Trends in aging: Alzheimer's and Dementia, the Pearl stage

By Wendy McHaney
June 27, 2014 at 1:27 a.m.

Wendy McHaney

Wendy McHaney

Today's column continues through the Senior Gems approach to care based on the Allen Cognitive Disability Theory. My previous columns discussed the first five stages - Sapphire, Diamond, Emerald, Amber and Ruby. This next series of columns will explore the final, late stage of dementia, also known as the Pearl stage.

A pearl was chosen to represent this stage because the gem is hidden inside a shell. It looks as if there is nothing of value on the outside, but inside the shell is an amazing gem. The following are some basic characteristics of a Pearl:

Muscle control is greatly diminished, leaving their muscles turned on. Pearls will often curl up and lean to one side.

Pearls are unable to have isolated muscle movement.

Pearls may writhe as their muscles are unable to relax during movement.

Movement may be painful, so movement should not be forced.

At this stage of dementia, the top of the brain, which controls muscles, dies. As a result, all of the muscles are basically turned on with no ability to turn them off. The disease is destroying a lot of the control the brain has over the body.

When walking, a pearl's back is curled forward and arms are pulled in. They are also taking smaller steps and walk on the front of their feet. A Pearl no longer has isolated movements, making it impossible for them to sit down fluidly. As a result, they fall into a chair when trying to sit down.

The strongest muscles in their bodies are pulling across, in and down, which is why the arms and legs are pulled in. If a Pearl is sitting for a long period of time, their body is curled up. They may fall off to one side, unable to keep their balance and continue to sit up straight.

A Pearl can also fall forward from a sitting position. Because they no longer have isolated movements, they cannot straighten out their legs or arms to catch themselves. This can result in falls and injuries. Despite their outward rigidity, it is important to remember there is still a person inside the shell.

The next column will address how to provide care for a Pearl.

Senior Helpers is presenting free workshops and support groups at Copperfield Village, 501 E. Larkspur St., every other Thursday morning from 10:15 to 11:15 a.m. Call 361-894-8901 for more information about these workshops.

Previous columns on the stages of dementia as well as other trends in aging can be found at

Sources: SH Franchising Senior Gems training materials.

Wendy McHaney is a certified senior adviser and the owner and director of operations of Senior Helpers. For more information about Senior Helpers, visit



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