Is There an End to Alzheimer's?

Alzheimer's is generally considered a chronic illness that progresses over time. It is also a fatal disease. Each person experiences the course of the disease differently, and the reasons for death vary, but the outcome is the same.¹

The Alzheimer's Association describes the disease as a progressive brain disorder that causes dementia, leading to the loss of memory, cognition, and the ability to care for oneself. The brain is the body's control center. When it can no longer function correctly, it can affect all aspects of daily life, including the ability to speak, walk, swallow, and breathe.²

Alzheimer's is a progressive condition

Many progressive diseases are categorized into stages that describe symptoms and general experiences that patients and their families can expect. A respected system that divides Alzheimer's into seven stages was developed by Dr. Barry Reisberg from New York University (NYU).¹

Reisberg 7 stages of Alzheimer's

The 7 stages of Alzheimer's are described as follows:³

• Stage 1: No impairment - symptoms of dementia are not detectable
• Stage 2: Very mild decline - there may be minor memory problems but often not distinguishable from normal age-related memory loss. Generally, still undetectable by families or physicians.
• Stage 3: Mild decline - There are noticeable cognitive changes and impairments with functions that can affect organizational skills, word selection, misplacement of personal possessions, and remembering the names of new people. This can be among the most difficult stages for loved ones, as the prospect of looming decline sets in for the family, including the person with Alzheimer's.
• Stage 4: Moderate decline - There are clear indications of dementia, including the decline in short-term memory, forgetting personal history, and an inability to manage finances or pay bills.
• Stage 5: Moderately severe decline - Some independence and functionality remain intact, such as bathing and using the bathroom independently, but may require assistance dressing appropriately. They are still able to recognize and converse with close family members and friends. Many people require assistance with tasks of daily living because of significant confusion.
• Stage 6: Severe decline - Confusion is the hallmark of Stage 6. Constant supervision is required, including professional care for many. Major personality changes and behavior problems can present, as can a loss of awareness of surroundings and the loss of bladder and bowel control.
• Stage 7: Very severe decline - In the final stage of Alzheimer's, most people lose the ability to communicate or respond to their environment. They need assistance with all aspects of life, including eating, and may lose their ability to swallow. Autonomic nervous system functions that we don't think about, like heart rate, breathing, digestion, and sleep cycles, can be severely affected.

The process of dying

A diagnosis of Alzheimer's is not typically made at stage 1. The manifestation of symptoms that are recognizable often do not present until stage 2 or 3. Symptoms of the later stages are signs that a person is nearing death.⁴

The process of dying varies based on the presence of other medical conditions. In the advanced stages of Alzheimer's, people often become weak from lack of nourishment and movement and can become susceptible to infections. They are at increased risk for choking and aspiration, often developing pneumonia which can end up being the recorded cause of death.²

If people have other underlying or age-related medical conditions, they may die from complications of those illnesses, even before they reach the final stages of Alzheimer's. Examples include heart disease, stroke, kidney failure, dehydration and malnutrition, infections, and bedsores. In these cases, Alzheimer's, despite its progression, may not be the proximate cause of death.

The advance of Alzheimer's is unique to each person and can be unpredictable. Much has been written about maintaining individual comfort and dignity. There are steps to take to make sure appropriate medication regimens are followed, creating familiar surroundings whether the person remains at home, or is in a specialized center, hospital, or hospice unit.

End-of-life planning

Many people are capable of making end-of-life decisions during the early stages of the disease. Understanding someone's wishes about the process of dying can diminish some of the inevitable stress associated with decision-making.⁵

Evaluating comfort care and quality-of-life versus heroic measures to prolong life is often a challenging consideration as stages of Alzheimer's move from one to the next.