Have you ever noticed a loved one with late-stage Alzheimer’s disease or another form of dementia coughing in a way that worries you? Maybe they only cough while eating, or it sounds like they’re choking. Their breathing might make it sound like they need to cough, but they struggle to do so.

Coughing — or having trouble coughing — can be related to a person’s stage of dementia. The good news is that understanding why your loved one coughs or has trouble coughing can help you improve their care and give them the support they need.

What Coughing Sounds Like in Late-Stage Dementia

Several members of myALZteam have described what their loved ones’ coughs sound like. One member described their loved one’s cough as a “nagging tickle cough,” while others described more intense coughing, wheezing, or choking:

• “He would cough so hard, he couldn’t breathe.”
• “Just worried about my mom. She has a terrible cold and cough. I can hear her wheezing when she breathes.”
• “My husband often feels like something is stuck in his throat. He then gets hiccups and coughs up phlegm.”
• “My husband had a dreadful choking fit. So awful to watch him so uncomfortable.”
• “When my loved one continues to have pneumonia, it is so frustrating, as you can hear when he coughs that it comes up in his throat or mouth.”

Why Coughing Problems Might Occur

A loved one with late-stage dementia might cough while they’re eating or after a meal. They also might cough frequently if they have an infection in their lungs.

Problems With Chewing or Swallowing

Some people with late-stage Alzheimer’s disease and other forms of dementia may cough because they have trouble chewing and swallowing their food. Swallowing becomes more and more difficult as dementia advances.

When someone with dementia has trouble swallowing, they may accidentally breathe food or liquid into their windpipe. When this happens, the food or drink can irritate the lungs and airway, triggering coughing. You might also notice your loved one choking on food or drink because of difficulty swallowing.

Aspiration Pneumonia

As dementia advances into later stages, coughing itself becomes difficult, even when food gets into the lungs and airway. In Lewy body dementia, the cough reflex becomes weaker over time. This means difficulty swallowing may no longer trigger a cough during the later dementia stages, as it might have in earlier stages.

When a person with dementia can’t clear food or saliva from their airway, those particles can stay in the lungs. The trapped food can attract bacteria and lead to an infection called aspiration pneumonia. This type of pneumonia often develops slowly, and many people — as well as their caretakers — may not realize that they’ve inhaled food or liquid.

You might eventually notice symptoms of aspiration pneumonia in a loved one with dementia, including:

• Wheezing
• Shortness of breath
• Fever
• Bad breath
• Feeling very tired
• Coughing up blood
• Coughing up pus

Aspiration pneumonia is one of the most common causes of death during late-stage dementia. If you notice any of the symptoms above, let your loved one’s doctor know right away.

Other Viral Infections

As people age, the immune system naturally becomes less effective at fighting off infections. The immune system is slower to react and produces fewer antibodies to fight off viruses and bacteria that cause infections.

Some forms of dementia can cause additional damage to the immune system, causing it to decline even faster. As a result, your loved one with late-stage dementia might get sick more often with respiratory infections that cause coughing, such as COVID-19 or the common cold, and they may also experience more complications from them.

What Coughing Problems Could Mean

Frequent coughing while eating or trouble coughing are both common symptoms of late-stage dementia. Certain types of coughing, problems with clearing the throat, and breathing changes tend to happen more often in later or final stages of dementia.

Some causes of coughing, like aspiration pneumonia, can be life-threatening for people with late-stage dementia.

Breathing Changes in Late-Stage Dementia

Changes in breathing are a common sign that dementia has reached a very late stage. A person with dementia might breathe very fast, very slow, or stop breathing entirely before gasping for air.

In late-stage dementia, breathing might sound wet or congested, as if mucus or fluid is stuck in the throat or chest. If a person is approaching the end of life, you may notice these breathing changes along with other signs and symptoms.

Not all coughing problems mean that a person with late-stage dementia is at risk of severe complications or death. Talk to your loved one’s doctor if they cough frequently or have trouble coughing.

How To Manage Dementia-Related Coughing Problems

Your loved one’s dementia care team can help you find out why your family member is coughing or having trouble coughing and can treat the underlying issue. They can also offer tips for managing coughing and reducing choking risks.

Managing Problems With Chewing and Swallowing

There are steps you can take to help a person with dementia who frequently coughs or chokes while eating. Chewing and swallowing problems can make it harder for a person with dementia to eat enough, but you can use supportive strategies to help them eat more.

In late-stage dementia, hand feeding is usually preferred over tube feeding. If a loved one is having problems swallowing, caregivers might be able to reduce coughing or choking by:

• Giving them soft foods that are easy to swallow
• Avoiding crunchy and hard-to-chew foods
• Helping them take small sips of water between bites
• Using sauces to moisten foods before eating
• Keeping the person's head elevated while they eat

Taking these steps might help prevent food or liquid from going down the windpipe, which can reduce the risk of aspiration pneumonia. To further improve swallowing problems and avoid complications, your loved one’s healthcare provider might recommend speech therapy.

Preventing and Managing Aspiration Pneumonia

Contact your loved one’s doctor right away if you notice signs of aspiration pneumonia, like coughing up blood or a fever. Your loved one’s healthcare provider might prescribe antibiotics to treat aspiration pneumonia or other bacterial lung infections that can cause coughing in late-stage dementia.

What Members Say

Members of myALZ team have shared practical tips for managing swallowing difficulties and coughing in late-stage dementia:

• “We are now on pureed foods because of the coughing situation!”
• “I have started using a potato masher for my mom’s vegetables and things that are not so easy to cut.”
• “A couple of rounds of speech pathology might help.”
• “We add thickener to her drinks to try to keep the fluid from going in her lungs, which causes aspiration pneumonia.”

Creating an End-of-Life Care Plan

Even if your loved one isn’t in end-stage dementia yet, it can be helpful to create an end-of-life care plan if they start to experience frequent coughing, difficulty swallowing, or breathing changes. Advance care planning can reduce stress for families as dementia progresses, and ensure that your loved one’s preferences are respected as the disease progresses — especially if they can still participate in decisions about their future care.

Your loved one’s primary care provider can guide you through the decision-making process and help decide what steps to take if complications like aspiration pneumonia happen.

Join the Conversation

On myALZteam, people share their experiences with Alzheimer’s disease, get advice, and find support from others who understand.

Have you noticed a loved one with Alzheimer’s disease coughing more than usual or struggling to cough? Let others know in the comments below.