Expert: Mary Gordon - 8/11/2006

Question
My mom died 2 wks ago from alzheimers disease.  Prior to the last month and half before her death her body was strong. Her mind was going but her body was strong. In early february the doctor put her on seroquel in conjuntion with her aricept because she would not sleep at nite. It worked until one nite she was in such a deep sleep that we could not wake her. Eventually she woke up. After that she would just sleep all day. The doctor said to give it to her everyother nite we decided it was best to take her off the seroquel. But she just continued to sleep all day and nite. To be exact she was dopey and began to slur her speach. Eventually she lost her will to walk and needed to be fed.  This was such a sudden and drastic change and it all happened 6-7 wks before her death.  Is this normal? Does the heart eventually give out with Alzheimers?  I would really apreciate if you answer my questions. Thank you.

Answer
Hi Aida,

Here is the clinical description of the last stag , which can last as long as couple of years.
Level 7
      Very severe cognitive decline (Late Dementia or Severe AD). All verbal abilities are lost. Frequently there is no speech at all - only grunting.
      Incontinent of urine, requires assistance toileting and feeding. Lose basic psychomotor skills, e.g., ability to walk, sitting and head control.
      The brain appears to no longer be able to tell the body what to do. Generalized and cortical neurologic signs and symptoms are frequently
      present.

      7a - Speech ability limited to about a half-dozen intelligible words
      7b - Intelligible vocabulary limited to a single word
      7c - Ambulatory ability lost
      7d - Ability to sit up lost
      7e - Ability to smile lost
      7f - Ability to hold up head lost

Grim, isn't it? So you can see for yourself, they hit a certain point with the brain damage, and everything just spirals inward. It isn't just a matter of losing their will to walk - they literally have lost the ability to control and coordinate their muscles. They no longer seem to feel hungry or thirsty - or maybe if they do feel something, they have no idea what the sensation means. In the final stages, my mother in law would push all food away - it was like she didn't know what it was, let alone how to chew or swallow it. Like your mother, my mother in law was physically very healthy - good heart, good lungs, no internal problems, no cancer - and Alzheimer's still took her life. She stopped walking and talking a full two years before she died, and spent her days sitting in a chair or propped up in bed, like the living dead - she seemed barely aware of where she was, slept all the time etc..

I know you been through a terrible experience - it seems like an awful thing to say, but it does seem more merciful when some other illness carries them off before they reach the final stage of Alzheimer's itself.

It is also possible since your mother spiralled so quickly at the end, that she had other health issues going on such as tiny strokes. Its not uncommon for that to happen - really small strokes can contribute the cognitive decline and not show signs you can see like a bigger stroke.

At a certain point, the brain is so damaged, and the person is bedridden, and everything just starts to shut down, as they eat less and less, no matter how much you try to get food into them.  As you probably know, at that stage, they often experience skin breakdown and get susceptible to infections like pneumonia. Their kidney's quit working, and they die. It's like the tide going out - nature just carries them off.

Your mom was lucky to have you worrying about her and looking out for her. I know you have been through an awful strain, but she's free, and its over. You did the best you could in the face of a terrible, heartbreaking disease. Neither your mother nor you deserved this.

Thinking of you. There isn't a thing anyone could have done different.

Mary G.