Advanced Dementia–the Last Stages of Dementia

By on April 12, 2013
stages of dementia and symptoms

Results from numerous Alzheimer’s research studies concerning common features of advanced dementia validate several findings that apply to 98 percent of patients experiencing symptoms occuring in the moderate to late stages of dementia. These findings consist of:

  • Significant shrinking of the brain due to massive cell death is evident through brain imaging scans. Atrophy is especially apparent in the cortex and hippocampal areas.
  • Disruption of the natural circadian rhythm causes dementia patients to experience daytime sleepiness and nighttime wakefulness, which often leads to night wandering.
  • Incontinency becomes more of an issue as brain areas regulating bladder control deteriorate and muscle weakness increases.
  • Behavioral and personality changes precipitate paranoid delusions and engagement in compulsive or repetitive ctivities. Advanced dementia patients frequently believe that caregivers or family members are imposters or that they are trying to poison them. Repetitive actions such as shredding tissues, hand wringing or obsessively cleaning one spot on a window or countertop are also commonly observed behaviors.
  • Alzheimer’s patients in moderate stages of dementia may recognize faces but are unable to remember names.  Late dementia brings the inability to remember faces or names.
  • The final stages of dementia will cause a total lack of response in dementia patients regarding environment or stimulus cues. Patients require assistance in all aspects of daily living due to extreme muscle and brain atrophy. They may stop communicating, adopt a mask-like expression and have difficulty swallowing. Tube feeding may eventually be necessary to ensure patients are receiving adequate nutrition.

Medications used to inhibit progression of Alzheimer’s disease and alleviate the most severe symptoms are primarily cholinesterase inhibitors designed to elevate levels of acetylcholine. AChE is a neurotransmitter heavily involved in the ability to remember and learn but also is responsible for stimulating muscle action. Advanced dementia patients who begin to develop muscle stiffness, tremors and uncontrollable muscle movements are suffering from dangerously low levels of AChE.

Donepezil and Namenda are two widely prescribed medications intended to treat moderate to severe dementia symptoms. Neither medication will “cure” Alzheimer’s but may enhance cognitive functioning by facilitating the ability of AChE receptors to release additional amounts of the neurotransmitter into the brain. Caregivers may notice improvements in recall and memory as well as less irritability and irrational thinking in patients taking these medications. However, when experiencing the final stages of dementia, patients generally do not respond to these drugs due to such advanced deterioration of the brain.

Placement of Advanced Dementia Patients in Nursing Homes

Unless families have access to in-home, 24-hour caregiving services, most will have to place loved ones suffering from progressive dementia into nursing homes. Alzheimer’s nursing homes differ from traditional nursing homes in the following areas:

  • Visitors are required to sign in to ensure patients are not subjected to abuse
  • Residents are outfitted with alarm bracelets to track movement of dementia patients
  • Most doors are equipped with keypad locks that require the person entering or leaving the room input a specific set of numbers
  • Alzheimer’s facilities frequently employ a circular design to the building in order to prevent ambulatory patients from becoming frustrated. Right angles and dead ends tend to confuse dementia patients
  • Staff members possess extra experience and knowledge regarding all aspects of late-stage Alzheimer’s disease. The facility should be able to provide proof of background checks performed on all employees, from kitchen workers to registered nurses
  • Staff/resident ratio in an  Alzheimer’s nursing home should be around one staff member for every five or six residents

advanced dementia

Death and Dementia–How Long Does Someone With Dementia Live?

Many Alzheimer’s dementia patients may live up to 20 or even 30 years following a diagnosis of the disease, depending on the patient’s health condition at the time of the diagnosis and level of care received during the progression of the disease. However, as a patient’s cognitive abilities decline, so does the functioning of their immune system, making them more vulnerable to potentially deadly illnesses like pneumonia.

Researchers studying moderate to advanced dementia patients entering 22 different Boston, Massachusetts nursing homes over a period of 18 months discovered that nearly 45 percent of these patients suffered one or more bouts of pneumonia following admittance to a facility. While younger individuals are generally treated for pneumonia with antibiotics like azithromycin, older people and especially those with Alzheimer’s experience difficulty in metabolizing medication due to liver and kidney dysfunction. Antibiotics frequently have little affect on pneumonia and may even cause severe reactions in elderly people who are hypersensitive to strong antibiotics.

Other complications influencing the lifespan of a dementia patient who needs 24 hour care but is not receiving it include:

  • Frequent falls
  • Dehydration and malnutrition
  • Suicide
  • Aggressive behavior that may force aggressive responses
  • Accidentally ingesting the wrong medication or taking too much or too little of a medication

Although taking medication to inhibit the progression of Alzheimer’s in the early stages is one important aspect of a holistic treatment plan designed to prolong the quality of life, it is inevitable that someone diagnosed with Alzheimer’s disease will experience advanced dementia and the debilitating symptoms characterizing this phase of the disease. Preparing for the possibility of placing a loved one in an excellent nursing home facility sometime in the future will relieve family members of worrying about what to do when the time arrives.

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http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp#stage5

http://www.alzinfo.org/09/articles/when-patients-with-advanced-alzheimers-get-pneumonia

http://www.umm.edu/altmed/articles/alzheimers-disease-000005.htm

http://www.drdahlman.com/alzheimers-medications.shtml

http://www.bmj.com/content/330/7489/461?tab=responses

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2075467/

One Comment

  1. Gloria

    September 15, 2016 at 12:37 am

    I was the only one in a family of 4 others for almost 10 years. If you have extreme patience and want to go through taking care of a loved one 24/7 and I mean 24 hours 7 days a week doing everything then you’re an angel. My sister and her husband didn’t visit or call my mom the last 5 years of her life. My daughter helped in finding a nursing home.
    Keep her for one day and night and couldn’t do it. Everybody walked away except me.
    If you can help them by all means do it but be prepared for the worst is yet to come. I had to hire caretakers just to take a breath for a few hours here and there.
    Funny, when my Mom finally passed everyone was there with their hand out.
    Little did I know she had written a small will saying “To my only daughter that took care of me”. Well I got her tiny house and car but it wasn’t a gift as much as I appreciate it. I really worked endlessly and still wonder why I didn’t lose my mind.
    Thanks Mom

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