A little morbid, but I remembered today that people say things like “My mother died from Alzheimer’s.” But I don’t get how that works. Is it really the dementia or some other age-related cause? Does it eventually shut down their autonomic nervous system?
Iana doctor (though married to one).
I dont think dementia kills persay. My grandmother had dementia for almost twenty years. In the last ten she was essentially bedbound unable to do anything for herself. In the end she just faded away at the age of 91. I am not sure she would have lived any longer without it.
Essentially, my mother died from Alzheimer’s, though it was not the most immediate cause. Her mind had deteriorated over many years, though her physical health remained pretty robust. But eventually she got a severe case of flu. If her mind had been there, she would have fought it, and the doctors and nurses (at her nursing home) would have helped her fight it, but on both sides the will to live was no longer there, so she died about as peacefully as could be expected.
My understanding is that conditions which kill can also cause dementia. Dementia per se is a symptom. Alzheimer’s is poorly understood, but involves plaques on the brin itself that seem to be physical damage. That could be killing you AND causing dementia – not dementia alone doing the killing.
Sailboat
From the National Institute on Aging:
The link has some details on how Alzheimer’s affects the brain.
My father had Alzheimer’s, but it was actually a urinary tract infection that killed him.
Normally, when a person has a urinary tract infection, there are noticeable (to him) symptoms, and the person seeks medical help, and the infection is treated. When an Alzheimer’s patient gets an infection, or any of a number of other things, either he can’t feel the symptoms or he can’t communicate that he feels them. Whoever is caring for him can’t constantly monitor the possibility of each and every possible health concern, so the infection continues unchecked.
Some of you have said that it isn’t the dementia that kills affected individuals, but rather certain complications of the dementia. That’s like saying it isn’t cancer that kills people, it’s the complications of cancer (see my response here for example). I think that logic is faulty.
In addition to causing cogntive impairment (i.e. the dementia itself), diseases like Alzheimers also cause impairment in various body reflexes and functions. For example, they cause the gag reflex to be lessened and often lead to the affected person “forgetting how to swallow”. That’s a set-up for pneumonia. Likewise, the inability to control urination, and the general immobility of advanced dementia, are also set ups for infection. Indeed, people with advanced dementia often become malnourished (they can’t swallow). This eventually leads to sufficient weakening of the body that, again, infection is inevitable.
So-called “autonomic” functions are also impaired in dementia. In the absence of the appropriate autonomic reflex (i.e. heart and blood pressure responses) to various stresses, minor problems can cause life-threatening manifestations (eg. low blood pressure, low temperature, etc.)
You may be surprised to learn that the median survival after the diagnosis of dementia is between three and four years. Dementia kills.
Dementia is a symptom of Alzheimer’s, which is a degenerative brain disorder. And not all Dementia is caused by Alzheimer’s; I’m not sure if it’s still the case but a decade ago we were told that a definitive diagnosis could only be done post-mortem.
As Alzheimer’s progresses it destroys portions of the person’s brain (you can see many photos of that here but this particular page shows it very clearly) which go a good deal farther towards killing you off than the fact that you no longer think lucidly does.
It’s still not definitive – Alzheimers doesn’t have the clear-cut signs on MRI that mark many other dementias – but the stage at which we can diagnose it to a reasonably high confidence is getting increasingly early. Basically from when the patient and/or their family have started to notice symptoms.
(IANA doctor, but I have a postgrad degree in neuroimaging).
ZOMBIE dementia.
I’ve nothing to add beyond KarlGauss’s excellent post. Glad neuroimagers like Mijin agree.
My mother died of dementia caused by Parkinson’s. Technically, she died of pneumonia but (see KarlGauss’s post) first her swallow reflex had gone. Before that her temperature regulation had gone wonky and her temperature shot up to 108. They put her in an ice-water filled blanket and put a feeding tube in her. The first time she got pneumonia, they “vacuumed” her lungs (never quite knew what that meant) but she was visibly unhappy with that. The second time, my stepfather “pulled the plug”. She had no cognitive life left in any case. It had been four months since she had been able to express a conscious thought.
I think that’s largely semantics. “She was hit by a car, and she died a week later because of traumatic brain injury suffered during the accident.” So, what’s the cause of death? The accident? Sure. Traumatic brain injury? Also true.
There are many diseases (Parkinsons, auto-immune disorders, etc) that don’t kill a person directly, but that make the patient more vulnerable to other fatal causes, often pneumonia, f’rinstance.
Not really surprising, since diagnosis of most dementia is at older ages. My father-in-law, for instance, was formally diagnosed of dementia at age 91, so it won’t be a surprise if he dies in the next year or two.
In late stage Alzheimers, quality of life is about zero. Sooner or later many patients will have some issue that could be treated aggressively, but most likely won’t be because it is pointless.
The patients may not seek care until it is too late anyway.
In my mothers case it was a bad infection in her knee. I suspect she was possibly overdosed with Morphine, leading to a massive stroke and death. If so, god bless the doctor that did it.
My mother died of Alzheimers. From first clear symptoms (unable to read clock time) to death in a nursing home (by refusing all nourishment) she lasted just over 5 years. The worst thing is if you get paranoid psychotic symptoms, which require skillful handling and calm. Usually that period passes, though disturbing behaviors continue. One woman my sister and I liked in an Alzheimers’ ward was known to staff as “a screamer.” Out of nowhere, she would release blood curdling screams, then quit. We were warned but never had the experience.
Early on, my mother was in a high-end California nursing home near my sister (good long term care insurance), later moving to an excellent state-run facility in Alaska, near me. In the California home, you walked through one set of doors into the 2nd stage Alzheimers wing to get to the 1st stage wing. It was a scene out of Hell, with patients utterly unable to care for themselves in any manner, mouths agape, wide-eyed thousand yard stares, sheets that smelled of urine and feces constantly being changed. Not a good place to be, and many things might get you in that state. Most die “early” of various causes. My mother lost at least three roommates over her 5 years in Alzheimers wards. Every time I visited she had a new roomate, it seemed. I saw one in a coma, hooked up to the music cart (comfort measures), in the last few hours of a life of 102 years. That’s how I discovered the meaning of the term “the death rattle” late in life. In another century we would all be better educated by life experiences.
In the end, my mother just got tired of it all, and nobody was willing to force life on her. It was a relatively easy ending as such things go.
As for diagnosis, she had a later secondary diagnosis of Parkinson’s Disease, which also sometimes causes dementia. A new Parkinson’s drug was a big help with the dementia, but even drinking protein shakes was a huge struggle, due to the stiff muscles of Parkinsons. Before she died, my sister and I considered the definitive diagnosis of an autopsy, but finally decided it was enough to take what the doctors had told us: Alzheimers and Parkinsons, both. Close enough for us.
Possibly tangential - apologies if so:
As far as death certification goes, the practice is to trace the progression of the “dying process” back to the primary disease or injury that initiated the chain of events that ended in the person’s death. That’s the difference between the immediate cause of death and the underlying cause of death (sometimes, confusingly, also called the proximate cause). So a person with dementia may “die of” pneumonia. That’s the immediate cause. What started the chain of events that lead to the pneumonia - dementia - is the underlying cause. The person with traumatic brain injury may also “die of” pneumonia as an immediate cause, but the underlying cause, and all the implications that flow therefrom, are of course quite different in those two cases. That’s why when a cause of death is given as “heart failure” or something like that, it’s really not telling you much, certainly not the most important thing. Eventually, everything spirals down to “heart failure” (or, my favorite “cardiorespiratory failure”). When you really get down to it, very few things that we think of as fatal, disease or injury, actually directly “cause” death, but you can always interject some nonspecific thing as an immediate or intermediate cause.
I wondered about this too. Part of my job is to handle death claims on customer accounts, and I have to get a death certificate from the person claiming the account. I’ve seen “dementia” listed as the cause of death several times and I didn’t understand how dementia could kill someone. Ignorance fought, thank you!
Like my mother, my grandmother “died” of dementia, in 1968, though probably not from alzheimers, as it seemed milder, for want of a better word. It was more a gentle fading of mental capacity and slipping into a world of fantasy.
She was in her 80’s, in a state-run nursing home in Alaska, when she broke a hip and was thus immobile. They made no attempt to repair the damage. They put her into a bed in a white-painted room by herself, where my cousin visited her. In a short time, measured in a few days, she died. Her death certificate says something along the lines of “congestive heart failure.” A notation further on says something like “complication of atherosclerosis,” or hardening of the arteries, which was the catch-all used for dementia in those days.
Under “cause of death,” My mother’s death certificate says “geriatric [lack of nourishment].” Can’t remember the actual medical terminology. Further on, it says the primary problem was Alzheimers and Parkinsons disease. This was in a “comments” section for her doctor, I believe.
So, these technical points are correct on how death is noted, it seems to me.
It’s a point worth making, but I think our querent was interested in the mechanism of death in these cases. Fair question: now he knows.
That “death rattle” is awful. I know that the dying person feels no pain, but it is terrible for the family members to see/hear that.
I don’t know if I’m adding anything to the thread but in the last year I’ve had a parent that died at a very old age that was diagnosed with Alzheimer’s but dementia was listed on the death certificate. I had an in-law that died at a relatively old age and dementia was listed on the death certificate. I’ve had a close family member diagnosed with early onset of Alzheimer’s. We don’t know how that will play out.
From what I have learned:
Dementia is a catch-all. When it is listed as a cause of death the coroner is really saying that this person was old and their systems started to fail. Their mental capacities were severely diminished and as a result their body gave out.
Alzheimer’s is a subset of dementia. It can more specifically be diagnosed because it follows a recognizable pattern. An MRI or a PET scan can show shrinkage of the brain. Alzheimer’s eats away the brain. And yes, the disease is not well understood. Currently, there is no cure but there are some promising studies that seem to show that it can be slowed down and maybe, to some degree, reversed.
There are other subsets of dementia such as Parkinson’s. A little bit of Goggling will explain it better than I can.
OK, so we’re back to cause of death. If a person was old, in deteriorating health, was in a nursing home or under constant care you will probably see dementia listed on the death certificate. Rarely, in those cases, will an autopsy be done because to do it is expensive and doesn’t explain much of anything. Oftentimes, the cause of death will be a laundry list of congestive heart failure, inability to swallow, yada yada, and dementia.
IANA doctor.