ABSTRACT

This is the most difficult stage, both for the patient and also for the caregiver, as it is in this phase that general disorganization of the personality occurs. The changes which take place are now clearly evident to strangers. In the space of about two and a half to three years the patient’s level of functioning drops from that of a five-year-old child to that of a child of about two years old. Through the loss of language the patient can no longer adequately put his emotions and experiences into words. The performance of the daily routine activities, such as washing and dressing, already learnt in childhood and carried out more or less automatically ever since, now poses problems and has to be taken over by the caregiver to an increasing extent. During the last part of this stage even the awareness of control of the call of nature is entirely lost. The motor functions now also become visibly disturbed. This rapid disintegration of the mental faculties and of the patient’s functioning in general, which causes a complete loss of his independence, is often accompanied by serious behavioral disturbances. The almost total incapacitation, in combination with serious behavioral disturbances, often leads later in this stage to the patient being admitted to a nursing home.