What happens in the last stages of dementia?
Since a patient with dementia may have trouble communicating, it's important to monitor for signs of pain or discomfort. End-stage dementia symptoms may indicate that the patient is dying or close to death:
- Problems with everyday functions, including bathing, dressing, eating, and going to the bathroom
- Inability to walk or sit up in bed without assistance
- Inability to speak and show facial expressions
- Dehydration and malnutrition due to trouble swallowing, eating, and drinking
- Increased risk of medical conditions such as urinary tract infections, aspiration pneumonia, skin breakdown, pressure ulcers (bedsores), or blood clots
- Agitation, restlessness, moaning, and changes in breathing
What is dementia?
Dementia is a progressive and irreversible condition characterized by persistent decline of neurocognitive functions, such as memory, attention, judgment, logical reasoning, and problem-solving.
Elderly people over the age of 85 account for 40% of cases.
What causes dementia?
Dementia is caused by damage to nerve cells and connections in the brain. Depending on the area of the brain affected, dementia can cause different symptoms.
Causes of dementia include the following:
- Alzheimer's disease: This is the most common cause of dementia that accounts for about 60%-70% of cases. Abnormal proteins, called amyloid plaques and tau tangles, get deposited mainly in the hippocampal region of the brain, leading to impaired learning and memory loss.
- Lewy body dementia: The second most common form of dementia is caused by abnormal deposits of protein in the brain, resulting in cognitive problems.
- Frontotemporal dementia: This rare form of dementia is associated with abnormal protein accumulation and degeneration of the frontal and temporal lobes of the brain.
- Vascular dementia: Impaired blood circulation in the brain, caused by conditions such as traumatic brain injuries, infections, long-time alcohol or drug use, and hydrocephalus (buildup of fluid in the brain)
What are the stages of dementia?
Signs and symptoms of dementia can be divided into three stages:
- Early stage:
- Losing track of the time
- Becoming lost in familiar places
- Middle stage:
- Becoming forgetful of people's names
- Becoming confused even when at home
- Increasing difficulty with communication
- Needing help with personal care
- Behavioral changes including repeated questioning
- Late stage:
- Becoming unaware of the time and place
- Having difficulty recognizing relatives and friends
- Having an increasing need for assisted self-care
- Having difficulty in walking
- Behavior changes that may arise suddenly and include aggression
What is end-of-life care for dementia?
End-of-life care should help the person to live peacefully until death by taking care of the following needs:
- Physical needs, including pain management and other symptoms
- Emotional needs, including managing distress
- Environmental needs, such as their surroundings
- Cultural, spiritual, or religious beliefs and practices
- Being treated with compassion and respect
- Being clean and comfortable
- Being in a familiar place surrounded by their loved ones
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The Alzheimer's Association. <https://alz-journals.onlinelibrary.wiley.com/journal/15525279>.
Montine, T.J. "Dementia Pathology." Medscape. Dec. 23, 2019. <https://emedicine.medscape.com/article/2003174-overview>.
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