Dementia is a general term for a chronic or persistent decline in mental processes including memory loss, impaired reasoning, and personality changes. Alzheimer’s disease is the most common form of dementia. Follow this article to learn more about dementia and what are the signs of death in elderly with dementia.

Dementia is not a specific disease but is rather a general term for the impaired ability to remember, think, or make decisions that interfere with doing everyday activities. Alzheimer’s disease is the most common type of dementia. Though dementia mostly affects older adults, it is not a part of normal aging. Dementia is a general term for a chronic or persistent decline in mental processes including memory loss, impaired reasoning, and personality changes.

Alzheimer’s disease is the most common form of dementia, accounting for 60-80% of all cases of dementia. It is also the 6th leading cause of death in the United States, and over 5 million Americans are currently living with Alzheimer’s disease. Alzheimer’s disease and most progressive dementias do not have a cure. While the disease inevitably worsens over time, that timeline can vary greatly from one patient to the next.

Caring for a loved one can be challenging and stressful, as the individual’s personality changes and cognitive function declines. They may even stop recognizing their nearest and dearest friends and relatives. As dementia progresses, the individual will require more and more care. As a family caregiver, it’s important to be able to recognize the signs of dying in elderly with dementia. Hospice can help by offering care wherever the individual resides, providing physical, emotional and spiritual care to the patient and supporting their family.

What is dementia?

Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — to such an extent that it interferes with a person’s daily life and activities. Some people with dementia cannot control their emotions, and their personalities may change. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living, such as feeding oneself.

Dementia affects millions of people and is more common as people grow older (about one-third of all people age 85 or older may have some form of dementia) but it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia. There are several different forms of dementia, including Alzheimer’s disease, which is the most common. Dementia is a syndrome – usually of a chronic or progressive nature – that leads to deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from the usual consequences of biological aging. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment.

Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by changes in mood, emotional control, behavior, or motivation. Dementia results from a variety of diseases and injuries that primarily or secondarily affect the brain, such as Alzheimer’s disease or stroke.

Dementia is currently the seventh leading cause of death among all diseases and one of the major causes of disability and dependency among older people worldwide. Dementia has physical, psychological, social and economic impacts, not only for people living with dementia, but also for their carers, families and society at large. There is often a lack of awareness and understanding of dementia, resulting in stigmatization and barriers to diagnosis and care.

What are the different types of dementia?

If someone you love gets diagnosed with dementia, it means they have a progressive and sometimes chronic brain condition that causes problems with their thinking, behavior, and memory. Dementia itself is not a disease, but a syndrome; its symptoms are common to several brain diseases. It will get worse over time. But medications might slow that decline and help with symptoms, such as behavior changes. There are many different types of dementia. Your loved one’s treatments will depend on the type they have.

  • Alzheimer’s disease
  • Vascular dementia
  • Dementia with lewy bodies
  • Parkinson’s disease dementia
  • Frontotemporal dementia
  • Huntington’s disease
  • Creutzfeldt-Jakob disease
  • Normal pressure hydrocephalus
  • Wernicke-Korsakoff syndrome

Alzheimer’s disease:

Experts think between 60% to 80% of people with dementia have this disease. More than 5 million Americans have been diagnosed with Alzheimer’s. It’s what most people think of when they hear “dementia.” If someone you know has Alzheimer’s, you’ll notice symptoms such as memory loss and trouble planning and doing familiar tasks. The symptoms are mild at first but get worse over a number of years. Your friend or relative might:

  • Be confused about where they are or what day or year it is.
  • Have problems speaking or writing.
  • Lose things and be unable to backtrack to find them.
  • Show poor judgment.
  • Have mood and personality changes.

Vascular dementia:

If a relative or friend of yours gets this type of dementia, it’s usually because they had a major stroke, or one or more smaller, “silent” strokes, which can happen without them realizing it. The symptoms depend on which part of their brain was affected by the stroke. While Alzheimer’s usually begins with memory problems, vascular dementia more often begins with poor judgment or trouble planning, organizing, and making decisions. Other symptoms may include:

  • Memory problems that disrupt your loved one’s daily life.
  • Trouble speaking or understanding speech.
  • Problems recognizing sights and sounds that used to be familiar.
  • Being confused or agitated.
  • Changes in personality and mood.
  • Problems walking and having frequent falls.

Dementia with lewy bodies:

Lewy bodies are microscopic deposits of a protein that form in some people’s brains. They’re named after the scientist who discovered them. If someone you know gets DLB, it’s because these deposits have formed in the part of the brain called the cortex. The symptoms include:

  • Problems thinking clearly, making decisions, or paying attention.
  • Memory trouble.
  • Seeing things that aren’t there, known as visual hallucinations.
  • Unusual sleepiness during the day.
  • Periods of “blanking out” or staring.
  • Problems with movement, including trembling, slowness, and trouble walking.
  • Dreams where you act out physically, including, talking, walking, and kicking.

Parkinson’s disease dementia:

People with the nervous system disorder Parkinson’s disease get this type of dementia about 50% to 80% of the time. On average, the symptoms of dementia develop about 10 years after a person first gets Parkinson’s. This type is very similar to DLB. They have the same symptoms, and people with both conditions have signs of Lewy bodies in their brains.

Frontotemporal dementia:

If your loved one has an FTD, they have developed cell damage in areas of the brain that control planning, judgment, emotions, speech, and movement. Someone with FTD may have:

  • Personality and behavior changes.
  • Sudden lack of inhibitions in personal and social situations.
  • Problems coming up with the right words for things when speaking.
  • Movement problems, such as shakiness, balance problems, and muscle spasms.

Huntington’s disease:

This is a brain disorder caused by a genetic defect that’s passed down through family members. While your loved one might have the gene for Huntington’s disease at birth, the symptoms don’t usually start to show up until they are between the ages of 30 and 50. People with Huntington’s get some of the same symptoms seen in other forms of dementia, including problems with:

  • Thinking and reasoning
  • Memory
  • Judgment
  • Planning and organizing
  • Concentration

Creutzfeldt-Jakob disease:

This is a rare condition in which proteins called prions cause normal proteins in the brain to start folding into abnormal shapes. The damage leads to dementia symptoms that happen suddenly and quickly get worse. Your loved one might have:

  • Memory and concentration problems
  • Poor judgment
  • Confusion
  • Mood swings
  • Depression
  • Sleep problems
  • Jerky muscles
  • Trouble walking

Normal pressure hydrocephalus:

This type of dementia is caused by a buildup of fluid in the brain. The symptoms include problems walking, trouble thinking and concentrating, and personality and behavior changes. Some symptoms can be treated by draining the extra fluid from the brain into the abdomen through a long, thin tube, called a shunt.

Wernicke-Korsakoff syndrome:

This disorder is caused by a severe shortage of thiamine (vitamin B-1) in the body. It most commonly happens in people who are long-term heavy drinkers. The dementia symptom that’s most common with this condition is a problem with memory. Usually a person’s problem-solving and thinking skills aren’t affected.

What are some of the early signs of dementia?

Dementia isn’t a single disease. Instead, it’s a broad term that describes a collection of symptoms. These symptoms can affect someone’s memory, as well as their ability to think, process information, and communicate with others.

According to the World Health Organization, more than 55 million people worldwide live with dementia, and more than 10 million new cases are diagnosed every year. And while Alzheimer’s disease is the most common cause of dementia, it’s not the only cause. Although dementia symptoms can vary due to the underlying cause, there are some key symptoms that are common warning signs of this condition.

  • Subtle short-term memory changes
  • Difficulty in finding the right words
  • Changes in mood
  • Apathy
  • Difficulty in completing tasks
  • Confusion
  • Difficulty in following storyline
  • A failing sense of direction
  • Repetition
  • Struggling to adapt change
  • Poor judgment

Subtle short-term memory changes:

Having trouble with memory can be an early symptom of dementia. The changes are often subtle and tend to involve short-term memory. A person with dementia may be able to remember events that took place years ago, but not what they had for breakfast. A person with dementia may also display other changes in their short-term memory, such as:

  • Forgetting where they placed items.
  • Struggling to remember why they entered a particular room.
  • Forgetting what they were supposed to do on any given day.

Difficulty in finding the right words:

Another early symptom of dementia is difficulty with communicating thoughts. A person with dementia may have a hard time explaining something or finding the right words to express themselves. They may also stop in the middle of a sentence and not know how to continue. Having a conversation with a person who has dementia can be challenging, and it may take longer than usual for them to express their thoughts or feelings.

Changes in mood:

A change in mood is also common with dementia. If you have dementia, it may not be easy to recognize this in yourself, but you may notice this change in someone else. Depression, for instance, is common in the early stages of dementia.

Someone who has dementia may also seem more fearful or anxious than they were before. They could get easily upset if their usual daily routine is changed, or if they find themselves in unfamiliar situations. Along with mood changes, you might also notice a shift in personality. One typical type of personality change seen with dementia is a shift from being shy or quiet to being outgoing.

Apathy:

Apathy, or listlessness, is a common sign in early dementia. A person with dementia may lose interest in hobbies or activities that they used to enjoy doing. They may not want to go out anymore or have fun. They may also lose interest in spending time with friends and family, and they may seem emotionally flat.

Difficulty in completing tasks:

A subtle shift in the ability to complete common tasks is another possible early warning sign of dementia. This usually starts with difficulty doing more complex tasks, like:

  • Balancing a checkbook
  • Keeping track of bills
  • Following a recipe
  • Playing a game that has a lot of rules

Along with the struggle to complete familiar tasks, a person with dementia may also struggle to learn how to do new things or follow new routines.

Confusion:

Someone in the early stages of dementia may often become confused. They may have trouble remembering faces, knowing what day or month it is, or figuring out where they are. Confusion can occur for a number of reasons and apply to different situations. For example, they may misplace their car keys, forget what comes next in the day, or have difficulty remembering someone they recently met.

Difficulty in following storylines:

Difficulty following storylines is a classic early symptom of dementia. People with dementia often forget the meaning of words they hear or struggle to follow along with conversations or TV programs.

A failing sense of direction:

A person’s sense of direction and spatial orientation commonly starts to get worse with the onset of dementia. They may have difficulty recognizing once-familiar landmarks and forget how to get to familiar places they used to have no trouble finding. It may also become more difficult to follow a series of directions and step-by-step instructions.

Repetition:

Repetition is common in people with dementia due to memory loss and general behavioral changes. The person may repeat daily tasks, such as shaving or bathing, or they may collect items obsessively. They also may repeat the same questions in a conversation or tell the same story more than once.

Struggling to adapt change:

For someone in the early stages of dementia, the experience can cause fear. Suddenly, they can’t remember people they know or follow what others are saying. They can’t remember why they went to the store, and they get lost on the way home. Because of this, they might crave routine and be afraid to try new experiences. Difficulty adapting to change is also a typical symptom of early dementia.

Poor judgment:

Another consequence of cognitive decline is the loss of the ability to make good decisions. For instance, a person with dementia may not be able to recognize dangerous situations. They may try to walk across a busy street without waiting until it’s safe to do so, or head outside in summer clothes when it’s snowing outside.

Another hallmark of poor judgment with dementia is the inability to use good financial judgment. Someone who was usually careful with their money may start giving money away to people or causes they hardly know.

What are the stages of dementia?

Health care providers use a comprehensive tool to assess the seven stages of dementia in elderly patients: the Global Deterioration Scale. Also known as the GDS, this trusted method enables caregivers and health professionals to determine how quickly dementia progresses in elderly patients and which symptoms to expect during each of the seven stages of dementia. A dementia stages chart can help caregivers track and monitor their loved one’s health status against stage-related symptoms. The seven stages of dementia are:

  • Stage 1: No cognitive impairment
  • Stage 2: Very mild cognitive decline
  • Stage 3: Mild cognitive decline
  • Stage 4: Moderate cognitive decline
  • Stage 5: Moderately severe cognitive decline
  • Stage 6: Severe cognitive decline
  • Stage 7: Very severe cognitive decline

Stage 1: No cognitive impairment

Though it may seem odd, stage 1 dementia is normal mental functioning without any cognitive decline. Someone in the first three dementia stages doesn’t usually exhibit enough symptoms to be diagnosed. While some cognitive impairment may be present, stages 1, 2, and 3 on the GDS are recognized as pre-dementia stages.

Stage 2: Very mild cognitive decline

Stage 2 dementia includes simple memory mistakes like a loved one wondering “Where did I put my keys?” or, “What was that person’s name?” A significant amount of the senior population experiences age-related forgetfulness, and caregivers or medical providers may not even notice such mild impairment. This explains why stage 2 is also known as “age-associated memory impairment” on the GDS.

Stage 3: Mild cognitive decline

When memory and cognitive problems become more regular, as well as noticeable to caregivers and family members, a person is said to be suffering from mild cognitive decline, which is also known as mild cognitive impairment (MCI). Stage 3 dementia doesn’t generally have a major impact on day-to-day functioning.

Stage 4: Moderate cognitive decline

Stage 4 dementia is when a person has clear, visible signs of cognitive impairment and exhibits personality changes — both of which are significant dementia symptoms. A person is not typically diagnosed with dementia until they’re at stage 4 or beyond. While the medical terminology for stage 4 dementia is moderate cognitive decline, this stage is officially diagnosed by the GDS as mild dementia. At this stage, doctors and caregivers will likely observe hallmark signs that dementia is getting worse, including difficulties with language and reduced problem-solving skills.

Stage 5: Moderately severe cognitive decline

This stage marks the onset of what many professionals refer to as “mid-stage” in the seven stages of dementia. At this point, a person may no longer be able to carry out normal activities of daily living (ADLs), such as dressing or bathing, or Instrumental activities of daily living (IADLs) without some caregiver assistance. Middle-stage dementia often lasts between two and four years, though every dementia patient will progress at a unique rate.

Stage 6: Severe cognitive decline

Stage 6 dementia marks a need for caregiver help to perform basic daily activities, such as eating, using the toilet, and other self-care. Seniors experiencing this stage of moderately severe dementia may have difficulty regulating sleep, interacting with others, or behaving appropriately in public settings.

Stage 7: Very severe cognitive decline

In stage 7, which is considered late-stage dementia, people can no longer care for themselves. Generally, for patients with severe dementia, all verbal ability is lost and movement becomes severely impaired. Symptoms of late-onset dementia disrupt bodily functions like the ability to chew, swallow, and breathe.

What are the signs of death in elderly with dementia?

Caring for a loved one through the final stage of life is never easy. Whether you carry all the responsibility or just want to be there for them, you probably wonder what to expect. Getting familiar with end-of-life symptoms in older adults can help you understand what your loved one may be experiencing, and promote a smooth transition for everyone. Everyone is different, so you shouldn’t expect to see all these end-of-life signs. Also, your loved one will progress at their own pace, which could be significantly fast or slow.

  • Appetite and digestive changes
  • Sleeping more
  • Withdrawal from the world
  • Anxiety and depression
  • Urinary and bladder incontinence
  • Changing vital signs
  • Confusion
  • Sensory changes
  • Breathing changes
  • Loss of consciousness

Appetite and digestive changes:

As one nears the end of life, metabolism and digestion gradually slow down. Fewer calories are needed, so loss of appetite and decreased thirst are normal. Trouble swallowing, nausea, and constipation can also interfere with appetite. There might be weight loss and signs of dehydration.

Sleeping more:

Generalized weakness and fatigue are common. Energy levels wane and time spent sleeping increases.

Withdrawal from the world:

You might notice a sense of resignation and withdrawal from the larger world. The person may create a protective bubble of fewer people and less curiosity about events outside the bubble. They might spend more time talking about the past than the present.

Anxiety and depression:

As the end of life becomes apparent, some people experience a growing fear or worry for themselves or for those who will be left behind. End-of-life anxiety and depression aren’t uncommon.

Urinary and bladder incontinence:

As the kidneys begin to fail, urine can become more concentrated and darker in color. Both bladder and bowel functions get harder to control.

Changing vital signs:

Heart rate, body temperature, and blood pressure begin dropping. With reduced circulation, the hands, arms, feet, and legs start to feel cool to the touch. The skin may turn dark blue, purple, or appear mottled.

Confusion:

Your loved one may be periodically confused. Time, place, and even close loved ones may be difficult to identify. You might note a limited attention span or repetitive motions like pulling at sheets or tugging at clothing.

Sensory changes:

Eyesight is weakening. Someone nearing death may see, hear, or feel things that you don’t, even speaking to others who have died. Sensory changes can also lead to illusions, hallucinations, and delusions.

Breathing changes:

Breathing grows increasingly slow and shallow with periods of shortness of breath. Fluid can collect in the throat as throat muscles relax. The person may be too weak to clear it by coughing, which can lead to noisy breathing known as a “death rattle.”

Loss of consciousness:

Waking your loved one can become difficult. Eventually, they’ll be uncommunicative and unresponsive, losing consciousness or falling into delirium. Eyes may develop a glassy appearance.

How can you support your loved one’s?

Your doctor will advise you on how to provide physical comfort based on their medical conditions. This may include administering medications for such things as pain, digestive issues, or anxiety.

  • Providing physical comfort
  • Providing emotional comfort

Providing physical comfort:

Whether or not you have professional caregivers or hospice care, there are some basic ways you can provide physical comfort:

  • Use a humidifier to aid breathing.
  • Apply lip balm and alcohol-free lotion to soothe dry skin.
  • Help them stay hydrated with ice chips or apply a wet washcloth to the lips.
  • Change positioning every few hours to prevent bedsores.
  • Provide comfy bedding and refresh as necessary.
  • Prepare soft foods, but don’t force a person to eat.
  • Use low lighting and block out loud or distracting sounds.
  • Let them sleep when they want to.

Providing emotional comfort:

To help provide emotional and spiritual support:

  • Encourage conversation if they’re up for it. Let them lead, be a good listener, and avoid initiating potentially stressful topics.
  • Even if they don’t respond, assume they hear you. Speak directly to them rather than about them. Identify yourself when you enter or leave the room.
  • Provide light physical contact by holding their hand or placing a hand on their shoulder.
  • Play their favorite music at low volume.
  • Don’t ignore, interrupt, or dismiss their thought process. Remain calm if they’re confused. If they’re talking to or seeing someone who isn’t there, let them be.
  • Express your love.
  • Don’t deny reality. If they want to say goodbye, let them. It can provide you both with peace of mind.

Conclusion:

Dementia isn’t one condition. Instead, it encompasses a number of different conditions that affect the brain. These conditions cause cognitive decline that affects a person’s memory, communication abilities, thought patterns, and behavior.

It’s not uncommon to hear the terms “dementia” and “Alzheimer’s disease” used interchangeably. But they are not the same. Alzheimer’s disease does indeed cause the majority of dementia cases, but many other disorders can affect a person’s memory or ability to process information.

If you notice that you or a loved one is beginning to have trouble with some cognitive tasks, don’t ignore it. Contact your doctor and ask for a consultation. While there is no cure for some types of dementia, medical experts can discuss treatments to slow down the progression of the disease.

Author

Nabeel Ahmad is the founder and editor-in-chief of Lone Mind. Apart from Lone Mind, he is a serial entrepreneur, and has founded multiple successful companies in different industries.

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