Progressive deterioration eventually hinders
independence, with subjects being unable to perform most common
activities of daily living. Speech difficulties become evident due to an
inability to recall vocabulary, which leads to frequent incorrect word
substitutions (paraphasias). Reading and writing skills are also
progressively lost. Complex motor sequences become less coordinated as
time passes and AD progresses, so the risk of falling increases. During
this phase, memory problems worsen, and the person may fail to recognise
close relatives. Long-term memory, which was previously intact, becomes
impaired.
Behavioural and neuropsychiatric changes become more prevalent. Common
manifestations are wandering, irritability and labile affect, leading to
crying, outbursts of unpremeditated aggression, or resistance to
caregiving. Sundowning can also appear. Approximately 30% of people with
AD develop illusionary misidentifications and other delusional
symptoms. Subjects also lose insight of their disease process and
limitations (anosognosia). Urinary incontinence can develop. These
symptoms create stress for relatives and caretakers, which can be
reduced by moving the person from home care to other long-term care
facilities.
