Category: Blog Post

When a loved one has late-stage dementia, knowing what to anticipate might be helpful. The loss of a loved one can be a difficult notion to grasp and comprehend. Understanding what is ahead can help you prepare both mentally and physically.

Knowing when a dementia patient is on the verge of passing away can be challenging. Early signs of the dying process may include indications of late-stage dementia and a rapid decline in the patient’s condition.

How long will someone with dementia live?

Although dementia is a life-limiting illness, it is exceedingly challenging to predict how long a person with dementia will live. Several factors influence this.

It may be easier to predict how long someone will live and how they will die if they also have another illness that may shorten their life (such as cancer or heart failure).

An individual can die from another illness at any stage of dementia. As a result, people might pass away before their dementia symptoms get severe.

A person in the final stages of dementia may deteriorate gradually over several months. Typically, at this time, they will:

• become more feeble
• experience infections and falls more frequently
• have trouble swallowing, eating, and drinking
• more likely to require immediate medical attention
• become less mobile
• more sleep
• Talk less frequently.

A person with advanced dementia is more likely to have a compromised immune system. As a result, individuals are more likely to contract infections, which in some situations may be chronic. Pneumonia brought on by an infection is one of the most typical causes of death for dementia patients.

A person with advanced dementia may exhibit signs that indicate they are on the verge of passing away, yet they may still be able to function for several months. Planning and putting in place measures for someone’s passing become quite challenging due to this unpredictability.

What are the symptoms that a person with dementia is approaching the end of their life?

Knowing when a dementia patient is approaching the end of their life can help with providing the appropriate care. It can be challenging to determine the exact moment, though.

This unpredictability can significantly affect how the person feels and how their family, friends, and caregivers feel.

Late Stage Dementia

Your loved one with dementia will eventually enter the late stages of the disease. This stage is also known as advanced dementia or end-stage dementia. Their symptoms become acute at this point.

The person will experience difficulties performing routine tasks, including showering, getting dressed, eating, and using the restroom. They might not be able to walk or sit up without assistance and constantly require care. At this stage, they would become bedridden.

Additionally, they could lose their capacity to talk and make facial emotions like a smile. Seeing this transformation can be very difficult for family members.

Signs of late-stage dementia

Some later-stage dementia symptoms may indicate the patient is nearing the end of life. These include:

• speech confined to single, potentially meaningless words or sentences
• having trouble understanding what is being stated to them
• needing assistance with most daily tasks
• eating less and experiencing swallowing issues
• bowel and bladder incontinence
• having trouble sitting up, difficulty walking or standing, and becoming bedbound.

A person with dementia is likely nearing the end of their life if they exhibit most or all of these symptoms. They could also be very feeble, suffer from recurring infections, or have pressure ulcers (or bedsores).

Signs of the dying process

More changes are typical as a person’s condition deteriorates, and they are just days or hours away from dying. A person might:

• deteriorate at a faster rate than before
• become unconscious
• be incapable of swallowing
• become restless and agitated
• develop an uneven breathing pattern
• have breathing that sounds chesty or rattling
• have chilly feet and hands.

These changes are common during the dying process, and the person is frequently unaware of what is happening.

What assistance may medical professionals offer at this point?

Healthcare providers can explain these changes to you so you comprehend what is happening.

Medical personnel might intervene to lessen the patient’s suffering. If the patient cannot swallow, they can administer medication via skin patches, small injections, or syringe pumps, which deliver a constant flow of medication through a tiny needle under the patient’s skin. Consult your general practitioner or another qualified healthcare provider about this.

How can you manage dementia end-of-life symptoms of your loved one?

It’s crucial for caregivers to closely monitor their loved one for pain or discomfort because people with advanced dementia frequently have trouble speaking. Some examples of such symptoms include moaning or shouting, restlessness or an inability to fall asleep, grimacing, or sweating. It can also be a sign that you should contact a hospice or palliative care provider for assistance with pain management.

Hospice can offer a hospital bed or other equipment to raise the head if a person with end-stage dementia has problems sitting up without help.

Families may find it most difficult when a loved one with dementia loses the ability to swallow or eat. Because a person with dementia cannot comprehend the advantages of IV drips or feeding tubes, they frequently get extremely agitated and try to remove them, resulting in further discomfort and infection risk. Instead, concentrate on keeping the person at ease.

References

1. How to know when a person with dementia is nearing the end of their life. Alzheimer’s Society . https://www.alzheimers.org.uk/get-support/help-dementia-care/recognising-when-someone-reaching-end-their-life. Accessed: 3rd August, 2023.
2. Dying From Dementia With Late-Stage Symptoms. Very Well Health . https://www.verywellhealth.com/what-is-it-like-to-die-of-dementia-1132331. Published Online: 26th October, 2022. Accessed: 3rd August, 2023.
3. Signs of Dying in the Elderly with Dementia. Crossroads Hospice & Palliative Care. https://www.crossroadshospice.com/hospice-resources/end-of-life-signs/dementia/. Accessed: 3rd Aug, 2023.

A recent study relates the risk of Alzheimer’s to the gut microbiome. People with early indicators of the disease exhibited similar gut microbiome compositions that differed from those without early symptoms of the disorder.

The cause of Alzheimer’s disease is still a mystery to researchers because it is a complex ailment. According to a recent study, your gut bacteria may influence whether you get Alzheimer’s disease or not.

Researchers at Washington University School of Medicine have found that individuals with Alzheimer’s who are in the early stages of the disease – when brain changes have started but before cognitive symptoms are noticeable – have an assortment of bacteria in their intestines that are different from the gut bacteria of healthy individuals.

What is the new research about?

The scientists discovered that experiencing changes in gut bacterial populations may be an early sign of the disease. These alterations can sometimes develop years before the first indications of cognitive decline, such as memory loss and confusion.

The study, which examined the gut microbiome and composition of 164 senior citizens (aged 68 to 94) with normal cognitive function, was published in the journal Science Translational Medicine. To find those who might have early signs of Alzheimer’s, the researchers looked for the presence of the proteins amyloid and tau in the participants’ brains and had them take cognitive tests.

The scientists then compared the bacteria identified in the guts of 49 preclinical Alzheimer’s patients to those who did not show symptoms of Alzheimer’s proteins via fecal samples to determine if their microbiomes were distinct.

Researchers discovered that individuals with preclinical Alzheimer’s had distinct gut microbiomes from those who did not have the condition. In particular, individuals with preclinical disease frequently had larger quantities of bacteria responsible for degrading the amino acids arginine and ornithine, which contribute to protein synthesis. In general, those without preclinical Alzheimer’s had higher levels of microorganisms engaged in glutamate breakdown, which can preserve neurons.

The researchers also compared that information to risk factors such as a family history of Alzheimer’s, the participants’ age, genetics, and diabetes status, as well as brain images, to determine who was in the early stages of Alzheimer’s—and it was quite accurate.

The researchers stated that gut microbiome implications of preclinical Alzheimer’s neuropathology could help understand the disease’s etiology and find gut-derived markers of its risk.

How are the gut and brain connected?

Although your gut and brain are present in different regions of your body, research has revealed that they can influence one another. The gut-brain axis, which is essentially communication between your brain and gut, connects some activities in your intestine with your brain’s emotional and cognitive regions.

Here are some instances of your gut-brain axis in action: When you are stressed, you may experience diarrhea or constipation, or when you are nervous, you may experience butterflies in your stomach.

Researchers are still investigating how the gut-brain axis can affect a variety of disorders, including IBS (irritable bowel syndrome), depression, and obesity.

What connection exists between the gut and the brain in Alzheimer’s disease?

At this moment, nothing is certain. According to the co-author Beau M. Ances, it’s difficult to distinguish if the gut influences the brain or the brain influences the gut. That means it is unclear if the gut microbiota alterations are due to brain abnormalities or if the gut changes truly contribute to Alzheimer’s.

Some previous studies have also explored this connection.

• According to a previous study, chronic inflammation in the brain can increase the likelihood of developing Alzheimer’s by triggering cell damage and death.
• Another research has reported that high-fiber diets, including whole grains, fruits, and vegetables, may also help lower inflammation.
• According to the National Institute on Aging (NIA), specific gut bacteria turn the fiber in these foods into substances known as short-chain fatty acids (SCFAs), which can reduce inflammation and may enhance animal memory.
• A high-fiber diet, for example, changed the species of bacteria in the gut microbiome, increased the generation of SCFAs, and decreased the expression of some genes that govern inflammation in the brain, according to the findings of one mouse study published last year.

What’s next?

There are some ambiguities. The most recent study discovered that despite consuming essentially the same diet, persons with preclinical Alzheimer’s disease and those who were healthy had distinct gut microbes.

According to Dr. Ances, this research may eventually result in a diagnostic test that is more user-friendly and widely available.

People who have early signs of Alzheimer’s disease may also benefit from taking action to halt the disease’s course or perhaps prevent it.

In addition, Dr. Ances and his team have started a five-year follow-up research to determine whether variations in the gut microbiome are a cause or a consequence of the alterations in the brain that are characteristic of early Alzheimer’s.

References

1. Ferreiro, A.L., Choi, J., Ryou, J., Newcomer, E.P., Thompson, R., Bollinger, R.M., Hall-Moore, C., Ndao, I.M., Sax, L., Benzinger, T.L. and Stark, S.L., 2023. Gut microbiome composition may be an indicator of preclinical Alzheimer’s disease. Science Translational Medicine, 15(700), p.eabo2984.
2. Carabotti, M., Scirocco, A., Maselli, M.A. and Severi, C., 2015. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Annals of gastroenterology: quarterly publication of the Hellenic Society of Gastroenterology, 28(2), p.203.
3. Newcombe, E.A., Camats-Perna, J., Silva, M.L., Valmas, N., Huat, T.J. and Medeiros, R., 2018. Inflammation: the link between comorbidities, genetics, and Alzheimer’s disease. Journal of neuroinflammation, 15(1), pp.1-26.
4. McGrattan, A.M., McGuinness, B., McKinley, M.C., Kee, F., Passmore, P., Woodside, J.V. and McEvoy, C.T., 2019. Diet and inflammation in cognitive ageing and Alzheimer’s disease. Current nutrition reports, 8, pp.53-65.
5. Beyond the brain: The gut microbiome and Alzheimer’s disease. National Institute on Aging. https://www.nia.nih.gov/news/beyond-brain-gut-microbiome-and-alzheimers-disease. Published Online: 12th June, 2023. Accessed: 31st July, 2023.
6. Vailati-Riboni, M., Rund, L., Caetano-Silva, M.E., Hutchinson, N.T., Wang, S.S., Soto-Díaz, K., Woods, J.A., Steelman, A.J. and Johnson, R.W., 2022. Dietary fiber as a counterbalance to age-related microglial cell dysfunction. Frontiers in Nutrition, 9, p.835824.
7. Miller, K. An Early Sign of Alzheimer’s Disease May Be Lurking in Your Gut, Study Finds. https://www.prevention.com/health/memory/a44211806/gut-alzheimers-risk-link-bacteria-microbiome-study/. Published Online: 16th June, 2023. Accessed: 31st July, 2023.
8. Altered gut bacteria may be early sign of Alzheimer’s disease. Washington University School of Medicine in St. Louis. https://medicine.wustl.edu/news/altered-gut-bacteria-may-be-early-sign-of-alzheimers-disease/. Published Online: 14th June, 2023. Accessed: 31st July, 2023.
9. When Gut Bacteria May Be an Early Sign of Alzheimer’s Disease. Times. https://time.com/6287229/gut-alzheimers-connection-microbiome-bacteria/. Published Online: 14th June, 2023. Accessed: 31st July, 2023.

Many people with dementia in its final stages might not eat or drink. Additionally, they could get dysphagia, which would make it difficult for them to swallow effectively. The amount of time a person can survive without food and water varies, but experts think adequate end-of-life care may help them live better.

Why do individuals with advanced dementia stop consuming food and liquids?

There are numerous causes for why someone can quit eating and drinking. Most people have a decline in activity and calorie requirements when a neurocognitive condition worsens.

The National Foundation of Swallowing Disorders estimates that at least 45% of patients with dementia also have dysphagia (or trouble swallowing) [1]. As a result, a person may be unable to consume enough nutrition and liquids.
Additionally, people with dementia might not maintain their oral hygiene as consistently as they once did. It can lead to sore mouths, infected teeth, and uncomfortable dentures [2].

Another possibility is that the brain damage has extended to the hypothalamus, which controls food intake [3]. Alternatively, it is possible that the person has lost the ability to recognize food or has stopped remembering to eat.

Aging can also be a factor in swallowing problems since the muscles lose bulk and become weaker and less mobile with age. The individual may feel as though they are choking on food or are unable to get it out of their mouth.

How long can a person with dementia survive without food or liquids?

Nobody knows how long someone can live without eating or drinking because it involves many variables. These factors include the person’s age, general health, and the ability of their immune system to combat infections.

Dysphagia is typically present in the later stages of neurocognitive disorders, so if someone has it, it may be a sign that their condition is worsening. As a result, there is a higher chance that someone will inhale food or fluids and develop a chest infection [4].

Although it is impossible to anticipate how long a person can go without eating or drinking, dysphagia can signal the beginning of end-of-life care [5].

What is artificial nutrition and hydration (ANH)?

Artificial nutrition and hydration (ANH) is a process in which medical professionals use a tube to administer nutrients and fluids intravenously into a patient’s body. This tube enters the stomach via the nose or a stomach-mounted device.

However, these doctors must provide such therapies in a healthcare facility, which many patients with neurocognitive disorders find stressful. Some people may attempt to take the tubes out.

Since it is unknown whether ANH offers any overall benefits, doctors do not usually advise this treatment for patients with late-stage dementia.

According to the American Speech-Language-Hearing Association, tube feeding does not enhance a dementia patient’s quality of life [6]. Furthermore, it claims that feeding through a tube does not lower their risk of getting a chest infection.

The Alzheimer’s Association advises people with neurocognitive disorders to plan their end-of-life care while they can still communicate and make decisions. It can include whether or not they desire ANH [7].

What indicators tell that an individual is nearing death?

When a person with dementia is on the verge of passing away, their condition worsens more quickly. They can become agitated and incontinent.

The Alzheimer’s Society of the UK lists the following as symptoms that a person with dementia is nearing death [8]:

• loss of consciousness
• unsteady breathing
• restlessness
• rattly sound in the chest
• cold hands and feet

According to a 2019 study, pneumonia was the cause of mortality for 50% of those who needed hospital treatment because they had dementia [9].

Tips to support a person with late stage dementia

Doctors advise assisting patients to eat and drink for as long as possible, even if in small amounts. Here are some tips to help you support your late stage dementia patient.

• Offer soft food.
• Thicken liquids with unflavored gelatin or cornstarch.
• Alternate bites of food with sips of fluid.
• Offer ice cream or sherbet.
• Serve finger food if the patient has trouble using cutlery.
• Help the patient sit in an upright and comfortable position.

References

1. Caregiver’s Guide to Dysphagia in Dementia. NFOSD. https://swallowingdisorderfoundation.com/caregivers-guide-dysphagia-dementia/#. Published Online: 7th Feb, 2017. Accessed: 4th July, 2023.
2. Espinosa-Val, M.C., Martín-Martínez, A., Graupera, M., Arias, O., Elvira, A., Cabré, M., Palomera, E., Bolívar-Prados, M., Clavé, P. and Ortega, O., 2020. Prevalence, risk factors, and complications of oropharyngeal dysphagia in older patients with dementia. Nutrients, 12(3), p.863.
3. Vercruysse, P., Vieau, D., Blum, D., Petersén, Å. and Dupuis, L., 2018. Hypothalamic alterations in neurodegenerative diseases and their relation to abnormal energy metabolism. Frontiers in molecular neuroscience, 11, p.2
4. Espinosa-Val, M.C., Martín-Martínez, A., Graupera, M., Arias, O., Elvira, A., Cabré, M., Palomera, E., Bolívar-Prados, M., Clavé, P. and Ortega, O., 2020. Prevalence, risk factors, and complications of oropharyngeal dysphagia in older patients with dementia. Nutrients, 12(3), p.863.
5. End-of-Life Care for People With Dementia. National Institute on Aging. https://www.nia.nih.gov/health/end-life-care-people-dementia. Accessed: 4th July, 2023.
6. Alternative Nutrition and Hydration in Dysphagia Care. ASHA. https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/alternative-nutrition-and-hydration-in-dysphagia-care/. Accessed: 4th July, 2023.
7. End-of-life Planning. Alzheimer’s Association. https://www.alz.org/help-support/i-have-alz/plan-for-your-future/end_of_life_planning. Accessed: 4th July, 2023.
8. How to know when a person with dementia is nearing the end of their life. Alzheimer’s Society. https://www.alzheimers.org.uk/get-support/help-dementia-care/recognising-when-someone-reaching-end-their-life. Accessed: 4th July, 2023.
9. Manabe, T., Fujikura, Y., Mizukami, K., Akatsu, H. and Kudo, K., 2019. Pneumonia-associated death in patients with dementia: A systematic review and meta-analysis. PloS one, 14(3), p.e0213825.
10. Dementia: How long can a person live without eating or drinking? Medical News Today. https://www.medicalnewstoday.com/articles/dementia-how-long-can-a-person-live-without-eating-or-drinking. Published Online: 8th Aug, 2022. Accessed: 4th July, 2023.

Researchers at Scripps Research and the University of Bologna have recently discovered that the combination of genetic predisposition and alcohol use disorder (AUD) may hasten the progression of Alzheimer’s. The study’s findings elucidate the molecular processes driving memory loss and may have broader ramifications for comprehending and managing Alzheimer’s, irrespective of the consumption of alcohol.

According to a recent study published in eNeuro, mice exposed to periodic high amounts of alcohol showed signs of cognitive loss about two months earlier than they would have otherwise. Ethanol increases the onset of Alzheimer’s disease (AD) by several months or possibly a few years in people with a hereditary predisposition to the disorder.

While there hasn’t been much research on how alcohol affects Alzheimer’s progression, epidemiological studies have indicated that alcohol use disorder may raise the overall risk of dementia development.

The researchers performed an experiment where mice were subjected to recurrent alcohol use over months, simulating the amounts of alcohol exposure reported in people with alcohol use disorder.

They contrasted the behavior of control mice with those with three particular gene mutations linked to an increased risk of Alzheimer’s.

What is the link between dementia & alcohol?

Previous studies have suggested a link between alcohol consumption and brain damage. The National Institute for Health and Care Excellence (NICE) and Alzheimer’s Disease International examined several research studies on the relationship between alcohol use and dementia development.

Both reviews adopted a systematic methodology in which experts assessed the findings of numerous earlier published research investigations.

These studies observed that people who drank heavily or binge drank (consuming a lot of alcohol quickly) had a higher risk of developing Alzheimer’s disease or any other form of dementia than people who drank moderately.

The NICE-evaluated research concentrated on sizable populations of hundreds or even thousands of people, commencing in mid-life (age 40–64). They followed them for more than five years, often far into old age, to examine how long-term behavioral habits could affect dementia risk.

How might alcohol harm the brain?

Brain damage can result from heavy alcohol use over an extended period. Long-term heavy drinkers are more likely to have less white matter in their brains, which aids in signal transmission between various brain regions. It may cause problems with how the brain works.

Additionally, prolonged heavy drinking can lead to thiamine B1 deficiency and Korsakoff’s syndrome, a memory condition that affects short-term memory.

How alcohol and genetic predisposition can accelerate Alzheimer’s onset?

The current study’s findings showed that mice exposed to alcohol gradually lost the ability to acquire and retain spatial patterns, and they started to exhibit these cognitive deficits earlier than mice in the control group.

The researchers discovered cognitive deficits in mice who received alcohol treatment almost two months before the standard period when such abnormalities would appear.

They thoroughly investigated the gene expression in the brains of those mice exposed to alcohol and those that weren’t to comprehend the underlying causes of alcohol use disorder.

They also compared the gene expression profiles of over 100,000 individual cells.

According to the findings, alcohol exposure caused significant changes in gene expression across the prefrontal brain.

The researchers observed increased expression of genes linked to neuronal excitability, neurodegeneration, and inflammation, specifically in the alcohol-exposed animals.

Supporting cells, including astrocytes, microglia, and endothelial cells, also showed abnormal gene expression patterns in reaction to alcohol exposure, indicating that these modifications were not confined to neurons.

Previously, neurons were primarily considered responsible for Alzheimer’s-related responses. Scientists have only recently discovered the involvement of these additional cell types in Alzheimer’s progression.

Alcohol alters gene expression, which may result in memory loss.

The researchers contrasted the gene transcription profiles of alcohol-exposed mice with the control group at different ages and stages of Alzheimer’s but with identical genetic backgrounds.

They found that the alcohol-exposed mice’s gene transcription profiles resembled older mice with more severe cognitive deterioration than mice their age.

Upon comparing the alcohol-exposed mice to the same type of mice at different Alzheimer’s stages (including mice without any impairments and severely compromised mice), the researchers found that alcohol exposure changed the gene expression patterns in a way typically associated with advanced stages.

How can it help in future research?

The first step toward understanding the molecular mechanisms underlying memory loss and creating treatments is to comprehend how gene expression changes in various cell groups throughout Alzheimer’s.

The researchers hypothesize that the gene transcription mechanisms involved in Alzheimer’s development with alcohol use disorder (AUD) may also contribute to the explanation of disease progression without alcohol use.

Although the researchers focused on familial Alzheimer’s in this study, the team plans to investigate whether alcohol usage also affects the incidence and course of sporadic Alzheimer’s in individuals who are not genetically prone to the disease in the future.

References

1. Sanna, P.P., Cabrelle, C., Kawamura, T., Mercatelli, D., O’Connor, N., Roberts, A.J., Repunte-Canonigo, V. and Giorgi, F.M., 2023. A history of repeated alcohol intoxication promotes cognitive impairment and gene expression signatures of disease progression in the 3xTg mouse model of Alzheimer’s disease. Eneuro.
2. National Institute for Health and Care Excellence, 2015. Dementia, disability and frailty in later life—mid-life approaches to delay or prevent onset. NICE guideline [NG16].
3. Prince, M., Albanese, E., Guerchet, M. and Prina, M., 2014. World Alzheimer Report 2014. Dementia and Risk Reduction: An analysis of protective and modifiable risk factors (Doctoral dissertation, Alzheimer’s Disease International).
4. Excess alcohol consumption may speed up progression of Alzheimer’s disease. Medical News Daily. https://www.medicalnewstoday.com/articles/excess-alcohol-speeds-up-alzheimers-progression. Published Online: 23rd June, 2023. Accessed: 3rd July, 2023.
5. Alcohol and Dementia. Alzheimer’s Society. https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/alcohol. Accessed: 3rd July, 2023.
6. Alcohol in Excess Hastens Alzheimer’s Progression. Neuroscience. https://neurosciencenews.com/alcohol-genetics-alzheimers-23448/. Published Online: 12th June, 2023. Accessed: 3rd July, 2023.