Alzheimer's Disease
Alzheimer's Disease
Definition
Dementia is a general term for memory loss and other cognitive abilities.
Alzheimer's Disease (AD) is the most common cause of dementia.
The primary known risk factor for the disease is aging, but AD is not a normal part of aging. Alzheimer’s Disease is progressive so symptoms will worsen with time. There is currently no cure for the disease, but treatments are available to slow down the progression.
Characterestics of Alzheimer's disease:
- Cortical atrophy and loss of neurons, particularly in the parietal and temporal lobes.
- Loss of brain mass.
- Enlargement of the ventricals of the brain.
Risky factors:
1-Advancing age, >85 y/o risk increases nearly 50%
2-Direct family history with the disease (mother, father, brother or sister)
3-Cardiovascular risk factors: mid-life obesity, mid-life hypertension, hyperlipidemia, diabetes mellitus
4-Head trauma - older adults with moderate traumatic brain injury (TBI)
5-History of Depression
6-Progression of Parkinson-like signs in older adults
7-Folate deficiency
8-Hyperinsulinemia
9-Hyper/Hypothyroidism
10-Sleep Disturbances
11-High Blood Pressure in midlife
How to prevent dementia?
1-Regular fish consumption
2-Regular consumption of omega - 3 fatty acids
3-Regular exercise due to cardiovascular benefits increasing oxygen & blood to the brain
4-Diets low in sugar and saturated fats
5-Prevention of head trauma & falls
6-Adequate intake of vitamins C,E, B6, and B12, and folate
Warning Signs of Early Diagnosis of Alzheimer's Disease:
1. Memory changes that disrupt daily life.
2. Challenges in planning or solving problems.
3. Difficulty completing familiar tasks at home, at work or at leisure.
4. Confusion with time or place.
5. Trouble understanding visual images and spatial relationships.
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps.
8. Decreased or poor judgment.
9. Withdrawal from work or social activities.
10. Changes in mood and personality
Problems facing patients with alzehimer's:
1-Gait problems:
Some patients with Alzheimer’s disease have walking difficulties. When these difficulties occur, patients walk with slow and irregular steps and find it hard to negotiate turns, climb onto a stepping stool, avoid obstacles in their path, or lie down and rise from the doctor’s couch, ''frontal gait disorder,” a syndrome coterminous with gait apraxia which defined as the loss of ability to properly use the lower limbs in the act of walking and includes disturbances of trunk movements, standing, and walking. This mainly resulting from decreased balance and increase risk of fall.
They have erect posture with slight broad base, difficulty initiating gait, reduced cadence and short shuffling with hesitated steps as if glued to the floor.
Shuffling gait can be seen in alzhemier’s disease and early sign in parkinsonis’s disease.
2- Most patients with Alzheimer's suffer from depression and so they tend to ba alone and take forward flexion attitude of head and upper trunk leading to kyphosis deformity.
Objective examination:
1-Strenght of upper trunk extensors and hand grip.
2-ROM.
3-Reflexes: hyperactive reflexes and primitive reflexes.
4-Sensation and vision and hearing.
5-coordination
6-Gait analysis
7- Bed mobility
8-sitting-standing
9-sitting and standing balance
Physical performance testing:
= For mobility: Timed up and go test
= For balance and fall risk: Berg balance scale.
= Endurance capacity: 6 minuit walk test.
How Can a Physical Therapist Help?
For people with Alzheimer's disease, research shows that:
1. Physical activity can improve memory
2. Regular exercise may delay the onset of dementia and Alzheimer's disease
3. Regular exercise may delay the decline in ability to perform activities of daily living in people who have Alzheimer's disease
The therapist may use various teaching methods, techniques to simplify instructions, and unique approaches, including:
1- Mirroring - With this technique, the physical therapist serves as a "mirror," standing directly in front of the person to show them how to move. To help the person raise his or her right arm, the therapist's left arm would be raised
2- Task breakdown - Physical therapists are trained in how to give step-by-step instruction by breaking down the task into short, simple "pieces" to be completed separately. For example, if the therapist wants to teach a person how to safely move from lying in bed to sitting in a chair, the therapist might have the person practice rolling to the side, then pushing up to sitting, then moving to a chair in separate steps.
3- Chaining- The physical therapist can provide step-by-step instructions by linking one step to the next step in a more complicated movement pattern. This technique usually is used once task breakdown has been successful and unites the separate steps of moving from lying in bed to sitting in a chair, to make it one fluid movement
4- Hand over hand facilitation - The physical therapist takes the hand or other body part of the person who needs to move or complete a task and moves that body part through the motion.
5- Gait training to improve walking pattern.
6- Balance training three times per week including these domains: backward walking, side walking, heel walking, toe walking, sit to stand.
7- Stretching exercise for pectoralis major muscles
8- Strenghthening of upper back muscles and neck extensors muscles for kyphosis.
9- Strengthening exercises two times per week for large muscle groups.
10- Aerobic exercise to improve cognition and reduce dementia risk such as walking, jogging, swimming, dancing, aerobic exercise classes, bicycle riding,………… 3 times per week, 150 minuites weekly.
11- Teach the caregiver these exercises to remind the patient perform it regularly.
