Legendary film star Rita Hayworth. President Ronald Reagan. Charlotte's Web author E.B. White. These household names all had Alzheimer's Disease, and their biographies typically state that this is how they died. They join a long list of celebrities who died from the disease.
Alzheimer's is a neurodegenerative disease that progressively erodes a person's memory and ability to function. But it's not a fatal disease; people with Alzheimer's die from an underlying condition that develops due to deterioration.
In recent years, researchers have scrutinized data from studies to determine which illnesses have consistently claimed the lives of Alzheimer's patients. Understanding the end-of-life experience for Alzheimer's patients is crucial because scientists expect the number of people living with the disease will double by 2050.
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Understanding Alzheimer's Deaths
Most celebrities who had Alzheimer's and passed away, would likely be recategorized as "death from pneumonia." In a 2019 article in Plos One, researchers conducted a meta-analysis of published studies to determine the frequency of pneumonia-related deaths.
The authors examined data from 19 studies and found that pneumonia was listed as the cause of death in 29.69 percent of dementia patients. (Alzheimer's is the most common form of dementia.)
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The frequency was higher — almost 50 percent — when autopsies were the source of the death confirmation. The number was lower (less than 20 percent) when death certificates served as the source.
The study also found that pneumonia-related deaths were twice as likely for patients with dementia than those without.
Swallowing Struggles from Advanced Dementia
Other studies confirm pneumonia is associated with advanced dementia, and it's attributed to patients' inability to swallow.
Patients with advanced dementia develop dysphagia, the medical term for having difficulty with swallowing. Dysphagia involves several changes to the patient's mouth as a result of brain atrophy, including a decrease in tongue strength as well as saliva production.
At the same time, as a patient develops dysphagia, they can also lose their ability to recognize food placed into their mouth. During feedings, caregivers have to remind the patient to swallow. Attempts to swallow, however, can be unsuccessful, and one-third of patients will aspirate bacteria into the lungs and then develop pneumonia as a result.
Dysphagia also increases the likelihood a patient will develop dehydration and malnutrition. Clinicians continue to question whether such patients should receive artificial nourishment and whether such nourishment can help keep them comfortable during the disease's advanced stages.
Many people associate Alzheimer's and dementia with progressive memory loss. A person initially forgets where they placed objects around the house or when they are due for an appointment. As the disease progresses, they forget aspects of their life and fail to recognize their loved ones.
Some clinicians have categorized Alzheimer's as having seven progressive stages. Cognitive impairment may be subtle in the early stages before the disease advances into notable memory loss and then profound cognitive degeneration. In the end stages, a person will not be able to speak, feed themselves or control their bodily functions.
As the patient becomes immobile, they can succumb to a range of health complications. Being bedridden places continuous pressure on certain parts of the body and can lead to bedsores and then infection. Bed confinement also places the patient at risk of deep venous thrombosis — a medical condition that involves blood clots in a deep vein.
Similarly, being incontinent can lead to urinary tract infections that, left untreated, can advance into greater infections.
Alzheimer's patients in the mild to moderate stages also have a greater fall risk due to changes in their stride length, speed and cadence. People with Alzheimer's might also have judgment impairments that prevent them from avoiding hazards while moving. Researchers predict that as instances of Alzheimer's increase, so will fatal falls.
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