Q: If Alzheimer’s is a disease of the memory, how do people die from it?
A: Alzheimer's disease (AD) is very complex and always fatal. It manifests initially with marked memory failure, but as it progresses, it also has an effect on higher brain functions. In the later stages of the disease, balance and coordination as well as autonomic functions like heart rate, breathing, digestion and sleep cycles are severely affected.
When the clinical picture of the disease is fully developed, a patient will be unable to perform the tasks that keep our bodies alive and functioning. Neurological damage causes the patient to lose the ability to coordinate even simple movements. Eventually, they are unable to walk, communicate, maintain control of their bladder and bowels, feed themselves, chew, and swallow food without significant assistance and careful supervision. The later stages can be both emotionally and physically taxing not only for patients themselves, but also for their family caregivers. At this point, if the subject has not already been discussed, family members may wish to consider hospice care for their loved one.
This lack of self-awareness and self-care, prolonged confinement to a bed, feeding failure and inability to receive proper nutrition and hydration are all factors in the development of other life-threatening diseases. While brain damage associated with AD is the driving force behind the patient's decline and incapacitation, these secondary illnesses and conditions are actually responsible for causing the patient's death and are commonly cited as such on death certificates.
The most prevalent cause is a secondary infection, commonly pneumonia. Bacterial infections could be easily remedied with a course of antibiotics in healthy individuals. However, advanced AD patients are usually too frail and immunocompromised to fight, even with the assistance of these drugs. Infections often return after treatment, and many patients or their family members make the decision to forgo aggressive treatment options and/or resuscitation efforts that may cause pain and discomfort for only a short-term benefit.
All of the below conditions can cause or contribute to multiple organ failure and death.
- Heart attack
- Dehydration and malnutrition, whether through a voluntary stopping of eating and drinking (VSED) health care directive or the natural dying process
- Injuries and fractures caused by falls
- Pressure ulcers (bedsores)
- Kidney failure
- Lung infections like aspiration pneumonia due to inhalation of food particles
- Sepsis (if infections like UTIs and pneumonia spread)
Unfortunately, deaths with a primary cause of Alzheimer's disease and other forms of dementia are seriously underreported. This is especially true since AD can go unnoticed as it progresses slowly over the course of many years. Furthermore, a significant number of patients never receive an official neurological diagnosis.