Advanced Alzheimer Symptoms are relentless.  It strikes anyone, even President Ronald Reagan. This article addresses late-stage symptoms from the perspective of a caregiver.  To family and friends I say, “Caring is not love and understanding for the person you once knew, caring is love and understanding “at the moment” for the person whose memory is going, going, gone.” 


Between Alzheimer’s Disease progressing to the late stages and normal aging, the brain is estimated to lose 100,000 neurons per day. As accumulation mounts, over 365 million neurons are lost in10 years. These losses over time compares to the total of 100 billion neurons in the brain. As neuron losses accumulate, so do the symptoms. Ealy symptoms like repeated questions, lack of decision making, and faulty judgement seem minor while caregiver issues and decisions become more challenging. The caregiver is now challenged with a patient lifestyle of “at the moment”. Caregiver issues become finding activities and a social environment to maintain an individual’s self-esteem.   As the disease continues, it spreads to the amygdala, which is the trigger for emotions (joy, reward, fear, etc.). The patient’s personality is eventually impacted.  THIS IS ADVANCED ALZHEIMER DISEASE.

Late Stage AD Sypmtoms

So, what are the symptoms of Late Stage Alzheimer Disease, and how does a caregiver deal with them? The ability to read and write declines and is eventually lost. The neocortex, storage of long-term memory, knowledge learned during life, as well as functions to define who we are by storing our self-image and life events, becomes impacted. Additionally, its executive function provides the ability to think by recalling past episodes in life and applying learned knowledge that allows creativity and interaction in society. With the neocortex damaged there is no recall to associate sensory input to past episodes, and there is difficulty finding words to communicate, confusion increases, and confidence decreases even more.

Severe AD Symptoms

Security, morality, and hygiene issues, along with loss of self, wandering, and sun-downing (mood change when the sun sets) are all later symptoms. Caregivers must deal with these symptoms as accumulation of lost neuron increases.

Security: Without knowledge and recall, a patient depends on someone who is trusted (“Me and My Shadow”—caregiver’s slogan) for their security.  The caregiver, or a trusted, familiar person, must always be nearby. 

Morality and Hygiene Issues: These can take many paths, which are probably different for males and females.  Males could become verbally abusive.  This can create a very difficult and unpleasant situation for the caregiver, who must consider avoiding public settings.  Dinning in familiar settings with known friends is very beneficial.  A female may revert to modesty, a logical development since she’d be using the brain stem that contains undestroyed early values. This becomes difficult for the caregiver who must see that good hygiene is maintained.  A female may not want a male caregiver in the bathroom with her.  In this situation, the caregiver may have to remove door locks and see that a bathtub with curtains can be used to maintain privacy while collecting clothes that need to be washed.

“Loss of self” is one of the saddest parts of the disease for the caregiver and the family.  At this point memorabilia loses its significance.  Since recall and knowledge are gone along with reading, everything of interest is “at the moment”.  Walking, exercise, movies, simple jigsaw puzzles, lots of hugs, activities, music, and just BEING THERE are caregiver tools. 

Wandering is a confused state that occurs more when a person doesn’t have a caregiver.  However, it becomes serious even for a caregiver if it occurs while he/she is sleeping.  As in a memory care facility, the caregiver would need to develop an alarm system for sleeping hours. 

Sun-downing is a mood disturbance that could vary from agitation to severe anxiety, fear, and hallucinations.  Caregivers should first remember everything is “at the moment” and make attempts to change the mood with redirection, for example, a snack, ice cream, or some hugs. At this point a love one has lost the capability for self-sustaining “Activities of Daily Living (ADL) which now classifies the disease as ALZHEIMER’S DEMENTIA.


Changes in eating occur throughout the Dementia stage. Large, even “normal,” portions become overwhelming.  Appetite decreases.  Water intake becomes an issue.  The caregiver needs to work around these by providing small portions more often and between-meals snacks and using pop-sicles and/or Jell-O for water. As the disease continues to decline, the patient loses the purpose of utensils and begins to eat with their fingers (like a one year old). Later, they have problem finding their mouth. Without these capabilities, they will sit and stare at their food. CAREGIVER FEEDING BEGINS HERE

Decisions: The hardest family caregiver issue is the decision to continue personal home care or place a loved one in a memory care facility.  This is a personal decision that only each family caregiver can make.  A memory care facility is more difficult for the caregiver than the love one.  After a visit, the caregiver is gone from the love one’s mind within seconds, while the caregiver initially feels guilt that he left his love one. See Alzheimer’s Care Decisions


As Alzheimer’s Disease progresses, minor neuron loss begins in the early symptomatic stages, The first real inconvenience comes with loss of driving privileges. Caregivers become more concerned and involved as Me and My Shadow demonstrate fear and insecurity. The real care image comes into focus as Alzheimer’s Symptoms are relentless to where the patient demonstrate their inability to self-sustain Activities of Daily Living (ADL). Faced with decisions and an overload of care, caregiver stress surfaces and becomes a high level concern for caregiver’s health.  Though this is a real concern, I believe it can b e minimized by gaining knowledge, facing realistic expectations, and avoiding self pity.

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