Expert: Mary Gordon - 11/15/2010

Question
Is the end stage different for each individual who has AD

Answer
It's only different in that things may progress slower in some people than others, and that many people in the last stage have their situation complicated by a constellation of health complications due to being elderly and frail.

Not everyone dies from end stage dementia. Many people - in fact, the majority - will actually die from a complication of another of their health problems, rather than the dementia itself. It becomes very very difficult to diagnose or treat many health problems. Think about most older people - they often have heart problems, lung issues, kidney problems, diabetes, perhaps a history of stroke, cancer, all kinds of things. They can't answer questions, they can't cooperate with tests or procedures and therapies. They often don't complain because their dementia has left their perceptions and their speech impaired. The family is left with observing changes in behavior to try to guess if anything is changed or causing a problem. Quite often the family decides there is no point to try and deal with health problems other than making sure the person is not in pain or distress. They decide that comfort and serenity is most important. After all, putting the person through medical procedures can be scary, painful and upsetting when they can't understand what is going on or why. The side effects of many medical procedures can make the dementia worse (i.e. surgery) - and even if the treatment works, it may not be worth it in that you are not buying the person more quality time, but more time in which to suffer and decline. So - many families feel that palliative care is the best option for the majority of health problems

If a person does live to the natural end of dementia and are not kindly carried off by something else, that last stage is essentially the same for everyone because it's the ultimate stage of the brain injury. They will lose the ability to walk, talk, feed themselves or use the bathroom. They will become helpless and spend their days propped in a chair or in bed. They sleep more and more and are less and less alert. They become unaware of where they are or who they are with. No matter what anyone tries, they eat less and less and start to lose weight. They often start to get infections as their immune systems shut down. Eventually, they stop eating and drinking, their organs shut down and they lapse into a coma and pass away.

It's grim for the family, but the person does not seem to suffer, probably because their brain is so damaged, they are not really aware of what is happening to them.

Hope this helps.

Mary G.