Causes Of Death In People With Alzheimers Disease
Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology. She is an associate professor of neurology at Tufts Medical School and medical director of the Lahey Clinic Multiple Sclerosis Center in Lexington, Massachusetts.
The Alzheimers Association notes that Alzheimers disease is the sixth leading cause of death in the United States. It also points out that out of the top 10 causes of death, its the only one without an effective treatment or cure.
The Centers for Disease Control and Prevention also highlights Alzheimers as a significant cause of death, pointing out that between 1999 and 2014, deaths attributed to Alzheimers rose by 55%.
One of the challenges in tracking deaths from Alzheimers is that Alzheimers disease is not always identified as the cause of death on a death certificate. Sometimes, the conditions that develop from Alzheimers are listed instead as primary on the death certificate. In other cases, Alzheimers may have never been officially diagnosed. These challenges in tracking Alzheimers deaths are demonstrated in one study that found that deaths from Alzheimers in people over the age of 75 may be as high as six times the count officially recorded.
Average life expectancy for people living with Alzheimers is four to seven years after diagnosis, although some people may live as much as 20 years or more.
Young Onset Vs Early Stage
Its important to know that term young onset dementia does not mean the early stage of dementia. While most people diagnosed with young onset dementia are likely experiencing mild symptoms that indicate they are in the early stage, young onset and early stage have different meanings. A 57-year-old living with young onset dementia could already be in the late stage, while a 80-year-old just diagnosed with dementia might be in the early stage.
Its also important to note that young onset dementia encompasses all types of dementia. If a person is diagnosed with Alzheimers disease â the most common type of dementia âunder the age of 65, then that person can be said to have young onset Alzheimers disease. Likewise, if a person is diagnosed with frontotemporal dementia under 65, then that person has young onset frontotemporal dementia.
However, each person living with young onset dementia has their own preferred term to describe their dementia â ask them what they prefer!
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.
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Avoidable Use Of Health Care And Long
6.5.1 Preventable hospitalizations
Preventable hospitalizations are one common measure of health care quality. Preventable hospitalizations are hospitalizations for conditions that could have been avoided with better access to, or quality of, preventive and primary care. Unplanned hospital readmissions within 30 days are another type of hospitalization that potentially could have been avoided with appropriate post-discharge care. In 2013, 21% of hospitalizations for fee-for-service Medicare enrollees with Alzheimer’s or other dementias were either for unplanned readmissions within 30 days or for an ambulatory care sensitive condition . The total cost to Medicare of these potentially preventable hospitalizations was $4.7 billion . Of people with dementia who had at least one hospitalization, 18% were readmitted within 30 days. Of those who were readmitted within 30 days, 27% were readmitted two or more times. Ten percent of Medicare enrollees had at least one hospitalization for an ambulatory care-sensitive condition, and 14% of total hospitalizations for Medicare enrollees with Alzheimer’s or other dementias were for ambulatory care sensitive conditions.
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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How Can Healthcare Professionals Help At This Stage
Healthcare professionals can explain these changes so you understand what is happening.
Healthcare professionals can also take steps to reduce the persons pain or distress, often using medication.
If the person cant swallow, then medication can be provided through patches on the skin, small injections or syringe pumps that provide a steady flow of medication through a small needle under the persons skin. Speak to a GP or another health professional about this.
Stage : Age Associated Memory Impairment
This stage features occasional lapses of memory most frequently seen in:
- Forgetting where one has placed an object
- Forgetting names that were once very familiar
Oftentimes, this mild decline in memory is merely normal age-related cognitive decline, but it can also be one of the earliest signs of degenerative dementia. At this stage, signs are still virtually undetectable through clinical testing. Concern for early onset of dementia should arise with respect to other symptoms.
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Signs Of Death In Elderly With Dementia: End Stage
Dementia is a term used to describe the persistent or chronic decline in ones mental processes and this include personality changes, impaired reasoning, and memory loss. The most common form is Alzheimers disease and it accounts for over 70 percent of all the dementia cases.
It is one of the greatest causes of death in the United States with over five million people living with the disease in the country alone. One of the age groups affected by dementia is the seniors. If you are a caregiver, it is important to know the signs of death in elderly with dementia.
Most progressive dementias and Alzheimers disease do not have any cure. The diseases get worse with the passage of time, but the timeline can be very different from one person to the next.
Caring for persons with the diseases can be stressful and very challenging, especially when their personality begins to change and their cognitive function starts to decline. It is possible that the individual will not even recognize the people who are closest and dearest to them.
As the disease progresses, the person needs more and more support from the caregiver and the family. If the person is elderly, the caregiver needs to know about all the signs that the patient may be dying.
You may need to put the patient on hospice so as that he or she can get the appropriate care during such moments. This offers the family and the patient spiritual, physical, and emotional care.
What Goes On Medically
Medically, what goes on depends on which of the three possibilities obtains.
Suppose that the Alzheimerâs patient passes from a secondary condition. Then the medical cause of death will depend on the particulars of that condition. So, suppose that an immobile Alzheimerâs patient develops a blood clot in his or her calf. Doctors will try to treat the clot by using blood thinners. But, if the clot breaks loose a person can die any or three ways. Firstly, the clot could block an artery. This may happen any number of places, but it is most dangerous around the lungs. Called a âpulmonary embolism,â a blood clot near the lungs can cut off oxygen to the body and brain. Secondly, the clot could cause the person to go into cardiac arrest. If the clot passages into the heart, the heartâs pumping may become erratic and fatal arrhythmias may develop. Thirdly, the clot could go towards the brain, block an artery there, and cause a fatal stroke.
If a person develops pneumonia, then the main risk is that of infection. Pneumonia is characterized by a personâs having âfluid-filledâ sacs in the lungs. In the first place, the fluid impedes the lungâs ability to pass oxygen into the blood stream. But the fluid is also a breeding ground for bacteria. This bacteria can make its way into the blood, travel around to other organs, and cause a massive, whole-body infection that a person is unlikely to recover from.
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Youll Need Support For Yourself Too
The National Institute on Aging points out that caregivers can experience confusion, depression, anxiety, fatigue, and grief at times. Its a good idea to plan regular times for others to take over caregiving responsibilities so you can take care of your own needs and experience some respite and relief.
Watch Our Talk The Last Stage Of Alzheimers: What You Need To Know With Jasja Kotterman And Dr Liz Sampson Of University College London:
And then one day, the spell broke. She was hungry and thirsty, and drank and even ate and chewed, slowly, but with relish. And we gave her as much as we dared without causing her to choke. The doctor told us we would have many more months with her if she kept eating. It was a relief to hear this, and we had a few good daysso good that I planned to go back home, my sister made plans to head back to work, and my father planned to visit friends in France. We would keep in touch and be ready to come back as soon as things got worse again.
But worse came the following day. The doctor called saying my mother had developed a lung infection. She must have choked on something on one of the good days, some water, some food had entered her lungs and triggered a lung infection.
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A Step Closer To Understanding How Brain Cells Die In Alzheimer’s Disease
New research from the Australian Institute for Bioengineering and Nanotechnology at the University of Queensland has brought us a step closer to understanding how protein clumps called amyloid plaques contribute to the death of brain cells in Alzheimers disease.
The research, published in the highly regarded journal Stem Cell Reports, shows that an increased production of plaques surprisingly does not lead to an increase in brain cell death, suggesting that they dont kill neurons directly or, if they do, they dont work alone.
Currently, Alzheimers disease effects around a quarter of a million Australians, accounting for more than two-thirds of all dementia cases.
One of the major hallmarks of Alzheimers disease is the accumulation of the so-called beta-amyloid plaques. These plaques are formed when a type of protein in the brain, called amyloid precursor protein , is broken down into smaller fragments. These fragments, which are called beta-amyloid, then clump together to form plaques.
It is widely thought that these amyloid plaques contribute to the death of neurons in people with Alzheimers, either directly, or by causing another protein, called tau, to form toxic neurofibrillary tangles. Thus, reducing amyloid plaques has been the focus of many efforts to treat the condition.
People with Down syndrome have an extra copy of chromosome 21, and therefore carry an extra copy of the amyloid precursor protein gene, says lead author Dr Dmitry Ovchinnikov.
Stage : Moderate Dementia
Patients in stage 5 need some assistance in order to carry out their daily lives. The main sign for stage 5 dementia is the inability to remember major details such as the name of a close family member or a home address. Patients may become disoriented about the time and place, have trouble making decisions, and forget basic information about themselves, such as a telephone number or address.
While moderate dementia can interfere with basic functioning, patients at this stage do not need assistance with basic functions such as using the bathroom or eating. Patients also still have the ability to remember their own names and generally the names of spouses and children.
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What To Expect At The End Of Life
The way people with Alzheimerâs disease die is different from person to person, but thereâs a basic pattern to the process. They slowly lose the ability to control basic body functions, such as eating, drinking, and toileting. After a while, their body shuts down.
They canât move much on their own. They donât want to eat or drink, and they lose weight. They often get seriously dehydrated. It can get hard for them to cough up fluid from their chest. In the last stages, many people with dementia get pneumonia.
Some other common signs that someone with Alzheimerâs disease is close to the end of their life include:
- They speak very few or no words.
- Theyâre not able to do very basic activities such as eat, move from a bed to a chair, or change their position in a bed or chair.
- They canât swallow well.
- They get sores because they sit or lie in the same position for too long. These are called bedsores or pressure ulcers.
Use And Costs Of Health Care And Long
Among Medicare beneficiaries with Alzheimer’s or other dementias, black/African Americans had the highest Medicare payments per person per year, while whites had the lowest payments . The largest difference in payments was for hospital care, with black/African Americans incurring 1.7 times as much in hospital care costs as whites .
- Created from unpublished data from the National 5% Sample Medicare Fee-for-Service Beneficiaries for 2014.
In a study of Medicaid beneficiaries with a diagnosis of Alzheimer’s dementia that included both Medicaid and Medicare claims data, researchers found significant differences in the costs of care by race/ethnicity. These results demonstrated that black/African Americans had significantly higher costs of care than whites or Hispanics/Latinos, primarily due to more inpatient care and more comorbidities. These differences may be attributable to later-stage diagnosis, which may lead to higher levels of disability while receiving care delays in accessing timely primary care lack of care coordination duplication of services across providers or inequities in access to care. However, more research is needed to understand the reasons for this health care disparity.
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The Basics Of Alzheimers Disease
Scientists are conducting studies to learn more about plaques, tangles, and other biological features of Alzheimers disease. Advances in brain imaging techniques allow researchers to see the development and spread of abnormal amyloid and tau proteins in the living brain, as well as changes in brain structure and function. Scientists are also exploring the very earliest steps in the disease process by studying changes in the brain and body fluids that can be detected years before Alzheimers symptoms appear. Findings from these studies will help in understanding the causes of Alzheimers and make diagnosis easier.
One of the great mysteries of Alzheimers disease is why it largely affects older adults. Research on normal brain aging is exploring this question. For example, scientists are learning how age-related changes in the brain may harm neurons and affect other types of brain cells to contribute to Alzheimers damage. These age-related changes include atrophy of certain parts of the brain, inflammation, blood vessel damage, production of unstable molecules called free radicals, and mitochondrial dysfunction .
How Does Alzheimer’s Disease Affect The Brain
Scientists continue to unravel the complex brain changes involved in Alzheimers disease. Changes in the brain may begin a decade or more before symptoms appear. During this very early stage of Alzheimers, toxic changes are taking place in the brain, including abnormal buildups of proteins that form amyloid plaques and tau tangles. Previously healthy neurons stop functioning, lose connections with other neurons, and die. Many other complex brain changes are thought to play a role in Alzheimers as well.
The damage initially appears to take place in the hippocampus and the entorhinal cortex, which are parts of the brain that are essential in forming memories. As more neurons die, additional parts of the brain are affected and begin to shrink. By the final stage of Alzheimers, damage is widespread and brain tissue has shrunk significantly.
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Risk Factors For Alzheimer’s Dementia
The vast majority of people who develop Alzheimer’s dementia are age 65 or older. This is called late-onset Alzheimer’s. Experts believe that Alzheimer’s, like other common chronic diseases, develops as a result of multiple factors rather than a single cause. Exceptions are cases of Alzheimer’s related to uncommon genetic changes that increase risk.
2.7.1 Age, genetics and family history
The greatest risk factors for late-onset Alzheimer’s are older age,, genetics, and having a family history of Alzheimer’s.-
Age is the greatest of these three risk factors. As noted in the Prevalence section, the percentage of people with Alzheimer’s dementia increases dramatically with age: 3% of people age 65-74, 17% of people age 75-84 and 32% of people age 85 or older have Alzheimer’s dementia. It is important to note that Alzheimer’s dementia is not a normal part of aging, and older age alone is not sufficient to cause Alzheimer’s dementia.
- One in 10 people age 65 and older has Alzheimer’s dementia.,,
- The percentage of people with Alzheimer’s dementia increases with age: 3% of people age 65-74, 17% of people age 75-84, and 32% of people age 85 and older have Alzheimer’s dementia. People younger than 65 can also develop Alzheimer’s dementia, but it is much less common and prevalence is uncertain.
3.1.1 Underdiagnosis of Alzheimer’s and other dementias in the primary care setting
3.1.2 Prevalence of subjective cognitive decline
What I Wish I Knew Before My Mothers Alzheimers Death
As with many Alzheimers patients, it was the family who suggested my mother get her memory tested. She was 68 years old, repeating herself, losing things and occasionally paranoid and combative with my father, something we had never seen from her before. We thought she might be depressed, but the notion that she might have dementia crossed our minds. She was diagnosed with mild cognitive impairment, the earliest stage of forgetfulness, in 2008, but was not officially given the diagnosis of Alzheimers until 2010, when she had an epileptic seizure. After that, her memory and cognitive faculties deteriorated sharply.
This is not the story of an Alzheimers patient swinging between the ignorance of their forgetfulness and the panic of watching their own ongoing decline come into focus, nor the story of the fear, the bouts of irritability, and the deep sorrow felt by family members watching their loved one slowly disappear before their eyes. We went through all that, yes. But this is the story of the last three excruciating months of my mothers life. She died in her familys arms at the age of 76, having battled Alzheimers bravely for more than eight years.
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