At the final and most severe stage of dementia the person has lost almost all ability to communicate verbally, often being limited to occasional words, sounds, or expressions. They require full assistance with all aspects of personal care including washing, dressing, eating, and using the toilet. Many people are no longer able to walk or sit upright without support, and muscle stiffness and contractures are common. Swallowing becomes increasingly difficult, raising the risk of aspiration pneumonia. The person is typically awake for only short periods and may show little or no recognition of you or other family. Despite the severity of physical and cognitive decline, the person can still experience pain, discomfort, and emotional responses, so maintaining comfort, dignity, and human connection remains the central goal of care.