ABSTRACT
References 316
Many of the distinctions among the illnesses that cause the syndrome of dementia become blurred or disappear in advanced or late stage dementia for several reasons. First, neuropathological abnormalities become so widespread that almost all brain systems that subserve cognition and function become impaired. A second and related issue is that the widespread involvement of subcortical or ‘downstream’ structures and systems results in widespread and near total dysfunction of ‘upstream’ cognitive and motor systems that are not directly involved by neuropathology. Thus, this chapter will approach late stage or advanced dementia as a single or common end point of all the dementias even though some distinctions, for example the frequency of myoclonus and seizures, do persist. Thus, while knowledge of the unique aspects of specific diseases plays a prominent role in the care of people with dementia in the earlier stages of the dementia, this is usually not the case in late-stage dementia (Robinson et al., 2006).
