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As a patient approaches the severe stage of AD, symptoms will become more problematic and patients will be harder to manage on your own. Memory loss and behavioral changes are likely but are any therapies possible to help manage these cases?

Alzheimer’s Disease is a disease of progressive mental and physical decline. If you have been following along, you are already aware that there are 3 distinctive phases to this disease. The first is termed mild Alzheimer’s disease and symptoms will be hard to differentiate from normal aging. As AD becomes more progressive, Stage 2 will be reached. This is where patients will experience moderate AD and symptoms will be much more prevalent. The final stage that patients will experience is termed Advanced Alzheimer’s Disease. This is the stage that we will be focusing on today. After reading this, you will be more familiar with some of the key symptoms you can expect to encounter during this stage as well as potential treatments that are available to you. 

The symptoms of severe or late Alzheimer’s disease 

Once you have reached this stage of AD, there is a significant decline in cognitive function in patients at this stage. As you may remember from our exploration of Moderate AD, patients will begin to have problems with communication and even recognizing familiar faces and places as the disease worsen.

These early symptoms are just the beginning points of the spectrum that the patient is currently traversing. At the severe AD stage, these symptoms become much more pronounced. Expect a patient at Stage 3 AD to have severe memory loss, problems with communication and daily activities and greater changes in behavior and personality compared to what was seen in the earlier stages. 

The key term to focus on at this stage would be severe dementia. This is a term that just means that there is a significant drop in mental capacity. This is something that is highly variable and can vary dramatically from person to person. Although other diseases also have severe dementia as an active component to symptoms that could be expected, it seems that dementia in AD is rather slow in progression compared to other diseases. This means that you will not have to worry about just a rapid decline in mental function compared to other conditions. Although it may not mean much, this extra time can be critical in helping plan out additional therapy and treatments while also enjoying quality time with the loved one afflicted with the disease. 

In general, patients with late-stage AD are much more demanding to care for compared to earlier forms of the disease:

  • Conversations will become quite difficult. 
  • Patients may also have problems sitting still, walking or standing.
  • Patients at this stage are also more prone to infections so expect frequent trips to the hospital.
  • Patients may also have difficulty holding up their heads or swallowing so feeding can be quite problematic for patients at this stage.
  • There can be an associated complete loss of bladder and bowel control as well.
  • These patients are also more likely to be agitated during certain periods of the day and may even become aggressive without provocation.
  • The sleep-wake cycle is typically also inverted so those caring for patients at this stage may become quite fatigued when episodes erupt during late night hours. 

Treatment options available at advanced stage 

By this stage of the disease, chances are you are already quite familiar with the types of drugs on the market that can help delay cognitive decline. Donepezil and memantine are two of the staple therapies but their effects are limited. Once the brain becomes too damaged, these medications will lose their effects almost overnight in some cases so the decline in a patient can be alarming. 

The best option that you can do for a loved one who is at this stage of the disease or approaching it is to hire help in order to lessen the burden. These patients will need around-the-clock care and oftentimes, you will need a team of family, friends and medical professionals to help. 

It is also a wise decision to take your partner for vaccinations against the flu annually at this stage. Because they are more fragile, it is likely that they can become infected very easily. Vaccinations can help prevent these infections or at least reduce the severity of the disease. Antibiotics will also be a mainstay therapy but be wary of the fact that as patients with severe AD likely will also have swallowing difficulty, it may be hard to give medications. Ask your doctor to see if injections of the antibiotics are possible or if the pills can be mixed with water and still be effective. 

Another potentially uncomfortable situation for loved ones of a patient suffering from AD is what to do when the patient loses their ability to make decisions. By this late stage of AD, this will likely be the case and as the frequency of infections seems to increase as the patient declines, frequent trips to the hospital will be a likely occurrence.

Patients at this stage of the disease should already have advanced directives for what their wishes would be once they cannot make decisions for themselves. This is the best way to relieve the tension and grief that can occur if there is a disagreement between family members over what the patient may have wanted. Make sure that this plan is in place while the patient still has the capacity to make decisions in order to facilitate this process. 

As part of this advanced directive, patients should also have the ability to suggest where they would like to be cared for. Patients can choose between staying at home, going into extra care housing, hospital care or even hospice care depending on the circumstances. Bear in mind that this is not a binding decision if it becomes too difficult for loved ones to manage. I have seen several occurrences in the wards where elderly spouses try to honor the wishes of their loved ones with AD by agreeing to provide care at home. This can quickly lead to exhaustion, depression and anger. The best thing to do is to be honest with yourself about your abilities to manage your partner as they decline. If it becomes too much, ask for help. 

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