their families âthrough the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritualâ to maintain or improve quality of life . Parallel to the development of palliative care dementia care developed separately both based on the same values for enhancing care of people with dementia and improving quality of life . Notably lessons learned from palliative care for people with cancer cannot simply be transferred to palliative care for people with dementia.
As dementia progresses people experience reduced or lost verbal communication abilities with a consequent impact on care. Despite restrictions in verbal communication people with advanced dementia can use other means of nonverbal communication such as body tension or minimal movements, turning their head away, frequency of breath and paralinguistic signals are all means of communication to express their current wishes or needs . Agreement or rejection reactions in a situation can be observed, although interpretation of nonverbal communication varies between health professionals .
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Causes Of Alzheimer’s Disease
Alzheimer’s disease is the most common type of dementia.
Alzheimer’s disease is thought to be caused by the abnormal build-up of 2 proteins called amyloid and tau.
Deposits of amyloid, called plaques, build up around brain cells. Deposits of tau form “tangles” within brain cells.
Researchers do not fully understand how amyloid and tau are involved in the loss of brain cells, but research into this is continuing.
As brain cells become affected in Alzheimer’s, there’s also a decrease in chemical messengers involved in sending messages, or signals, between brain cells.
Levels of 1 neurotransmitter, acetylcholine, are particularly low in the brains of people with Alzheimer’s disease.
Medicines like donepezil increase levels of acetylcholine, and improve brain function and symptoms.
These treatments are not a cure for Alzheimer’s disease, but they do help improve symptoms.
Read more about treatments for dementia.
The symptoms that people develop depend on the areas of the brain that have been damaged by the disease.
The hippocampus is often affected early on in Alzheimer’s disease. This area of the brain is responsible for laying down new memories. That’s why memory problems are one of the earliest symptoms in Alzheimer’s.
Unusual forms of Alzheimer’s disease can start with problems with vision or with language.
Read more about Alzheimer’s disease.
What Are The Symptoms
Each person is unique and will experience dementia in their own way. The different types of dementia tend to affect people differently, especially in the early stages.
A person with dementia will often have cognitive symptoms . They will often have problems with some of the following:
- Day-to-day memory difficulty recalling events that happened recently.
- Repetition repeating the same question or conversation frequently in a short space of time.
- Concentrating, planning or organising difficulties making decisions, solving problems or carrying out a sequence of tasks .
- Language difficulties following a conversation or finding the right word for something.
- Visuospatial skills – problems judging distances and seeing objects in three dimensions.
- Orientation – losing track of the day or date, or becoming confused about where they are.
Some people have other symptoms including movement problems, hallucinations or behaviour changes.
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Common Forms Of Dementia
There are many different forms of dementia. Alzheimer’s disease is the most common form and may contribute to 60-70% of cases. Other major forms include vascular dementia, dementia with Lewy bodies , and a group of diseases that contribute to frontotemporal dementia . Dementia may also develop after a stroke or in the context of certain infections such as HIV, harmful use of alcohol, repetitive physical injuries to the brain or nutritional deficiencies. The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
Stage : Moderately Severe Dementia
When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:
- Delusional behavior
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