10 Signs Death is Near in Dementia Patients

What is dementia?

Dementia is a syndrome referring to a progressive decline of brain function. It adversely affects thinking, memory and behavior and can disrupt a sufferer’s personal and professional life. ^[1]

It is common for your memory to be affected by everyday stress and fatigue, but if you see a pattern of forgetfulness in yourself or a loved one, it is advised to seek a medical diagnosis as soon as possible. ^[1]

Many people enjoy active and rewarding lives for many years after being diagnosed with dementia, and the medical guidance and help received can be essential to them doing so. ^[1]

Types of dementia

Dementia is an umbrella term used to describe a range of conditions adversely affecting the brain. The 4 most common forms of dementia and some of their symptoms are detailed below. ^[2]

Alzheimer’s disease

• Gradual, progressive decline – symptoms appear mild at first and intensify over time
• Short term memory loss and problems with 3-word or 5-word recall in early stages
• Executive function damage in later stages – this may look like an inability to plan, poor judgement or time management
• Mood and personality changes

Vascular dementia

• Sudden or gradual onset
• Typically caused by a stroke
• Difficulty speaking and understanding speech
• Vision loss
• Problems with movement and falls depending on extent of the stroke.
• Thinking and reasoning typically affected more than memory loss in early stages

Lewy body dementia (LBD)

• Lewy bodies (microscopic deposits of protein) form in the cortex
• Related to Parkinson’s disease – over 80% of individuals with LBD develop Parkinson’s
• Poor executive function in early stages
• Visual hallucinations in early stages
• Sustained periods of staring into space

Frontotemporal dementia

• Disorders that affect the frontal and temporal lobes of brain e.g., Picks disease
• Occur at a younger age – between 40 and 75.
• More personality and behavioral irregularities than memory impairment in early stages
• Sudden bouts of aggression, agitation and a lack of inhibition in social situations.

What are 10 signs death is near in people with dementia?

A person with dementia will typically decline as time goes by. The rate at which this happens depends on the person, the type of dementia, and medical intervention.

As the disease develops, a person can struggle with greater memory loss and problems with self-regulation. ^[2] Their judgement, their ability to convey and understand information, and their movement all deteriorate, until finally, a person with severe dementia is no longer able to care for  themselves.

Here are 10 signs death is near in dementia: ^[3]

1. Eating, drinking and swallowing difficulties
2. Irregular breathing pattern
3. Increased frailty
4. Become less mobile
5. Sleep more
6. Either unable to speak or speaking in barely intelligible phrases/utterings
7. Have more infections
8. Need urgent medical care
9. Bowel and bladder incontinence
10. Lose consciousness intermittently

What does the final stage of dementia look like?

In the final stages of dementia, a person experiences an intense decline in quality of life. This experience depends on both the individual and the form of dementia they suffer from.

Below is a list describing how the final stages can look in the 4 most common types of dementia:

Alzheimer’s disease

• Median 4-8 years after diagnosis until final stage of dementia
• Persons appear unresponsive to their surroundings
• Difficulty communicating
• Cannot control movement e.g., walking, sitting, and lying down
• Require around the clock care
• Increased vulnerability to infections, especially pneumonia ^[4]

Vascular dementia

• Around 5 years following onset of symptoms
• Severe cognitive impairment and decline
• Difficulty communicating
• Behavioral issues
• Loss of control of bodily functions – incontinence
• Difficulty swallowing
• Require 24-hour care and supervision ^[2]

Lewy body dementia

• Median 3-4 years following clinical diagnosis
• Loss of appetite
• Loss of ability to swallow
• Difficulty walking
• Diminishing cognition
• Decreased communication
• Increased sleepiness
• Increased hallucinations
• Require 24-hour care as symptoms progress ^[6]

Frontotemporal dementia

• Between 1-3 years following clinical diagnosis
• Incontinence and pressure ulcers
• Loss of appetite
• Epilepsy
• Difficulty walking
• Increased vulnerability to infections, especially pneumonia.
• Involuntary functional disorders
• Require 24-hour care and supervision ^[7]

How does dementia cause death?

Dementia isn’t solely responsible for death, rather it causes complications that lead to death. A person in the final stages of dementia has a higher risk of contracting potentially fatal diseases.

Aspiration pneumonia, coronary heart disease, and gastrointestinal disease are among the conditions people with advanced dementia are more prone to contracting. ^{[7] [8]}

A lack of inclination to eat or drink combined with an inability to swallow leads to malnutrition and dehydration, another leading cause of death in dementia patients. ^[8].

A lack of mobility and gait problems may also increase the risk of blood clots forming in the lungs.

How to prepare for your loved onee's final stage of dementia

Coping with a loved one’s struggle with dementia can feel disheartening. Whilst there is no cure, you can take steps to provide them with comfort and care.

Advanced care planning is recommended in early stages after diagnosis. ^[6] Having plans in place make the end-of-life process easier and can ease the emotional burden on the family.

For example, during a 2019 study into end-of-life care, a child of someone with dementia claimed that his parents getting their medical documentation in place was extremely beneficial when it came to the final stages of their lives. ^[6]

Making advanced directives such as living wills, power of attorney and other health care instructions could prove helpful down the line.

There are numerous medical options, such as palliative or hospice care, that can be effective in providing comfort for someone with dementia and helping them connect with their family. ^[9]

Hospice care experts can also provide succor to caregivers for dementia patients towards the end of their loved one’s life, as they cope with an overwhelming number of different emotions. ^[9].