ABSTRACT
In this stage of Alzheimer’s disease the mental functions have become so seriously impaired that the patient can no longer manage on his own. He needs practical help with the necessary daily routine activities at home. He functions at the comparable level of a five to seven year old child. Encouragement alone is no longer sufficient. It is now obvious even to an outsider that he has dementia. His intellectual abilities now fail him to such an extent that it interferes with maintaining himself as an independent person in the community. In terms of decline in functions of self care, this stage is characterized by the inability to choose proper clothing to wear in the way he used to. Factors such as lack of initiative and self neglect play a role. The patient lacks the ability to survey possible alternatives, to discriminate between alternatives, and to appraise the actual situation on which his choice must be based. If he makes a choice at all, the choice is impulsive and inopportune. The behavioral disturbances, which accompany the disrupted mental faculties, now also have a detrimental influence on the patient’s functioning and call not only for insight but also for a great deal of tact on the part of the caregiver. While the patient may function at a level comparable to that of a six year old, he does not see the world through the eyes of a healthy, inexperienced child. He is a disabled adult who feels his control over his world slipping.
