End Stage Alzheimer's Disease

Cognitive function deteriorates almost completely in Alzheimer's last stage. This stage may last for several years. Someone who is suffering with end-stage Alzheimer's cannot survive without constant care.

What End-Stage Alzheimer's Looks Like

With the deterioration of cognitive function in Alzheimer's last stage, the patient:

• Can't eat, bathe or use the washroom without assistance
• Can't walk, move, sit or even hold her head up without assistance
• Has little or no memory capacity
• Is usually incontinent (unable to control bladder and bowel movements)
• May cry out repeatedly
• May have difficulty swallowing (may choke on food)
• May lose the ability to speak coherently or at all
• Loses almost all muscle coordination (muscles become rigid)
• Often can't respond to environmental stimuli
• Often loses weight
• Sleeps more (although sleep patterns may be disturbed).

Certain distinct physical characteristics accompany end-stage Alzheimer's. As muscles grow rigid, physical deformities, called contractures, can develop. A contracture is a shortening of the muscle or joint that inhibits the full range of movement of a joint. Contractures often develop in the elbows, wrists and fingers as a result of the characteristic inactivity of Alzheimer's late stage. Once developed, contractures can't be cured or reversed.

End-Stage Alzheimer's Care Issues

Constant care is required during Alzheimer's last stage. The caregiver must take into consideration not only the disease itself, but also the many complications that can arise from the disease, including:

• Bedsores (called "decubitus ulcers" or "pressure ulcers") can develop because the patient's skin often becomes very thin and tears easily, due to immobility and subsequent lack of blood supply to the affected area. Bedsores are treatable if noticed early.
• Bladder incontinence is a common problem in Alzheimer's last stage. The caregiver can lessen this problem by scheduling regular bathroom trips.
• Broken bones are another complication. Because muscle control is severely impaired, falls, bruises and broken bones are common in end-stage Alzheimer's. The caregiver must inspect the person after a fall for signs of bruising and broken bones, as the patient may not be able to communicate the pain of a break.
• Constipation may also be an issue. The caregiver must monitor bowel movements to avoid prolonged constipation. Adequate nutrition and fluids can help to reduce constipation.

Other complications — such as urinary tract infections, recurrent fevers, pneumonia and other respiratory problems — may also arise during end-stage Alzheimer's disease. Delirium can be a result of acute infections. During this stage, the goal of Alzheimer's care is to make the patient as comfortable as possible.

Resources

Alzheimer's Association. (n.d.) Stages of Alzheimer's. Retrieved June 11, 2010, from http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp.

Alzheimer Society of Canada. (n.d.) What is Alzheimer's disease? Retrieved April 23, 2010, from http://www.alzheimer.ca/english/disease/whatisit-intro.htm.

American Health Assistance Foundation. (n.d.) Alzheimer's symptoms and stages. Retrieved June 10, 2010, from http://www.ahaf.org/alzheimers/about/symptomsandstages.html.

Fisher Center for Alzheimer's Research Foundation. (n.d.) Clinical stages of Alzheimer's disease. Retrieved June 11, 2010, from http://www.alzinfo.org/clinical-stages-of-alzheimers-disease.asp.

Mayo Clinic. (2008). Alzheimer's stages: How the disease progresses. Retrieved June 11, 2010, from http://www.mayoclinic.com/health/alzheimers-stages/AZ00041.

U.S. National Institutes of Health National Institute of Aging. (n.d.) Understanding stages and symptoms of Alzheimer's disease. Retrieved June 10, 2010, from http://www.nia.nih.gov/Alzheimers/Publications/stages.htm.