Stage 7: Very severe cognitive
(Severe or late-stage Alzheimer's disease)
This is the final stage of the disease when
individuals lose the ability to respond to their
environment, the ability to speak and, ultimately,
the ability to control movement.
- Frequently, individuals lose their capacity
for recognizable speech, although words or
phrases may occasionally be uttered
- Individuals need help with eating and
toileting and there is general incontinence of
- Individuals lose the ability to walk without
assistance, then the ability to sit without
support, the ability to smile, and the ability
to hold their head up.
- Reflexes become abnormal and muscles grow
rigid. Swallowing is impaired.
As the disease progresses from mild to mid-stage,
the signs of AD may become more noticeable to family
members and friends. At this point, changes in the
relationship usually occur, moving spouses or adult
children beyond their inherent roles toward
caregiving roles. Mid-stage is the longest of the
three main stages and during this time, the reality
of the disease hits home.
The hallmarks of this stage may include: an
increase in memory problems, uncertainty about
person, place and time, delusions, troublesome
behaviors, incidents of wandering and getting lost,
notable personality changes, decreasing motivation
levels, disrupted sleep patterns, changes in
communication and the performance of personal care
tasks. This stage clearly leads to increased
dependence on the caregiver for support.
Although there are certainly many focal points of
AD to regard during the middle stage, five important
considerations emerge: safety, managing behaviors,
structured activities, caregiver support and using
1) Safety :
Usually at this mid-stage, the need for caregiver
assistance becomes essential for the safety of the
individual with AD. A safe environment is critical
at this point since problems with memory and
judgment increase and the person with AD can become
more vulnerable to fires, accidents or falls.
- There may be times to gently remind the
person about their diagnosis, especially as it
relates to a safety issue.
- As soon as (probable) Alzheimer’s disease is
diagnosed, a person with AD should be carefully
supervised, limited or even prevented from
driving. The risk to self and other innocent
people is greatly accelerated and although
difficult, steps may need to be taken to remove
the car keys and plan for alternative
- Install home monitoring systems such as
alarms, door locks or safety guards if needed.
- Enroll the person with AD in the Alzheimer’s
Association’s Safe Return program or obtain an
ID or medical alert bracelet for them to wear at
- At some point, safety issues such as not
turning off the faucet or stove, or engaging in
unpredictable or dangerous activities may
determine whether a person needs 24 hour
supervision or can continue living at home.