The Late Stage
The downward spiral of disease progression continues as the individual enters the Late Stage of Alzheimer’s disease. Comparison of either an MRI or CT scan would show global (all areas) atrophy of the cerebral cortex. When compared to previous images there would be a noted enlargement of the ventricles. (Note: the degree of atrophy is usually determined by viewing images of the size of an individual’s ventricles. It is not that the ventricles actually are enlarged; they just appear larger because the cerebral cortex has atrophied significantly).
At this point, patients with AD often cannot recognize family members or express themselves verbally. They are completely dependent on others for care and at times seem to have lost all sense of self. Common symptoms can include: weight loss, seizures, skin infections, difficulty swallowing, increased sleep, incontinence of both bowel and bladder, and loss of verbal skills.
Nonverbal communication, especially touch, between the caregiver and the patient is very important. Individuals who are unable to respond verbally will often respond to a smile, kind gesture, or a caring touch. Careful observation of the patient’s facial expressions, eye contact or lack of it, and body language can help the caregiver assess comfort or pain, anger, hostility, and misunderstanding. As caregivers develop experience with the disease they will gain more skill in interpreting these nonverbal signals. We do not know to what degree the person is able to understand at any stage of this disease; therefore, the care of a person with AD demands ongoing assessment, planning, intervention, and evaluation throughout the course of the disease.
People with Alzheimer’s disease often have other health problems common to older adults such as CHF (congestive heart failure), hypertension, diabetes, and genitourinary conditions. At the end of life individuals are partly or completely bedbound. Death comes most often in the form of a secondary infection which the body is unable to fight or from aspiration pneumonia caused by the individual’s inability to swallow causing them to inhale food or liquid into their lungs.