We have reached the final stage of Alzheimer’s disease (AD) as defined by the Alzheimer’s Association: Stage 7 Very Severe Cognitive Decline — Severe or late-stage Alzheimer’s disease. There are many places on the Internet where you can get information about Alzheimer’s disease and when one is diagnosed with Alzheimer’s or has a family member diagnosed with the dreaded disease, one cannot get enough information.

One outstanding source of information is the Fischer Center for Alzheimer’s Research Foundation. They have an excellent Web site discussing the seven clinical stages of Alzheimer’s disease, but they break it down further into sub-stages. Below is the Alzheimer’s Association summary of “Stage 7 Very Severe Cognitive Decline.” It will be followed by a description of the Fischer Center’s sub-stages of stage 7.

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.

According to the Fischer Center for Alzheimer’s Research Foundation, there are 6 consecutive functional sub-stages for stage 7. In brief, they are:

1. Speech is limited to approximately a half dozen intelligible words or fewer in the course of an intensive contact and attempt at an interview with numerous queries. (approximately 1 year)
2. Speech becomes even more limited — a single intelligible word. (approx. 1.5 years)
3. Patients lose the ability to ambulate independently. (approx. 1 year)
4. Patients lose the ability to sit up independently. Patients will fall over when seated unless there are arm rests to hold the patient up in the chair. (approx. 1 year)
5. Patients will lose the ability to smile. Only grimacing facial movements are observed in place of smiles. (approx. 1.5 years)
6. AD patients lose the ability to hold up their head independently. (approx. 1.5 years)

Keep in mind that these are not independent sub-stages. They can overlap. I never saw my father to this last stage, although I recall having to sit him up because he was always tilting to one side. It is really important even in earlier stages to have a chair with a side because they fall asleep easily.

Of the 35 million people in the world living with AD or a related dementia, those that receive the best care have the best chance of living the longest. Many pass away due to other illnesses. In the case of my dad, the official cause was pneumonia contracted after surgery for a broken hip from a fall in a nursing home. Although sometimes I wonder — did he have osteoporosis and did the broken hip cause the fall and not vice versa? Men don’t often get screened for osteoporosis and if that’s the case, the hip breaks first followed by the fall.

In just 20 years, the number of Alzheimer’s cases is expected to double. The longer you live, chances are you’ll find yourself in this unfortunate situation. Are you doing anything to prevent or slow down dementia?

Research shows that we forget 30% of what we’ve heard after 20 minutes, and 50% within a half-hour.

Although there is still no conclusive test for the determination of Alzheimer’s disease (AD), there is hope and occasionally, new information. Last month, Science Daily reported that:

Elderly people exhibiting memory disturbances that do not affect their normal, daily life suffer from a condition called “mild cognitive impairment” (MCI). Some MCI patients go on to develop Alzheimer’s disease within a few years, whereas other cases remain stable, exhibiting only benign senile forgetfulness. It is crucial to develop simple, blood-based tests enabling early identification of these patients that will progress in order to begin therapy as soon as possible, potentially delaying the onset of dementia.

A group of investigators, led by Professor Massimo Tabaton of the University of Genoa, Italy, have data that sheds light on this issue. The results of their research are published in the October issue of the Journal of Alzheimer’s Disease.

The investigators report that the concentration in blood of amyloid beta “42,” the toxic molecule that is believed to be the main cause of Alzheimer’s disease, is, on average, higher in MCI cases that went on to develop Alzheimer’s disease approximately three years later. The values of amyloid beta in blood vary considerably among the patient groups examined (MCI that develop Alzheimer’s disease; MCI stable; normal subjects). “This variability is likely very important,” Dr. Tabaton noted and went on to add, “but means that this needs further work before we can use this test for a definitive diagnosis.” For example, the scientists are going to set up a test that picks up a variant of amyloid beta potentially more specific of the disease.

There’s progress, but we still have a long ways to go to find an effective test. A conclusive blood test would certainly be ideal. But even if we were to have a conclusive test, doctors still have very few effective treatments for Alzheimer’s disease. And still, as it has been for a long time, only an autopsy will reveal definitively whether or not a person truly had Alzheimer’s.