What Are The Symptoms Of The Final Stages Of Alzheimer’s

Tips For Managing Dementia End

Because individuals with advanced dementia will often have difficulty communicating, it is important that caregivers keep a close eye on their loved one for signs of pain or discomfort. These signs may include moaning or yelling, restlessness or an inability to sleep, grimacing, or sweating. This may also signal that its time to call hospice or a palliative care team to help with the pain management.

If an individual with end-stage dementia is having trouble sitting up without assistance, hospice can provide a hospital bed or other equipment to lift their head.

Perhaps the hardest thing for families is when a loved one with dementia is no longer able to eat or swallow. Because an individual with dementia is unable to understand the benefits of feeding tubes or IV drips, they will often be incredibly distressed and attempt to remove them, causing added pain and risk of infection. Instead, focusing on keeping the individual comfortable. Supporting them with mouth care to prevent their mouth from becoming dry will allow them to make their final transition in peace.

Problems With Eating And Drinking

Changes in eating and drinking patterns are also considered to be part of end-stage dementia signs.

Most people will lose their appetite, which makes them eat less. As a result, most people with dementia will lose weight in an unhealthy manner.

Losing weight may have an effect on a persons IMMUNE system, making it harder for the body to fight off other diseases.

Many people will have a problem with eating and drinking because they develop mouth sores or have problems swallowing.

Swallowing issues arise when a persons reflexes and muscles cease to function correctly.

What Are The Final Stages Of Dementia

Dementia is a general term used to categorize mental decline. Each individual experiences unique characteristics in every stage. Experts divide Dementia into different stages and depending on which expert you follow. However, the final stages of Dementia share many different aspects that can make caring for these individuals extremely difficult.

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How To Ensure The Person Eats Well

In the later stages of Alzheimers disease, many people lose interest in food and caregivers may notice changes in how or when they eat. They may not be aware of mealtimes, know when they’ve had enough food, or remember to cook. If they are not eating enough different kinds of foods, they may not be getting the nutrients they need to stay healthy.

Here are some suggestions to help a person with late-stage Alzheimer’s eat better. Remember that these are just tipstry different things and see what works best for the person:

• Serve bigger portions at breakfast because it’s the first meal of the day.
• Offer several smaller meals throughout the day.
• Serve meals at the same time each day.
• Make the eating area quiet. Turn off the TV or radio.
• Control between-meal snacks. Lock the refrigerator door and food cabinets if necessary.
• If the person has dentures, make sure they fit. Loose dentures or dentures with bumps or cracks may cause choking or pain, making it harder to eat. Remove poorly fitting dentures until the person can get some that fit.
• Let the person’s doctor know if they lose a lot of weight, for example, if he or she loses 10 pounds in a month.

You can also try different ways of preparing the person’s plate. For example:

If the person needs help eating, you might try to:

When choosing foods to eat and liquids to drink, these suggestions might help:

Stage : Severe Cognitive Declinemoderately Severe Dementia

Stage 6a

At this stage, the ability to perform basic activities of daily life becomes compromised. Functionally, five successive substages are identifiable. Persons initially in stage 6a, in addition to having lost the ability to choose their clothing without assistance, begin to require assistance in putting on their clothing properly. Unless supervised, the person with Alzheimers disease may put their clothing on backward, they may have difficulty putting their arm in the correct sleeve, or they may dress in the wrong sequence.

The total duration of the stage of moderately severe Alzheimers disease is approximately 2.5 years in otherwise healthy persons.

Stage 6b

At approximately the same point in the evolution of AD, but generally just a little later in the temporal sequence, AD persons lose the ability to bathe without assistance . Characteristically, the earliest and most common deficit in bathing is difficulty adjusting the temperature of the bath water. Once the caregiver adjusts the temperature of the bath water, the AD person can still potentially otherwise bathe independently. As this stage evolves, additional deficits occur in bathing and dressing independently. In this 6b substage, AD persons generally develop deficits in other modalities of daily hygiene such as properly brushing their teeth.

Stages 6c, 6d, 6e

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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.

Talking Point

Late Stage Alzheimer’s Disease

The late stage of Alzheimer’s disease is characterized by:

• Inability to sit, stand, walk, eat, swallow, or care for themselves
• Bladder or bowel incontinence
• Seizures
• Skin infections
• Difficulty with conversations, although the person may be able to say a few words or phrases
• Loss of awareness of their surroundings

Alzheimers disease destroys peoples brain cells, resulting in significant mental and physical impairment. This condition eventually affects a persons ability to think, move, function, and communicate. The person becomes extremely vulnerable to infections such as pneumonia, because their inability to swallow can cause food or liquid to enter their lungs.

Over time, the person may become bedridden and require full-time care. Family members may consider hospice services to help care for the person and ensure their comfort in the final stages.

Read Also: Can Prevagen Help Dementia

What To Do About Incontinence

Incontinence means a person can’t control his or her bladder and/or bowels. This may happen at any stage of Alzheimer’s disease, but it is more often a problem in the later stages. Signs of this problem are leaking urine, problems emptying the bladder, and soiled underwear and bed sheets. Be sure to let the doctor know if this happens. He or she may be able to treat the cause of the problem.

Accidents happen. Try to be understanding when they occur. Stay calm and reassure the person if he or she is upset. Incontinence supplies, such as adult disposable briefs or underwear, bed protectors, and waterproof mattress covers, may be helpful. Learn more about dealing with incontinence.

Stage : Severe Decline

People with the sixth stage of Alzheimers need constant supervision and frequently require professional care. Symptoms include:

• Confusion or unawareness of environment and surroundings
• Inability to recognize faces except for the closest friends and relatives
• Inability to remember most details of personal history
• Loss of bladder and bowel control
• Major personality changes and potential behavior problems
• The need for assistance with activities of daily living such as toileting and bathing
• Wandering

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Stage : Very Severe Cognitive Declinesevere Dementia

At this stage, AD persons require continuous assistance with basic activities of daily life for survival. Six consecutive functional substages can be identified over the course of this final seventh stage. Early in this stage, speech has become so circumscribed, as to be limited to approximately a half-dozen intelligible words or fewer . As this stage progresses, speech becomes even more limited to, at most, a single intelligible word . Once intelligible speech is lost, the ability to ambulate independently , is invariably lost. However, ambulatory ability may be compromised at the end of the sixth stage and in the early portion of the seventh stage by concomitant physical disability, poor care, medication side-effects or other factors. Conversely, superb care provided in the early seventh stage, and particularly in stage 7b, can postpone the onset of loss of ambulation. However, under ordinary circumstances, stage 7a has a mean duration of approximately 1 year, and stage 7b has a mean duration of approximately 1.5 years.

In persons with AD who remain alive, stage 7c lasts approximately 1 year, after which persons with AD lose the ability not only to ambulate independently but also to sit up independently , At this point in the evolution, the person will fall over when seated unless there are armrests to assist in sitting up in the chair.

Data Source And Extraction

Clinically Determined AD Severity Cohorts

Mild AD, moderate AD, and severe AD cohorts were identified on the basis of the initial targeted keyword search of clinicians notes. If a note contained keywords corresponding to more than one AD severity stage, it was classified into the cohort of lower severity.

MMSE and MoCA-Based Staging of AD Severity

Objective AD severity staging in this analysis was based on published and publicly available standard ranges/cutoffs for MMSE and MoCA test scores . Mild AD was defined as a score of 2124 on MMSE and 1825 on MoCA moderate AD was defined as a score of 1320 on MMSE and 1117 on MoCA severe AD was defined as a score of 12 or less on MMSE and 10 or less on MoCA.

Read Also: Dementia Neurotransmitter

What To Do About Body Jerking

Sudden twitching or jerking, known as myoclonus, is another condition that sometimes happens with Alzheimer’s. The person’s arms, legs, or whole body may jerk. This can look like a seizure, but the person doesn’t pass out. Tell the doctor right away if you see these signs. The doctor may prescribe one or more medicines to help reduce symptoms.

Read about this topic in Spanish. Lea sobre este tema en español.

Maintaining Healthy Skin And Body

A person in the late stage of the disease can become bed-ridden or chair-bound. A lack of mobility may lead to skin breakdown, pressure sores, and contractures. Here are some ways to help maintain the person’s skin and body condition.

Alleviate body pressureChange the person’s position at least every two hours to relieve pressure and improve skin moisture. Make sure the person is comfortable and is kept in good body alignment. Use a pillow to support arms and legs. Consult a health care professional about proper technique to lift and turn the person.

Keep the skin clean and dryThe person’s skin can tear or bruise easily. Use minimal force and friction when cleaning fragile skin. Wash the skin with mild soap and blot dry. Check the skin daily for rashes, sores, and skin breakdowns.

Protect bony areas with pillows or padsIf you use moisturizer on the person’s skin, apply it gently over bony areas do not massage the lotion into these area.

Prevent limb contractures This can occur when a person is confined to a chair or bed. To maintain the person’s range of motion in the joints, carefully and slowly move his or her arms and legs two to three times a day. Perform these exercises when the person’s skin and muscles are warm, such as immediately after bathing. A physical therapist can show you the proper technique for range of motion exercises.

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Stage : Mild Cognitive Impairment

Persons at this stage manifest deficits which are subtle, but which are noted by persons who are closely associated with the person with mild cognitive impairment. The subtle deficits may become manifest in diverse ways. For example, a person with mild cognitive impairment may noticeably repeat queries. The capacity to perform executive functions also becomes compromised. Commonly, for persons who are still working in complex occupational settings, job performance may decline. For those required to master new job skills, such as a computer or other machinery, decrements in these capacities may become evident.

MCI persons who are not employed, but who plan complex social events, such as dinner parties, may manifest declines in their ability to organize such events. This may be an early stage of Alzheimers, however, it is important for the person to seek medical help as soon as possible, to determine if a broad variety of medical conditions may be causing or contributing to the persons difficulties. Blood tests and an MRI of the brain should be obtained to assist in determining if the individual has MCI due to Alzheimers and whether there are other causes or contributing conditions to the persons cognitive decline.

Some MCI persons may manifest concentration deficits. Many persons with these symptoms begin to experience anxiety, which may be overtly evident.

Offer Touch And Human Contact

Sit with the person, hold their hand and talk to them as if they can still hear you. Hearing can be the last sense that a person loses at death. This shows that you care and shows respect. If family are at their loved ones bedside, stay with the person when the relative has a break, and again hold the persons hand.

The care team would need to plan how you can provide this kind of one-to-one support.

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When To See A Gp

If you’re worried about your memory or think you may have dementia, it’s a good idea to see a GP.

If you’re worried about someone else’s memory problems, encourage them to make an appointment and perhaps suggest that you go along with them.

Memory problems are not just caused by dementia they can also be caused by depression, stress, medicines or other health problems.

A GP can carry out some simple checks to try to find out what the cause may be, and they can refer you to a specialist for more tests if necessary.

Read more about diagnosing Alzheimer’s disease.

Page last reviewed: 05 July 2021 Next review due: 05 July 2024

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.

Also Check: Aphasia And Alzheimer’s

Stage : Moderately Severe Decline

During the fifth stage of Alzheimers, people begin to need help with many day-to-day activities. People in stage five of the disease may experience:

• Difficulty dressing appropriately
• Inability to recall simple details about themselves such as their own phone number
• Significant confusion

On the other hand, people in stage five maintain functionality. They typically can still bathe and toilet independently. They also usually still know their family members and some detail about their personal histories, especially their childhood and youth.

Middle Stage Alzheimer’s Disease

The middle stage is the longestit can sometimes last years.

Alzheimers disease is often diagnosed during this stage, because the symptoms become more evident and it becomes apparent they are not part of the normal course of aging.

These are some of the symptoms of middle stage Alzheimers disease:

• Severe memory loss and confusion
• Difficulty remembering their own name, family members, address, telephone number, and details from their personal history, such as which school they went to
• Tendency to wander and get lost
• Confusion about where they are and what day or time it is
• Inability to understand or learn new things
• Trouble with cognitive tasks like reading, writing, or dealing with numbers
• Altered sleep patterns, which may cause the person to sleep in the day and feel restless at night
• Personality changes, causing the person to become moody, withdrawn, anxious, frustrated, tearful, angry, abusive, or aggressive
• Difficulty with social situations
• Unexpected or inappropriate behavior, such as refusing to bathe or taking off their clothes in public
• Paranoid delusions, causing them to become suspicious of their loved ones
• Repetitive compulsive behaviors, such as shredding tissues or wringing hands

Recommended Reading: Alzheimers Awareness Ribbons

Hospice Care Offered To Alzheimers Patients

Hospice care is intended for individuals with a life expectancy of six months or less, so patients with Alzheimers disease or other forms of advanced dementia must meet the criteria to qualify for care. It can be hard to assess when the end of life will occur since the disease progresses at different rates for each patient, so families should begin the conversation about hospice care with a doctor when the patient begins to enter the later stages of Alzheimers disease.

Families caring for a loved one with advanced dementia who has a life expectancy of six months or more may benefit from palliative care even if the person doesnt yet qualify for hospice services. Palliative care works in conjunction with treatment directed by a health care provider, so the patient can continue to treat Alzheimers or other concurrent diseases while receiving support services.

Respite care is another option for family members caring for an Alzheimers patient. This type of care is intended to give a short break to family caregivers. In some cases, coverage for hospice care, palliative care and respite care may be covered by Medicaid, Medicare or private insurance, so check with your provider to see if coverage is available.

What To Expect In The Late Stages Of Alzheimers Disease

As Alzheimers advances into the later stages, caregivers and family members can expect quite a few new symptoms of the disease. Fortunately, being prepared now can help people better cope with the challenges of the late stages of Alzheimers.

Although the disease doesnt affect every person the same way, informed caregivers can often reduce later stage crisis. Read our list of the symptoms to expect in the late stages of Alzheimers to better prepare for tomorrow, today.

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