Dementia

ALZHEIMER'S DISEASE + PHYSICAL THERAPY

US population estimates indicate that 5 percent of people over age 65—about 5.2 million—and more than 40 percent of people over the age of 85 have Alzheimer's disease. Along with memory loss and other cognitive problems, people with Alzheimer's disease may have difficulty performing simple tasks of daily living. Physical therapists partner with families and caregivers to help people with Alzheimer's disease keep moving safely and delay worsening of the condition.

What Is Alzheimer's Disease?

Alzheimer's disease is a progressive condition that damages brain cells and affects how we speak, think, and interact with other people. It's the most common cause of dementia, a group of brain disorders that cause a decline in memory and the ability to perform daily activities. And it's the fifth leading cause of death among adults over age 65 in the United States, after heart disease, cancer, stroke, accidents, and respiratory disease.

The risk of getting Alzheimer's disease increases with age; it's rare to get it before age 60. Having a relative with Alzheimer's disease raises your risk of getting it, but most people with the disease do not have a family history of it.

One of the major symptoms of Alzheimer's disease is confusion. There are several other potential causes of confusion, some of which may be reversible if discovered early:

  • If confusion comes on suddenly, schedule a visit with a physician or a neurologist immediately.
  • If confusion occurs or gets worse after a fall or a head injury, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent.

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Signs and Symptoms

There are 10 important warning signs of possible Alzheimer's disease:

  • Memory changes that disrupt daily life
  • Difficulty making decisions, especially in planning or solving problems
  • Difficulty completing familiar tasks
  • Confusion about time and or place
  • Trouble understanding visual images or the way things physically fit together (spatial relationships)
  • Finding the right words to say when speaking or writing
  • Misplacing items and losing the ability to retrace your steps
  • Poor or decreased judgment about safety
  • Withdrawal from work or social activities
  • Changes in mood or personality

People with Alzheimer's disease also may get lost in once-familiar places. In the later stages of the disease, they might get restless and wander, especially in the late afternoon and evening (this is called "sundowning"). They may withdraw from their family and friends or see or hear things that are not really there. They may falsely believe that others are lying, cheating, or trying to harm them.

Along with these "cognitive" symptoms, people with Alzheimer's disease may develop difficulty performing simple tasks of daily living in the later stages of the disease. Eventually, they may need assistance with feeding, bathing, toileting, and dressing. The physical ability to walk is usually retained until the very last stage of the disease; however, due to confusion and safety concerns, people with Alzheimer's disease may need supervision or an assistive device to help them get around safely.

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How Is It Diagnosed?

The exact cause of Alzheimer's disease remains unknown and is most probably due to many factors, which makes diagnosis difficult. Researchers are getting closer to making a diagnosis by using brain imaging studies such as computed tomography scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, or ultrasound. These tests can show abnormalities in brain structure or function. Mental function tests, cerebral spinal fluid tap, biomarkers, and genetic testing also can be used to help make a diagnosis. But a definitive diagnosis can be made only on autopsy.

Your physical therapists may play an integral role in recognizing early signs or symptoms of this disease. If they recognize you or your loved one is exhibiting signs or symptoms consistent with Alzheimer’s, they will make an appropriate referral to the necessary specialist.

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How Can a Physical Therapist Help?

For people with Alzheimer's disease, research shows that:

  • Physical activity can improve memory.
  • Regular exercise may delay the onset of dementia and Alzheimer's disease.
  • Regular exercise may delay the decline in ability to perform activities of daily living in people who have Alzheimer's disease.

As the movement experts, physical therapists can design exercise programs for people with a variety of health conditions, including Alzheimer's disease.

In the early and middle stages of Alzheimer's disease, physical therapists focus on keeping people mobile and help them continue to perform their roles in the home and in the community. In the later stages of the disease, physical therapists can help people keep doing their daily activities for as long as possible, which reduces the burden on family members and caregivers. Physical therapists also can instruct caregivers and family in how to improve safety and manage the needs of a loved one with Alzheimer's disease. Physical therapy can help improve quality of life and possibly delay the need for institutionalization.

People with Alzheimer's disease develop other conditions related to aging, such as arthritis, falls, or broken bones. Physical therapists are trained to treat these conditions in people who have underlying Alzheimer's disease. Therapists take into account the impact of the disease on other health conditions, on general health, and on the individual's ability to understand important instructions.

The therapist may use various teaching methods, techniques to simplify instructions, and unique approaches, including:

  • Visual, verbal, and tactile cueing - The physical therapist provides "cues such as pointing to objects or gesturing. For instance, lifting up both arms can signal the person to stand up. Cues can also be given verbally with short, simple, or one-step instruction. Tactile clues holding someone's hand to have them walk with you. Sometimes, 2 or 3 cueing techniques are used simultaneously.
  • 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.
  • 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 instance, 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.
  • 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.
  • 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.

Although people with Alzheimer's disease usually maintain the ability to walk well into the late stages of the disease, balance and coordination problems often lead to walking difficulties. The physical therapist will train the muscles to "learn" to respond to changes in the environment, such as uneven or unstable surfaces.

Train Family Members and Caregivers

The family and caregiver may need instruction in how to safely move, lift, or transfer the person with Alzheimer's disease to prevent injury to the caregiver as well as the person with Alzheimer's disease. In addition to hands-on care, physical therapists provide caregiver training to improve safety and to decrease the risk of injury. For instance, the therapist can show caregivers how to use adaptive equipment and assistive devices, such as special seating systems, canes, or long-handled reachers, and how to use good "body mechanics" (the way you physically move to do a task).

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Can this Injury or Condition be Prevented?

Although the answer to this question is still unknown, many research studies have found that people who are physically active are less likely than sedentary people—even in later life—to have cognitive decline or dementia as they age. Some research suggests that increased cardiorespiratory fitness might even prevent brain atrophy. Your physical therapist can design an exercise program to help you improve your odds for healthy aging.

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Real Life Experiences

Mr C is 76 years old and was diagnosed with possible Alzheimer's disease 2 years ago. Recently, he began having difficulty doing simple things he once took for granted, such as getting up from a chair and walking to the porch. His physical therapist will develop specific exercise programs to help Mr C keep his balance and decrease his risk of falling. His therapist explains to him that exercise programs also can help him improve his ability to participate in social activities, such as playing with his grandchildren. Exercise can lead to increased blood flow to the brain, which may help to improve his memory and other cognitive abilities.

Mr C's physical therapist will determine which assistive devices would improve Mr C's safety in the community. The therapist also will train Mr C's daughter in how to help Mr C make smoother movements when he rises from sitting to standing or puts dishes in the sink. The therapist also will develop cues to assist Mr C in completing more complex tasks.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

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What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat conditions or injuries. You may want to consider:

  • A physical therapist who is experienced in treating people with conditions related to aging. Some physical therapists have a practice with a geriatric focus.
  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in geriatrics physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

  • Get recommendations from family and friends or from other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have underlying Alzheimer's disease.
  • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

EXERCISE COUNTERS COGNITIVE DECLINE

A recent study in the journal, Medicine Science in Sports & Exercise, adds to the ever-growing body of evidence supporting the benefits of exercise. In addition to the plethora of physical benefits, it was found that moderate-to-vigorous exercise can reduce the risk of cognitive decline by 36%, as reported in Time (Exercise Keeps the Brain Young: Study - December 29, 2016).

With an aging population and continued projected increases for age-related cognitive impairments such as Alzheimer’s disease and other forms of dementia, these findings give hope that older adults can help delay the onset of cognitive decline. 

The study provided 6,400 people aged 65 years and older with an activity tracker for a week, and assessed their cognitive abilities during tasks. After 3 years, people who performed moderate-to-vigorous levels of physical activity were significantly less likely to experience cognitive problems than those who were sedentary or did light physical activity. 

Other studies have shown that receiving physical therapy first for low back pain lowers costs, including basic education from a physical therapist prior to back surgery, and in instances when advanced imaging has been prescribed

As movement experts, physical therapists can design exercise programs for people with dementia or Alzheimer’s disease to include keeping them active and independent for as long as possible.

PHYSICAL THERAPY AND ALZHEIMER'S DISEASE

US population estimates indicate that 5 percent of people over age 65—about 5.2 million—and more than 40 percent of people over the age of 85 have Alzheimer's disease. Along with memory loss and other cognitive problems, people with Alzheimer's disease may have difficulty performing simple tasks of daily living. Physical therapists partner with families and caregivers to help people with Alzheimer's disease keep moving safely and delay worsening of the condition.

What Is Alzheimer's Disease?

Alzheimer's disease is a progressive condition that damages brain cells and affects how we speak, think, and interact with other people. It's the most common cause of dementia, a group of brain disorders that cause a decline in memory and the ability to perform daily activities. And it's the fifth leading cause of death among adults over age 65 in the United States, after heart disease, cancer, stroke, accidents, and respiratory disease.

The risk of getting Alzheimer's disease increases with age; it's rare to get it before age 60. Having a relative with Alzheimer's disease raises your risk of getting it, but most people with the disease do not have a family history of it.

One of the major symptoms of Alzheimer's disease is confusion. There are several other potential causes of confusion, some of which may be reversible if discovered early:

  • If confusion comes on suddenly, schedule a visit with a physician or a neurologist immediately.
  • If confusion occurs or gets worse after a fall or a head injury, immediately call 911 or emergency medical services (EMS) so that an ambulance can be sent.

Signs and Symptoms

There are 10 important warning signs of possible Alzheimer's disease:

  • Memory changes that disrupt daily life
  • Difficulty making decisions, especially in planning or solving problems
  • Difficulty completing familiar tasks
  • Confusion about time and or place
  • Trouble understanding visual images or the way things physically fit together (spatial relationships)
  • Finding the right words to say when speaking or writing
  • Misplacing items and losing the ability to retrace your steps
  • Poor or decreased judgment about safety
  • Withdrawal from work or social activities
  • Changes in mood or personality

People with Alzheimer's disease also may get lost in once-familiar places. In the later stages of the disease, they might get restless and wander, especially in the late afternoon and evening (this is called "sundowning"). They may withdraw from their family and friends or see or hear things that are not really there. They may falsely believe that others are lying, cheating, or trying to harm them.

Along with these "cognitive" symptoms, people with Alzheimer's disease may develop difficulty performing simple tasks of daily living in the later stages of the disease. Eventually, they may need assistance with feeding, bathing, toileting, and dressing. The physical ability to walk is usually retained until the very last stage of the disease; however, due to confusion and safety concerns, people with Alzheimer's disease may need supervision or an assistive device to help them get around safely.

How Is It Diagnosed?

The exact cause of Alzheimer's disease remains unknown and is most probably due to many factors, which makes diagnosis difficult. Researchers are getting closer to making a diagnosis by using brain imaging studies such as computed tomography scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, or ultrasound. These tests can show abnormalities in brain structure or function. Mental function tests, cerebral spinal fluid tap, biomarkers, and genetic testing also can be used to help make a diagnosis. But a definitive diagnosis can be made only on autopsy.

Your physical therapists may play an integral role in recognizing early signs or symptoms of this disease. If they recognize you or your loved one is exhibiting signs or symptoms consistent with Alzheimer’s, they will make an appropriate referral to the necessary specialist.

How Can a Physical Therapist Help?

For people with Alzheimer's disease, research shows that:

  • Physical activity can improve memory.
  • Regular exercise may delay the onset of dementia and Alzheimer's disease.
  • Regular exercise may delay the decline in ability to perform activities of daily living in people who have Alzheimer's disease.

As the movement experts, physical therapists can design exercise programs for people with a variety of health conditions, including Alzheimer's disease.

In the early and middle stages of Alzheimer's disease, physical therapists focus on keeping people mobile and help them continue to perform their roles in the home and in the community. In the later stages of the disease, physical therapists can help people keep doing their daily activities for as long as possible, which reduces the burden on family members and caregivers. Physical therapists also can instruct caregivers and family in how to improve safety and manage the needs of a loved one with Alzheimer's disease. Physical therapy can help improve quality of life and possibly delay the need for institutionalization.

People with Alzheimer's disease develop other conditions related to aging, such as arthritis, falls, or broken bones. Physical therapists are trained to treat these conditions in people who have underlying Alzheimer's disease. Therapists take into account the impact of the disease on other health conditions, on general health, and on the individual's ability to understand important instructions.

The therapist may use various teaching methods, techniques to simplify instructions, and unique approaches, including:

  • Visual, verbal, and tactile cueing - The physical therapist provides "cues such as pointing to objects or gesturing. For instance, lifting up both arms can signal the person to stand up. Cues can also be given verbally with short, simple, or one-step instruction. Tactile clues holding someone's hand to have them walk with you. Sometimes, 2 or 3 cueing techniques are used simultaneously.
  • 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.
  • 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 instance, 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.
  • 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.
  • 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.

Although people with Alzheimer's disease usually maintain the ability to walk well into the late stages of the disease, balance and coordination problems often lead to walking difficulties. The physical therapist will train the muscles to "learn" to respond to changes in the environment, such as uneven or unstable surfaces.

Train Family Members and Caregivers

The family and caregiver may need instruction in how to safely move, lift, or transfer the person with Alzheimer's disease to prevent injury to the caregiver as well as the person with Alzheimer's disease. In addition to hands-on care, physical therapists provide caregiver training to improve safety and to decrease the risk of injury. For instance, the therapist can show caregivers how to use adaptive equipment and assistive devices, such as special seating systems, canes, or long-handled reachers, and how to use good "body mechanics" (the way you physically move to do a task).

Can this Injury or Condition be Prevented?

Although the answer to this question is still unknown, many research studies have found that people who are physically active are less likely than sedentary people—even in later life—to have cognitive decline or dementia as they age. Some research suggests that increased cardiorespiratory fitness might even prevent brain atrophy. Your physical therapist can design an exercise program to help you improve your odds for healthy aging.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat conditions or injuries. You may want to consider:

  • A physical therapist who is experienced in treating people with conditions related to aging. Some physical therapists have a practice with a geriatric focus.
  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in geriatrics physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

  • Get recommendations from family and friends or from other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have underlying Alzheimer's disease.
  • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Authored by William Staples, PT, DPT, GCS. Reviewed by the MoveForwardPT.com editorial board.

6 WAYS OBESITY CAN WEIGH ON THE BRAIN

Obesity not only impacts your physical health; it also impacts your brain. An assistant professor at Texas A&M Health Science Center School of Public Health, who’s received National Institute on Aging funding to study obesity’s effects on brain function in seniors, notes obesity can change the structure of the brain and cause atrophy.

1.     A higher BMI is associated with poorer episodic memory – or difficulty recalling past events – in young adults ages 18 to 35. The findings in a research article published in The Quarterly Journal of Experimental Psychology suggested that people who are overweight may experience memory slightly less vividly or in less detail. Other evidence indicates memory plays an important role in regulating what we eat; and clouded memory can make it harder to watch what one eats and lose weight.

2.     Midlife obesity is associated with a higher risk of dementia. Being obese in one’s 40’s through 60’s is associated with a higher risk of dementia as you age. It’s linked to an increased risk of Alzheimer’s, the most common form of dementia, and a leading cause of death in the US. The true cause is not clear, but it is clear that added pounds negatively affect cardiovascular health, which plays a significant role in brain function.

3.     Obesity in older individuals is associated with changes in brain activity that affect neuromuscular function – including making it harder to grab/grasp onto things. If your grip is not reliable, people can become a much higher risk of falls. It should also be noted, in studies where this information was proposed, obese individuals’ grasping ability was further impaired under stress.

4.     Researchers found obese subjects also expended more mental resources when walking, even though they were able to walk as well as non-obese test subject. And stress further taxed the brain of obese individuals, compared to their normal-weight counterparts. In addition to the physical challenge, the added mental burden of obesity might also lead individuals to tire more quickly.

5.     Being overweight may dull your ability to experience pleasure. One previous study published in the Journal of Neuroscience noted that an area of the brain called the striatum was less activated in women after they had gained weight. The striatum plays a key role in encoding the reward we get from eating certain foods, like those high in sugar that are associated with the release of the brain chemical dopamine, causing us to feel pleasure. In addition to high-fat, high sugar diets leading to being overweight has been associated with this same dulling effect, which experts say can lead a person to overeat to regain that fleeting sense of pleasure.

6.     Obesity raises the risk of depression, and depression can raise the risk of obesity. We definitely know it contributes, and it may also contribute to bipolar disorder.

Health experts say losing weight typically has a positive impact on brain health. Lifestyle changes, including partaking in a heart-healthy diet and exercising regularly, have also proven a beneficial strategy to optimize mental function. As the obesity epidemic rages on, more studies are underway to shed light on those negative effects – and to shed light to help us better understand how to prevent or reverse them.