Family members are often much more aware of the nature and likely course of the illness than the patient. This is because the dementing process often destroys the brain centers responsible for self-awareness, including the patient's own awareness of decline in intellectual capacity. Nonetheless, some family members refuse to accept that the patient indeed has a brain disease and get upset when he or she behaves in an irrational fashion. Coming to terms with the changing personality of the person they once knew is never an easy task.
Later stages of the illness are characterized by confusion and disorientation, inability to recognize family members, breakdown in the ability to manage bodily functions, and incontinence of urine. Some patients become mute, and psychosis and behavioral changes like agitation and aggression may occur. Managing patients in the final stages is virtually impossible at home, and admission to a nursing home or similar long-term care facility becomes necessary. For family members and close friends, the most disturbing turning point seems to be when the patient can no longer recognize them and has ceased to be the person whom they once knew and loved.
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