Mental, physical and speech abilities in later stages of dementia

How dementia affects memory in the later stages

By the time the person reaches the later stages of dementia, they are likely to have significant memory loss. Recent memories may be lost completely (for example, what they had for breakfast or when they last saw a friend) and they may only remember parts of past memories.

The person may believe they are living in an earlier time period from their life (for example, when they were at school). This can mean they say things and behave in ways that don't make sense to those around them. 

The person may experience emotions from the past, or their emotions can be related to situations from the past. For instance, they might become distressed because they believe they need to go and collect their children from school but they are being prevented from doing this.

Recognising loved ones

The person may also confuse those around them for someone else (for example, thinking their partner is their sister). They may no longer be able to recognise themselves or loved ones. 

It can be extremely difficult when someone with dementia is not able to remember their own family or close friends. As hard as it may be, try not to take it personally. This memory loss is caused by the progression of the dementia. 

Even if the person with dementia is not able to place someone, they are still likely to experience feelings they associate with that person. For example, they may still feel safe and happy with familiar people around them. 

Tips for carers

• It is usually best not contradict a person if they are confused. 
• Try to keep the person in touch with people they know where possible. 
• If the person becomes distressed or frustrated because they can’t remember something, gently reassure them. Also consider changing the topic of conversation or activity. 
• It can help to introduce yourself every time you see the person. 
• If the person believes they are in an earlier time period, understanding their past can be helpful. It may explain certain phrases or questions they are saying. 

How later stage dementia affects concentration, planning and organisation

The person with dementia may develop increasing difficulties with other thinking abilities, such as concentrating, planning and organising. For instance, they may only be able to carry out simple activities, or not be able to concentrate for too long. 

They may be increasingly disorientated and have difficulties recognising where they are.

Tips for carers

Even if a person is having difficulty with their thinking abilities, it is still possible for them to get involved in meaningful, enjoyable activities. 

• The person may still get enjoyment from their hobbies, interests and activities if you can adapt and simplify them. There are also boardgames that are specifically designed for people living with dementia.  
• When introducing new activities, consider what they can and cannot do. For example, if a person cannot concentrate for long periods of time, a film they haven’t seen before might not be suitable. 
• Even if a person cannot fully do an activity, they can still enjoy the feelings and sensations of an activity. For example, they may enjoy the feel of wool even if they can no longer knit.
• In the later stage, people may respond more to things that stimulate their senses (sight, hearing, smell, touch, taste), than to words. Think of ways to stimulate the person’s senses. For example, they may enjoy stroking a pet or the feel and scent of hand lotion.  

How dementia affects physical health in the later stages

Mobility

Dementia is likely to have a big physical impact on the person in the later stages of the condition. They may gradually lose their ability to walk, stand or get themselves up from the chair or bed. They may also be more likely to fall. These problems can be caused by:

• dementia medication
• other medical conditions (for example strokes)
• sight loss
• balance problems 
• an uncomfortable environment.

Pressure ulcers

Many people with dementia (especially in the later stages) find themselves staying in one position for a long time (such as sitting in a chair) and not moving around much.

This means they are at risk of pressure ulcers (bedsores). Pressure ulcers can be easy to prevent early on. However, if they go unnoticed they can become painful and infected. 

Check regularly for any rashes, discolouration of the skin or pressure ulcers. If you see something or have concerns, speak to a GP or community nurse. Pressure-relieving mattresses and cushions are available following an assessment by a district nurse or occupational therapist. For more information about preventing, diagnosing and treating pressure ulcers, see the NHS website.

Infections and blood clots

As a person’s mobility decreases, they are also at risk of infections and blood clots. The person should be supported and encouraged to move around as much as they are able, for example through support to walk or chair-based exercises. 

Occupational therapists and physiotherapists can give advice about equipment and adaptations. You can also speak to a GP or community nurse about the best ways to support the person to move without injuring themselves. For more information, read our advice on exercise in the later stages of dementia. 

Illness and discomfort

Infections such as urinary tract infections (UTIs) can cause someone with dementia to feel more confused. Infections can also speed up the progression of dementia. It is important that infections are quickly diagnosed and treated. 

A person in the later stages of dementia may be unable to communicate with words that they are feeling unwell. However, a change in their behaviour may be a sign of discomfort or pain. Looking for any changes in them can help you to notice any problems. If you think the person may be unwell or in pain, speak to the GP.

Delirium

If the person with dementia is unwell and there is a sudden change in their mental abilities or behaviour that lasts several hours, it is often a sign they have delirium. Symptoms of delirium include:

• not paying attention or concentrating
• confused and muddled thinking
• disturbed language (for example, speech that doesn’t make sense)
• change in consciousness (for example, feeling drowsy or much more alert)
• change in the person’s sleep/wake cycle
• hallucinations and delusions.

If the person suddenly becomes confused or develops these symptoms they should see a doctor immediately.

Pain in the later stages of dementia

A person still feels pain in the later stages of dementia, although they may not be able to tell you. As a result they may start to behave in ways that are unusual. 

Many people in the later stages aren’t given enough pain medication and may be left in pain that could otherwise be treated. Common causes of pain in people with dementia include urinary tract and other infections, constipation and other conditions such as arthritis. If you think the person may be in pain, speak to a GP about medication and non-drug approaches (such as massages).

Speech in the later stages of dementia

In the later stages, the person is likely to have more problems communicating with words. They may have no speech. They may repeat the same phrase or sound. Some people say a lot, but their words may not make sense. 

Although the person might not be able to communicate with words, they may still be able to show their needs and emotions in other ways. Rather than speaking, they may use behaviour, facial expression, gestures and sounds to try and communicate how they are feeling and what their needs are.

Even if you don’t think the person can follow what you’re saying, continue talking to them clearly. They may still feel a certain way even if they don’t fully understand what you’re saying. You could also try responding to them in the way they respond to you (also known as ‘mirroring’). Read more of our tips for communicating. 

When you’re thinking about how to communicate with the person, bear in mind their needs and background – including their cultural needs. For example, people from some cultural backgrounds may feel uncomfortable or distressed if you’re too close to them when you’re communicating with them. The language they speak in may also be affected by dementia.