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Symptoms of Advanced Alzheimer's

VirginiaLynne was a caregiver for in-laws with Alzheimer's, and she shares her extensive research in dementia and elder care to help others.

The Unanswered Questions

I was a caregiver to two relatives with Alzheimer's. As a caregiver to a loved one with this disease, I know that there can be a lot of unanswered (and unasked) questions. Some the questions you may have as a caregiver include:

  • What does the future hold?
  • What are the signs that the end is near?
  • How much time is left?

Although I cannot definitively answer these questions for you, I can shed some light on what to expect, based on my own experience and research. In this article, I will cover:

  • 10 signs of end-stage Alzheimer's
  • Recognizing advanced Alzheimer's
  • Preparing for the end
  • Caregiver help

Signs of Advanced Stage Alzheimers

Individuals do not progress in the same way, but in general, the person in the final stages of dementia will be moving towards needing a full-time caregiver to do all of their daily personal care. Occasionally, a person in the late stage will rally, like when my mother-in-law suddenly called my son by name. However, in considering the overall condition of the person in late stages, there is a downward progression:

  1. Personal Care: inability to do daily living tasks at all. Can't take a bath, brush hair, or dress without help.
  2. Eating: Along with not being able to feed themselves, they may have trouble with chewing and swallowing. They may not want to eat, and caregivers may be asked to consider a feeding tube.
  3. Speaking: Frequently there will be a severe decline in the ability to speak. Perhaps the person will speak a few words or sounds, or not produce recognizable speech at all.
  4. Naming: Often loses the ability to know even familiar people or to recognize anyone by name.
  5. Mental State: A decline in mental functioning means that many of the most difficult psychological problems like hallucinations, paranoia, and aggressiveness will decline or disappear.
  6. Incontinence: In late stages, Alzheimer's individuals generally lose control of their urinary functioning. Soon afterward they will also be unable to control their bowels.
  7. Movement: Although some people remain ambulatory, most will have gait disorder and frequently in the late stages they will be wheelchair or bed-bound.
  8. Wandering and Restlessness: Any tendency to wander will be increased and the person may now lose their way even in their own house. They may not be able to find the way back from the bathroom to their bed.
  9. Weight Loss: Partly due to the inability to eat as well as process food, they may have their bodyweight decline, perhaps to even below 100 pounds. They may even be in the 70-80 pound range near death.
  10. Infections and Seizures: The decline in the brain and immune system leaves the person very vulnerable to other disorders and infections, particularly pneumonia because they often cannot clear out fluids from their lungs and inhale food.
My children with my mother-in-law. Even in late stage Alzheimer's, touching, family visits and sharing pictures and memories can be comforting.

My children with my mother-in-law. Even in late stage Alzheimer's, touching, family visits and sharing pictures and memories can be comforting.

Some Things Get Easier

While physical demands increase, emotional demands can get easier during this final stage. In fact, if you have dealt with the care of a person who has been combative or difficult, as I did with both of my in-laws, it might be helpful to know that while Advanced Alzheimer's brings most people to a point of needing 24-hour care, it also brings relief from some of the most troubling aspects of the intermediate stage: delusions, paranoia, aggression, and hallucinations.

Having taken care of both of my husband's parents in their journey through Alzheimer's, I have great empathy for other caregivers. The most helpful advice I got at this stage was from our family doctor, who had walked his own father through this disease. He told me, "Things actually get easier once people with dementia deteriorate past understanding what they have lost."

Last Stage Alzheimer's patients often sleep much of the day.

Last Stage Alzheimer's patients often sleep much of the day.