Advanced Dementia – The Last Stages of Dementia

Understanding the common features of advanced dementia in Alzheimer's disease, including brain atrophy, circadian rhythm disruption, incontinence, and more. Find out how long someone with dementia may live and the factors that can impact their lifespan.

Advanced Dementia – The Last Stages of Dementia

Alzheimer’s research studies found common features of advanced dementia. These findings apply to 98 percent of patients. They experience symptoms occurring in the moderate to late stages of dementia.

These findings consist of:

  • Significant shrinking of the brain. This is due to massive cell death. It is evident through brain imaging scans. Atrophy is noted in the cortex and hippocampal areas.
  • A Disruption of the natural circadian rhythm. This causes dementia patients to experience daytime sleepiness. It also contributes to nighttime wakefulness. This leads to night wandering.
  • Incontinency becomes more of an issue. The brain areas regulating bladder control deteriorate and muscle weakness increases.

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. This depends on the patient’s health condition at the time of the diagnosis. The level of care received during the progression of the disease. Also plays a part.

Yet, as a patient’s cognitive abilities decline, so does their immune system. Making them more vulnerable to potentially deadly illnesses like pneumonia.

Researchers studied advanced dementia patients entering 22 different Boston, Massachusetts nursing homes. Over a period of 18 months, they discovered that 45 percent of these patients suffered one or more bouts of pneumonia.

This happened following admittance to a facility. Younger individuals are generally treated for pneumonia with antibiotics like azithromycin. Older people experience difficulty in metabolizing medication due to liver and kidney dysfunction. Antibiotics frequently have little affect on pneumonia. Treating the pneumonia may even cause severe reactions in elderly people. As many become are hypersensitive to strong antibiotics.

Complications influencing the lifespan of a dementia patient requiring 24 hour care includes:

  • 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
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In the early stages of dementia, medications are introduced to try to inhibit the progression of Alzheimer’s. It is one aspect of a holistic treatment plan. It is designed to prolong the quality of life. It is inevitable that a person diagnosed with Alzheimer’s disease will experience advanced dementia. The debilitating symptoms characterizing this phase usually require placement in a nursing home.

Preparing and planning to place a loved one in a nursing home facility, in advance,  is important.  It will relieve family members of undue stress and worry. Many are concerned about what to do when the time arrives.

  • Behavioral and personality changes occur. Paranoid delusions and engagement in compulsive or repetitive activities occur. Advanced dementia patients frequently believe that caregivers or family members are imposters . Some even believe that they are trying to poison them.

Repetitive actions such as…

  • Shredding tissues
  • Hand wringing
  • Obsessively cleaning one spot are also commonly observed behaviors

Alzheimer’s patients, in moderate stages of dementia, may recognize faces, but are unable to remember names.  Later dementia brings the inability to remember faces or names.

The final stages of dementia will cause a total lack of response in dementia patients. They no longer respond to the environment or stimulus cues. Patients require assistance in all aspects of daily living. Extreme muscle and brain atrophy occurs. They may stop communicating, adopt a mask-like expression and have difficulty swallowing. Tube feeding may be suggested. It is at this time, hospice may be recommended.

Medications used to inhibit progression of Alzheimer’s disease are primarily cholinesterase inhibitors. They are designed to elevate levels of acetylcholine. AChE is a neurotransmitter. It is heavily involved in the ability to remember and learn. It is also responsible for stimulating muscle action.

Advanced dementia patients who begin to develop …

  • Muscle stiffness
  • Tremors
  • Uncontrollable muscle movements are suffering from dangerously low levels of AChE.

Donepezil and Namenda are medications intended to treat moderate to severe dementia symptoms. Neither medication will “cure” Alzheimer’s. They may enhance cognitive functioning. This is done by facilitating the ability of AChE receptors to release additional amounts into the brain.

Caregivers may notice improvements in recall and memory. Some may see less irritability and irrational thinking in patients taking these medications. When in the final stages of dementia, patients generally do not respond to these drugs. This is due to such advanced deterioration of the brain.

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Placement of Advanced Dementia Patients in Nursing Homes

Unless families have access to 24-hour in home caregiving services, most will have to place a loved one into a nursing home.

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. These doors 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. This is done in order to prevent ambulatory patients from becoming frustrated. Right angles and dead ends tend to confuse dementia patients
  • Staff members have extra experience. They have knowledge about all aspects of late-stage Alzheimer’s disease. The facility should be able to provide proof they preform background checks on all employees. Every employee, 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
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