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What Are the Final Stages of Dementia?

The three final stages of dementia are moderately severe cognitive decline, severe cognitive decline and very severe cognitive decline.

At first, someone going through the final stages of dementia will need frequent help with routine tasks. In the last two stages, they’ll have trouble recognizing you and, finally, have motor impairment and possibly lose the ability to walk or speak.

These are the last of seven stages of dementia, according to a guideline that’s known as the Global Deterioration Scale (GDS.) While these stages may sound dire, it’s important to remember that individuals with dementia can live full, happy lives, even after they’ve started to show symptoms. The final stages of dementia are, however, the time when they’ll need the most support.

In this article we’ll talk more about what you’ll likely see a friend or relative with dementia experience in these final stages. We’ll talk about both mental and behavior changes so you’re better prepared, as well as provide advice about what healthcare services will be helpful and how to emotionally prepare yourself for coming changes.

Moderately Severe Cognitive Decline

The hallmark of this stage is that an individual can no longer safely live without assistance. They need help with daily tasks like cooking or bathing. They may still know their name and be able to perform a few tasks like using the bathroom or eating by themselves. But they have important knowledge gaps, such as forgetting their address or disorientation about the date and time.

Since they can no longer live independently, they need a home caregiver or to move to a memory care community. Many times, this transition will enhance their lifestyle and make it possible for them to enjoy their time even more because they’ll have the support they need and will no longer need to struggle with daily tasks.

The dementia care in a supportive community will typically include medication management, which is a highly sought-after service since many individuals will have one or more medications they need to take regularly. Commonly-prescribed medications that may help at this point include:

  • Cholinesterase inhibitors (Aricept, Exelon and Razadyne) will boost levels of a chemical that helps with memory and judgment
  • Memantine (Namenda) aids in learning and memory

These drugs won’t stop the damage to brain cells, but they may lighten the symptoms for a while. Since they’re not a cure, you might want to discontinue them if there are unpleasant side effects such as nausea, agitation or sleep problems.

Appetite may begin to fade during this stage as well. They may forget about mealtimes, but a memory care community will ensure they get the right nutrition by:

  • Serving meals at the same time each day to establish a routine
  • Offering one plate, with one food at a time so choosing between several foods isn’t overwhelming
  • Turning off distractions like television so residents can focus on eating

Severe Cognitive Decline

At this stage, those with dementia need help with nearly all hygiene and daily living tasks. They may have trouble sleeping, suffer from paranoia or delusions and not recognize family members.

Communicating Well

There are creative ways to communicate and create new memories in this phase. A family member may forget your name but smile when they see your face, as they associate it with happy times.

Sometimes they want to talk even though they struggle to get their ideas across. They may repeat phrases but the thread is hard to follow.

One tip is to mirror the emotion the person is feeling. Body language may show they’re trying to say something funny or happy, so it’s fine to smile along and get in the spirit of things.

They may also feel uncomfortable but struggle to say so. They may look distressed and unhappy. It’s important to respond to these signals. They may just need a blanket or to use the bathroom. But often, their discomfort is more serious. Pain medication likely needs to be increased in the later stages because of higher likelihood of urinary tract infections, arthritis, constipation or muscle soreness.

Dementia Support from Memory Care Professionals

At this stage, symptoms can be managed best when you team up with a healthcare worker:

  • Aggression or agitation may be signs of an undiagnosed source of pain that a doctor can treat
  • Medications can ease hallucinations or delusions
  • A physical therapist or trained memory care staff can help with mobility issues like safe transfers from a bed to a chair
  • A speech and language therapist can evaluate your family member to make sure they swallow well

Very Severe Cognitive Decline

In the last of the dementia stages, your family member may be bedridden or need significant help to transfer from the chair to the bed. They need 24-hour supervision and may struggle to speak or walk.

Here are tips to keep the body healthy during this time:

  • Swallowing is harder during this stage, so food should be soft, like yogurt, scrambled eggs, smoothies and mashed potatoes. This is a natural adjustment that dementia care communities will make
  • Change their position every few hours to keep blood circulating and relieve pressure on the skin
  • Create a comfortable, home-like environment with favorite mementos, blanks and pillows that can also be used to support the person as they change positions
  • Keep skin clean with mild soap and gently blot dry, checking for red pressure points
  • Engage in enjoyable physical activities, especially those that encourage motion exercises that keep joints more supple

Bonding Through the Senses

Even if the brain isn’t working as it once was, the senses are still active. They bring pleasure and relief from trying to interpret the world through the mind. Try these soothing activities to bond with your family member:

  • Play familiar music
  • Provide a soft throw for snuggling
  • Open a window so they can feel the breeze and sunshine
  • Read a well-loved book in a soothing voice
  • Brush their hair
  • Gently pat scented lotion on their skin

Dementia Care in Texas

At The Villages of Windcrest, we know that dealing with the final stages of dementia can be a struggle, but we believe adults and their families can create moments of joy and positive new memories throughout the illness. To make that possible, we foster a thriving memory care community in Texas with high-level staff members that understand and empathize with your struggle. We’ll help you handle the challenges that come up, ensure your friend or relative is safe and comfortable and work with you to build new memories you can cherish for a lifetime.

All our flexible programs and packages can be tailored to your family’s unique needs. Here, both you and your relative will be supported and feel like family to all our staff.

The right support can make a world of difference. For more information on our community, including our dementia care services and amenities, please contact us. You can also download our memory care resource guide to learn more.


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