I know someone who had Alzheimer's. Was in excellent physical shape, had biomarkers of someone 20 years younger. Would go for daily walks for decades, consistently did yoga etc.
The issue, with late stage Alzheimer's (and possibly dementia in general), is that the brain starts to forget so many things it's not even funny (it never was). You forget to swallow water. You forget to chew food. You forget what the bathroom is for. It's far from "living with dignity", even if the body is still physically capable. I think lock-in syndrome is the only other medical situation I'd consider similarly traumatizing.
It would be abhorrent if you understood what was going on, but if you did you wouldn't be in that state. I'm not sure whether in general terms Dementia is as traumatic for the sufferer as the observer who attaches value to a historical person (who for all intents and purposes is gone)
My mothers mother avoided hospital until it became too apparent to everyone around here that my grandfather tricker her. She'd make jokes about her failing memory for years, and while some of it might have been genuine, in retrospect odds are she noticed it was getting bad and was obscuring it with humour.
For years afterwards, she would forget conversations partway through them, but clearly be aware that something was wrong. E.g. for some time she recognised me, but would wonder when I got there and how long I'd been there, and occasionally my name and who I was would slip, but she was otherwise lucid enough to understand that this was not normal.
My dads mother managed to hide the decline until one day my grandfather was going in to hospital for a minor operation, and she refused to get out of bed. The last time I saw her before that, she seemed lucid and held a conversation. I never had another conversation with her, though she lived another decade - she went non-verbal almost overnight, but it was clear this wasn't some sudden physical change; she'd held it together until then, and gave up. It might be her cognitive decline was faster, and less cruel, but we really don't know if it was, or if she just managed to conceal it until the very brink.
How much after that she managed to hold on to enough to recognise any of us - including her husband we don't know, because shortly after she went non-verbal she mostly stopped moving.
But one of the cruelest parts of Alzheimers is what it does for those left behind - my grandfather spent a whole decade in his 70's and 80's walking to the nursing home, sitting with her all day, every day, then walking home, after she was for all intents and purposes gone.
I called him once when he was in the hospital and had to be restrained. He begged me to come get him because he thought he had been kidnapped and was being held in a barn somewhere. There was no convincing him that the people around him were doctors and nurses who were trying to help him.
After I told him I couldn't come (I was in another country at the time) he begged me to call the police. By the end of the call he told me the barn was on fire and he was going to burn alive. It was enough to convince me that I needed to be in control of when and how I die.
My dad had no idea what was going on and he was 100x worse for it.
There's a reason we sedate people undergoing most medical operations.
The problem with dementia isn't just at the "old person chilling in room" state, as I mentioned if it progresses far enough (which is nearly guaranteed if they live long enough) basic bodily functions become difficult. A parallel case of eg paralyzed people (both of whom are unable to swallow properly for different reasons) shows how frequently they can die from something as simple as choking on their own saliva.
> There's a reason we sedate people undergoing most medical operations.
I'm not sure what you mean by this, if you're referring to people waking up but being unable to move being potentially torturous I agree.
It's not either-or, it's both. It takes time to reach the point where you're "unaware". Before that, you're fully aware of what's happening and that there's no escape. After that point, it will probably get "better" for you, the patient.
But it also gets way, way worse for everyone around you. With cancer, you're still yourself - you die as the person you were. With dementia (or Alzheimer's at least), you die twice, and people around you are left to tend to your corpse, which happens to move and eat (even if you forget to chew and swallow) for years after you're gone.
To me, they pretty much died once they stopped recognizing us. For one of them that was very soon after we realised something was wrong, and yet her body survived a decade after her mind was gone and it was awful seeing how it reduced her husband who spent all of those years in the same nursing home doing nothing but tending to her.
My other grandfather died of cancer a few years into his wife's alzheimers hospitalisation and frankly it feels to me like he got the better way out of him and his wife (but largely because it was a very aggressive cancer and he went during an attempted operation; maybe I'd have thought differently about it if he'd struggled with it for years).