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Physiotherapy In Action: Alzheimer’s Disease

by: - March 21, 2017
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Dr Lucia Corriette

By: Dr Lucia Corriette
Physiotherapist

According to the Alzheimer’s Association of America, Alzheimer’s disease is a common form of dementia and accounts for 60 to 80 percent of dementia cases. Dementia is described as loss of memory and other intellectual abilities serious enough to interfere with daily life. By 2005, 24.2 million people worldwide had dementia and 4.6 million new cases were being diagnosed every year.

Approximately 70% of these cases were caused by Alzheimer’s disease (AD). Alzheimer’s is the sixth leading cause of death in the United States. Those with Alzheimer’s live an average of eight years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions.

AD is not a normal part of aging, nor is it a disease of old age. Up to 5 percent of people with the disease have early onset AD (also known as younger-onset), which often appears when someone is in their 40s or 50s.

Risk Factors
• Age: One of nine people aged 65 or older has AD and nearly one of three people aged 85 or older.

• Family history: Having a close family member such as a parent, brother, sister or child with AD makes you more likely to have the disease. The risk increases if more than one family member has the illness.

• Genetics: The likelihood of developing AD can be determined genetically. Genetic tests are available for both APOE-e4 and the rare genes that cause the disease. However, routine genetic testing for AD is not currently recommended by health care providers.

• Head trauma: Serious head injury may be linked to a future risk of AD, particularly if this occurs repeatedly or involves loss of consciousness.

• Heart-head connection: Brain health has now been linked to heart health. Your brain is nourished by one of your body’s richest networks of blood vessels. Conditions that damage the heart or blood vessels include high blood pressure, heart disease, stroke, diabetes and high cholesterol. The reduction in blood supply to the brain caused by these conditions can put you at risk of developing AD.

• Type 2 diabetes: In observational studies, type 2 diabetes has been found to nearly double the risk of AD.

• Body weight: Prospective studies have linked both low and high body weight to an increased risk of cognitive impairment and AD.

Signs and Symptoms
• Difficulty remembering newly learned information

• Disorientation

• Mood and behavior changes

• Increased confusion about events, time and place

• Unfounded suspicions about family, friends and professional caregivers

• Increasing memory loss and behavior changes

• Difficulty speaking

• Difficulty swallowing

• Difficulty walking

The Clock Drawing Test
The Clock Drawing Test is used as a screening tool to assess the cognitive function of those suspected to have AD. The person is asked to draw the face of a clock, mark in the hours and then draw the hands to show a particular time. The diagram below shows the clocks drawn by individuals with Alzheimer’s disease.

AD is a progressive disease, which means that dementia symptoms get worse over a number of years. There is mild memory loss in the early stages, but eventually, in late-stage Alzheimer’s, those affected no longer have the ability have a conversation or respond to their environment.

Protective Factors
• Diet: It has been proven that consumption of a Mediterranean diet, which includes high intake of plant foods and fish, with olive oil as the main source of monounsaturated fat, a low intake of red meat and poultry and a moderate intake of wine, is associated with a reduced incidence of AD.

• Physical activity: The effect of physical activity on brain health is unclear. Some studies have shown that physical activity has a beneficial effect on brain health, while others have shown no connection.

• Intellectual stimulation: Several studies suggest that young and older people who engage in cognitively stimulating activities, such as learning, reading or playing games, are less likely to develop dementia than individuals who did not engage in these activities. However, this does not mean that well educated people do not develop AD.

Brain Changes in Alzheimer’s Disease
Nerve cells are destroyed because of the presence of plaques and tangles in the brain of those with AD. Plaques form between nerve cells and are deposits of a protein fragment called beta-amyloid. Tangles are twisted fibers of another protein called tau, and these are deposited in the nerve cells.

Plaques and tangles are also seen in many older people. However, patients who have AD have many more. They are also usually deposited in a typical pattern, with the first deposits located in parts of the brain responsible for memory. They are then formed in other areas of the brain.

It is believed that these plaques and tangles disrupt communication between nerve cells and disturb processes within the cells, causing their death. This is what leads to loss of memory, personality changes, problems carrying out daily activities and other symptoms of AD.

Over time, as nerve cells continue to die, the brain of someone with Alzheimer’s disease shrinks or atrophies.

Medical Management
At the moment, there is no known cure for AD. Medication is prescribed to address the symptoms of the disease. Therefore, the physician may prescribe drugs to help with memory loss. Personality changes such as irritability, anxiety, depression, agitation, restlessness, hallucinations, delusions, physical outbursts, verbal outbursts and difficulty with sleep are also treated with medications.

Other Treatment Options
There are a number of supplements and herbal remedies being proposed as effective treatment options for AD. Among these are caprylic acid and coconut oil, coenzyme Q10, coral calcium and Ginko biloba. These options have not undergone the phases of testing or scientific research required for approval by regulatory bodies such as the US Food and Drug Administration.

Some have turned to coconut oil as a more readily available and affordable source of caprylic acid. However, there have been no research studies to verify its use as a treatment for Alzheimer’s disease. In addition, details such as the dosage and frequency of use that is most effective would not be known.

Physiotherapy
People diagnosed with AD show a decline in mobility, ambulation, body care, and home management skills over time. They also have an increased risk of injuries, including falls and fractures. Although it is important to note that fall-related injuries can also be due to reactions to prescribed medications, musculoskeletal problems, and the physical environment (e.g. small mats on the floor).

Physiotherapy is geared towards addressing deficits in strength, endurance and flexibility. The exercise program should be performed regularly in order to maintain benefits. The program should be adjusted to suit the capabilities of the individual patient, since some will be strong and others, less active. The goal of physiotherapy is to engage the patient in exercises that maximize their capabilities and prolong their ability to engage in physical activities such as walking.

Take Away
AD is an increasingly common condition. It is important to be aware of the possibility of older family members developing this condition. Due to its progressive nature, plans will have to be made to ensure proper care of affected loved ones.

References
1. Alzheimer’s Association. What Is Alzheimer’s? http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp
2. Brodaty, H, Moore, CM. The Clock Drawing Test for Dementia of The Alzheimer’s Type: A Comparison of Three Scoring Methods in a Memory Disorders Clinic. International Journal of Geriatric Psychiatry, 12: 619±627, 1997.
3. Drugs and Diseases Reference Index. Alzheimer’s Disease. http://dxline.info/dictionary/alzheimers-disease
4. Mayeux R, Stern Y. Epidemiology of Alzheimer Disease. Cold Spring Harbor Perspectives in Medicine. 2012;2(8):a006239. doi:10.1101/cshperspect.a006239.
5. Reitz C, Mayeux R. Alzheimer disease: Epidemiology, Diagnostic Criteria, Risk Factors and Biomarkers. Biochemical pharmacology. 2014;88(4):640-651. doi:10.1016/j.bcp.2013.12.024.
6. Teri, L, McCurry, SM, Buchner, DM, Logsdon, RG, LaCroix, AZ, Kukull, WA, Barlow, WE, Larson, EB. Exercise and Activity Level in Alzheimer’s Disease: A Potential Treatment Focus. Journal of Rehabilitation Research and Development. 1998;35 (4): 411-419.
7. The AD Plan. Study Says this Vitamin Combination May Help in Alzheimer’s Prevention. http://theadplan.com/alzheimersdietblog/recipes/study-says-this-vitamin-combination-may-help-in-alzheimers-prevention/