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.
Supporting Dementia Caregivers At The End Of Life
Caring for people with Alzheimers or another dementia at the end of life can be demanding and stressful for the family caregiver. Depression and fatigue are common problems for caregivers because many feel they are always on call. Family caregivers may have to cut back on work hours or leave work altogether because of their caregiving responsibilities.
It is not uncommon for those who took care of a person with advanced dementia to feel a sense of relief when death happens. It is important to realize such feelings are normal. Hospice care experts can provide support to family caregivers near the end of life as well as help with their grief.
If you are a caregiver, ask for help when you need it and learn about respite care.
What Causes Alzheimer’s Disease To Progress So Quickly
The progression of Alzheimers disease varies widely between individuals, with most people living with the condition for between 3 and 11 years after the initial diagnosis. In some cases, people may survive for more than 20 years. When Alzheimers is detected early, there are possible treatments that can help to slow the progression of the disease and contribute to a longer life expectancy.
It is therefore crucial to plan for the future and follow the progression of the disease through each stage. Alzheimers disease first begins with physical changes in the brain. This can happen at a gradual pace before any noticeable symptoms appear. In fact, this pre-clinical Alzheimers disease stage can begin 10 to 15 years before any symptoms appear.
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Causes Of Vascular Dementia
Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills brain cells.
This can happen as a result of:
- narrowing and blockage of the small blood vessels inside the brain
- a single stroke, where the blood supply to part of the brain is suddenly cut off
- lots of “mini strokes” that cause tiny but widespread damage to the brain
In many cases, these problems are linked to underlying conditions, such as high blood pressure and diabetes, and lifestyle factors, such as smoking and being overweight.
Tackling these might reduce your risk of vascular dementia in later life, although it’s not yet clear exactly how much your risk of dementia can be reduced.
Stage : Moderately Severe Cognitive Declinemoderate Dementia
In this stage, deficits are of sufficient magnitude as to prevent catastrophe-free, independent community survival. The characteristic functional change in this stage is early deficits in basic activities of daily life. This is manifest in a decrement in the ability to choose the proper clothing to wear for the weather conditions or for everyday circumstances. Some persons with Alzheimers disease begin to wear the same clothing day after day unless reminded to change. The mean duration of this stage is 1.5 years.
The person with Alzheimers disease can no longer manage on their own. There is generally someone who is assisting in providing adequate and proper food, as well as assuring that the rent and utilities are paid and the finances are taken care of. For those who are not properly supervised, predatory strangers may become a problem. Very common reactions for persons at this stage who are not given adequate support are behavioral problems such as anger and suspiciousness.
Cognitively, persons at this stage frequently cannot recall major events and aspects of their current life such as the name of the current head of state, the weather conditions of the day, or their correct current address. Characteristically, some of these important aspects of current life are recalled, but not others. Also, the information is loosely held, so, for example, the person with moderate Alzheimers disease may recall their correct address on certain occasions, but not others.
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Making Medical Decisions For People With Dementia
With dementia, a persons body may continue to be physically healthy. However, dementia causes the gradual loss of thinking, remembering, and reasoning abilities, which means that people with dementia at the end of life may no longer be able to make or communicate choices about their health care. If there are no advance care planning documents in place and the family does not know the persons wishes, caregivers may need to make difficult decisions on behalf of their loved one about care and treatment approaches.
When making health care decisions for someone with dementia, its important to consider the persons quality of life. For example, medications are available that may delay or keep symptoms from getting worse for a limited time. Medications also may help control some behavioral symptoms in people with mild-to-moderate Alzheimers or a related dementia. However, some caregivers might not want drugs prescribed for people in the later stages of these diseases if the side effects outweigh the benefits.
It is important to consider the goals of care and weigh the benefits, risks, and side effects of any treatment. You may need to make a treatment decision based on the persons comfort rather than trying to extend their life or maintain their abilities for longer.
What Are The Average Life Expectancy Figures For The Most Common Types Of Dementia
The average life expectancy figures for the most common types of dementia are as follows:
- Alzheimers disease around eight to 10 years. Life expectancy is less if the person is diagnosed in their 80s or 90s. A few people with Alzheimers live for longer, sometimes for 15 or even 20 years.
- Vascular dementia around five years. This is lower than the average for Alzheimers mostly because someone with vascular dementia is more likely to die from a stroke or heart attack than from the dementia itself.
- Dementia with Lewy bodies about six years. This is slightly less than the average for Alzheimers disease. The physical symptoms of DLB increase a persons risk of falls and infections.
- Frontotemporal dementia about six to eight years. If a person has FTD mixed with motor neurone disease a movement disorder, their dementia tends to progress much quicker. Life expectancy for people who have both conditions is on average about two to three years after diagnosis.
To find out about the support available to someone at the end of their life, and to their carers, family and friends, see our End of life care information.
You can also call Alzheimers Society on 0333 150 3456 for personalised advice and support on living well with dementia, at any stage.
Dementia Connect support lineDementia Connect support line.
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Lewy Body Dementia Prognosis
Lewy body dementia is a form of dementia characterized by the development of abnormal deposits in the brain. People with Lewy body dementia have trouble with movement as well as cognitive decline. Thinking problems generally show up before movement problems. As Lewy body dementia progresses, affected individuals may also experience visual hallucinations and sleep problems.
Life expectancy for a person with Lewy body dementia is approximately 2 to 8 years after the onset of noticeable symptoms.
A Word About Progression
Alzheimers typically progresses slowly and transitions from mild to severe symptoms. The rate of progression varies widely between people. People with Alzheimers live an average of 4 to 8 years after their diagnosis, but some people live more than 20 years.
The risk of progressing to a higher stage increases with age. For example, in a
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What Is Frontal Lobe Dementia
The frontal lobes of the brain are located as the name suggests at the front of the brain. Loosely speaking, it contains what we call the higher functions of the brain. These are the areas of the brain responsible for emotions, understanding, speech some types of movement, planning and judgement in other words the things which make you a person, and personality. Like all dementias the people who develop symptoms face a slow loss of self and those who care for them, losing the person they care for by slow degrees.
Frontal lobe dementia is also known as frontotemporal dementia , or frontotemporal degeneration, it is an overarching term for several categories of a loss of brain function. The changes to the brain are caused by an abnormal build-up of tau proteins, which stop the brain cells from functioning properly, so they die. In frontal lobe dementia parts of the frontal and temporal lobes of the brain are damaged. It was previously known as âPickâs diseaseâ after the doctor Arnold Pick who identified and first documented the symptoms in a patient over a hundred yearsâ ago in 1892.
Unlike the most widely diagnosed form of dementia, Alzheimerâs disease, frontal lobe dementia occurs at a much younger age and is partly genetic. That means while there is no certainty that if you have had a close blood relative with FLD you will get it too, your chances of developing it are much higher than for other members of the population.
How Can I Support Someone With Dementia Towards The End Of Life
Knowing the person will make it easier to provide person-centred care that is focused on what they need and want. It can help to know about their likes, dislikes and their wishes for how they want to be cared for. If the person is not able to tell you about themselves, speak to their family, friends or other people who know them well.
Its a good idea to find out if the person has a copy of This is me , a document that records information about themselves. If you cannot speak to the person, ask those close to them if they have a copy. They may have these details recorded in their care plan.
There are many ways to support someone with dementia at the end of life.
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How Do You Know What Stage Of Dementia Someone Is In
During the diagnosis of dementia your doctor should be able to tell you which stage your symptoms are at. Most people are diagnosed around stage 3 or 4 this is when symptoms tend to have a noticeable impact on daily living.
There are over 100 types of dementia, each with some differing symptoms. However, things like memory loss and a change in cognitive function are common characteristics with most dementias.
While specific symptoms can start or get worse at any stage, most cases of dementia follow a similar pattern to the below.
1. No impairment. A person shows no signs of dementia, however some cognitive performance tests may suggest a problem.
2. Very mild decline. A person may start to show very slight behavioural symptoms. They may also begin to experience very mild or occasional memory loss. They will still be able to live and function independently.
3. Mild decline. This is when a person will have a more noticeable change in their cognitive ability. They may start to find decision making and reasoning more difficult. They may begin to repeat themselves a lot, or forget things that have happened recently.
4. Moderate decline. A person at this stage will usually have a lot of difficulty making plans. Theyre likely to frequently forget recent events too. Travelling can become confusing at this stage and they may become lost when going somewhere on their own. This is often referred to as middle stage dementia.
Physical Difficulties In The Later Stages Of Dementia
The physical changes of late-stage dementia are partly why the person is likely to need much more support with daily living. At this stage they may:
- walk more slowly, with a shuffle and less steadily eventually they may spend more time in a chair or in bed
- be at increased risk of falls
- need a lot of help with eating and so lose weight
- have difficulty swallowing
- be incontinent losing control of their bladder and bowels.
The persons reduced mobility, in particular, raises their chances of blood clots and infections. These can be very serious or even fatal so it is vital that the person is supported to be as mobile as they can.
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Moderate Dementia Or Moderately Severe Decline
Stage 5 lasts about 1 1/2 years and requires a lot of support. Those who dont have enough support often experience feelings of anger and suspicion.
People in this stage will remember their own names and close family members, but major events, weather conditions, or their current address can be difficult to recall. Theyll also show some confusion regarding time or place and have difficulty counting backward.
Caregiver support: People will need assistance with daily tasks and can no longer live independently. Personal hygiene and eating wont be an issue yet, but they may have trouble picking the right clothing for the weather or taking care of finances.
Stage : Moderate Cognitive Decline
Stage 4 is often referred to as the mild dementia stage. When an individual enters this period, he or she will clearly demonstrate deficits when given cognitive examinations.
During Stage 4, you can expect your family member or friend to show continued difficulties with concentration as well as trouble recalling recent events. Short-term memory issues may include things like forgetting what they ate for lunch that day. Memories about past events may begin to fade or become increasingly hard to recall.
Additionally, individuals at this stage of dementia find it hard to operate independently. You may notice they cannot manage their finances, or do not pay bills consistently or on time. The person may not be able to travel alone, especially to unfamiliar areas.
Social anxiety is common during this period. If you notice your family member or friend begin to withdraw themselves from social interactions, it may be due to memory difficulties. They may not remember names and begin to forget personal histories.
Lastly, he or she may also feel in denial about the symptoms and wont want to accept medical assistance. At this stage, a diagnosis from a physician is most likely and a care plan would be recommended. A caregiver may need to assist with managing finances and driving duties. The person will also need a lot of emotional support during this difficult time. Although timeframes for this stage will vary, Stage 4 lasts an average of two years.
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Mild Alzheimers Or Moderate Decline
Stage 4 lasts about 2 years and marks the beginning of diagnosable Alzheimers disease. You or your loved one will have more trouble with complex but everyday tasks. Mood changes such as withdrawal and denial are more evident. Decreased emotional response is also frequent, especially in challenging situations.
New symptoms of decline that appear in stage 4 may include:
- losing memory of personal history
- trouble with handling finances and bills
- inability to count backward from 100 by 7s
A clinician will also look for a decline in areas mentioned in stage 3, but there will often have been no change since then.
Caregiver support: Itll still be possible for someone to recall weather conditions, important events, and addresses. But they may ask for help with other tasks such as writing checks, ordering food, and buying groceries.
Stage : Very Severe Mental Decline/severe Dementia Quality Of Life: Very Severe Impact
Your loved one will not remember any of the past or recognize loved ones. He or she will have likely lost the ability to make healthcare decisions. You will need 24-hour care in the home for day-to-day activities. You may see your loved one:
- Lose the ability to speak, eat or swallow.
- Not be able to use the toilet or get dressed without help.
- Not be able to walk or sit without help.
- Loss of language skills throughout this stage
- Lose all bladder and bowel control.
- Loss of muscle control
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Changes In Mood Emotions And Perceptions
Changes in mood remain in the later stages of dementia. Depression and apathy are particularly common.
Delusions and hallucinations are most common in the late stage of dementia. They are not always distressing but they can explain some changes in behaviour because the persons perception of reality is altered.
People with later stage dementia often respond more to senses than words. They may like listening to songs or enjoy textures. For example, they may like the feel of different types of material.
What Is Vascular Dementia
Vascular dementia is the second most common type of dementia, with Alzheimers being the first. Some forms of dementia, like Alzheimers and dementia with Lewy bodies, are caused by excess protein build-ups in the brain. Vascular dementia is caused by impaired blood flow to the brain, such as from a stroke or a mini stroke. The blood flow disruption causes brain damage, and this can result in vascular dementia developing.
Like other forms of dementia, vascular dementia can develop over a number of years, and there are seven different stages that patients with this condition may go through. Typically, a person with vascular dementia will experience progressive cognitive decline, with difficulties making sound judgements, communicating, problem-solving, and memory issues. In the later stages, they may also experience some physical difficulties like issues with incontinence and swallowing.
There is no cure for vascular dementia, and it tends to shorten the life expectancy of a person significantly. Its important to note that every patient is different, and whilst one person may survive five years post-diagnosis, another person may go on to live for many more years with the disease.
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