End-stage sounds terrible, but unfortunately, dementia or Alzheimer's disease usually progresses, so over the years the mental powers are gradually diminishing. A late stage or end stage is when the dementia has progressed so far that memory and thinking are almost completely lost - and thereby the physical functions are significantly impaired, which can lead to death in the end.
Course individually very different
How fast that works and how it expresses itself in individual cases, is very different individually. It also depends on the type of dementia and the speed of its development. For example, vascular dementia caused by circulatory disorders in the brain is usually much slower and more moderate than Alzheimer's disease. But Alzheimer's too, there are very different courses - from a mental decline within 1-2 years to a slight progression over 10 years and more.
How long the illness process takes with his or her relatives, how fast it progresses or whether it even gets that far, is therefore hardly predictable in the initial stage.
Emotional perceptions often become recognizable even longer
How can a pronounced late-stage mental deterioration manifest itself? Mind you, we are really talking about the last and most extreme phase of the disease, which is often, but not always.
In extreme cases, the memory is then completely lost. The affected only recognize the closest relatives and confidants, someday then no one else. At least it seems that way, what actually happens inside of the dementia sufferer is, of course, also a guess. Many relatives (but not all) report that they are still very well perceived emotions until recently, so for example, a smile when the loved ones enter the room.
What is often the hardest to work with for partners, relatives and friends: Of those who are formerly ill, there is often hardly anything left to recognize in those who are ill at such a late stage. Everything that has been associated with one's beloved or loved one, which was "peculiar" to him or her, has then disappeared. This is difficult to accept, because with it the mutual exchange is ended forever. As a relative one remembers well how it used to be, what conversations there were and so on, and now there is only the body, a face that hardly reacts to you. If you then still perceive emotions, that is at least a small consolation.
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However, in vascular dementia or moderate Alzheimer's, the transition to this phase is much slower and more akin to a steady, year-over-year progression. For the relatives this variant is therefore often easier to bear, even in the late phase, because it does not occur so quickly and radically.
Eventually, the physical forces will disappear
Around-the-clock care is needed at this late stage of the disease - usually in a nursing home or alternatively with a 24-hour nursing home.
The mental deterioration will eventually be followed by physical decline. Often it begins with the food intake that does not work anymore, an increasing immobility is added. The own drive goes out almost completely, which weakens body and defenses. Since those affected in the end can no longer chew properly, swallow and breathe, the physical condition is becoming increasingly frail. Often it eventually comes to pneumonia or other infections. If vital bodily functions are severely impaired, it will eventually kill.
Author: Dr. med. Jörg Zorn