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Persevering Through Mid-Stage Alzheimer’s Disease
By Kristine Dwyer, Staff Writer

(Page 3 of 6)


Stage 7:  Very severe cognitive decline
(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 urine
  • 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 resources.

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.

Focal points:

  • 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 transportation.
  • 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 all times.
  • 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.


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