The final stage of Alzheimer's disease?

When Alzheimer’s patients, particularly in the end stage, cannot consume enough calories due to difficulties with eating or swallowing (dysphagia), several serious consequences can occur:

• Malnutrition:

Inadequate calorie and nutrient intake leads to weight loss, muscle wasting, and weakened overall health. This can exacerbate fatigue, reduce strength, and impair organ function.

•  Weakened Immune System:

Malnutrition increases susceptibility to infections like pneumonia, a common cause of death in end-stage Alzheimer’s, as the body lacks the energy and nutrients to fight illness.

•  Dehydration:

Difficulty swallowing liquids often accompanies eating problems, leading to dehydration, which can cause confusion, urinary tract infections, kidney issues, and electrolyte imbalances.

•  Increased Frailty:

Caloric deficiency accelerates physical decline, making patients more prone to falls, pressure ulcers (bedsores), and slower wound healing.

•  Worsened Cognitive and Physical Symptoms:

Lack of proper nutrition can intensify confusion, agitation, and lethargy, further reducing quality of life.

•  Higher Mortality Risk:

Persistent inability to eat sufficient calories often leads to a downward spiral, contributing to death, especially when combined with infections or other complications.

Care strategies may include modifying food textures (e.g., pureed diets), using feeding tubes (if aligned with care goals), or focusing on comfort feeding in palliative care. Decisions about interventions like tube feeding depend on the patient’s advance directives and family discussions with healthcare providers, as they carry risks like infection or aspiration. For more information, resources like the Alzheimer’s Association (alz.org) offer guidance on managing late-stage care.

In the end stage of Alzheimer’s disease (typically stage 7 on the Functional Assessment Staging Test), symptoms are severe and reflect profound cognitive and physical decline. The primary

symptoms include:

• Severe Cognitive Impairment:

Profound memory loss, inability to recognize family or self, and loss of ability to communicate meaningfully (limited to a few words or sounds).

•   Loss of Physical Abilities:

Inability to walk, stand, or sit without assistance; difficulty swallowing or eating, leading to weight loss or risk of choking; and loss of bowel and bladder control.

• Increased Vulnerability to Infections:

Susceptibility to pneumonia and other infections due to weakened immune system and immobility.

• Complete Dependence:

Requires full-time care for all daily activities, such as feeding, bathing, and dressing.

• Reduce Awareness:

Limited or no awareness of surroundings, time, or events; may only respond to basic stimuli like touch or pain.

These symptoms reflect the disease’s progression, where brain function is severely compromised. Care focuses on comfort and quality of life, often involving hospice or palliative care. For more details, you can refer to resources like the Alzheimer’s Association (alz.org).

Last Stage:

In addition to the progressive loss of muscle strength and motor function, which makes it difficult to walk and makes the patient bedridden, it also increases the risk of complications such as dysphagia and aspiration pneumonia, as well as the inability to self-manage food and excretions.