CNS-P

Progressive Disorders of the Central Nervous System (CNS-P)

Alzheimer's Disease

Description/Overview

Alzheimer's disease (AD) initially affects cognitive function & can be divided into 4 stages: preclinical, mild, moderate, & severe. In the preclinical stage, patients often demonstrate minimal cognitive impairment with memory loss usually being the first visible sign.

Physical Therapy Examination

General Considerations

• Use alerting cues & simple commands if patient demonstrates signs of dementia

• Provide reassurance & familiarity in place and activity selections

• May need family member assistance

History (Refer to Tab 2)

• May need to obtain history from a family member

Vital Signs

• Assess BP, HR, RR, & body temperature

Tests and Measures

Aerobic Capacity/Endurance

Assessment

• Assess BP, HR, & RR at rest & during & after activities

• If possible, administer 2-minute walk test & Borg Rating of Perceived Exertion (Tab 2) to determine measured & perceived exertion

Potential findings

• May have impaired responses to exercise due to deconditioning

Anthropometric Characteristics

Assessment

• Assess weight, height, & BMI

Potential findings

• Patients with AD may experience drastic weight changes (gains or losses) due to changes in eating behavior

Arousal, Attention, and Cognition

Assessment

• Administer Mini-Mental State Exam (Tab 2) to assess orientation, cognition, short- & long-term memory, & communication

Potential findings

• Patients with AD may

  • Become easily confused & disoriented regarding date, time, & place

  • Exhibit "sundowning" behaviors (increased risks of wandering, agitation, & confusion in late afternoon)

  • Experience hallucinations, agitation or delusions (for instance, believing "someone is trying to poison me")

  • Exhibit personality changes such as violent outbursts

  • Exhibit sleep-wake cycle changes (often sleep during the day & stay awake at night)

  • Experience difficulties in judgment

  • Show an inability to follow directions

  • Have difficulty performing complex tasks such as balancing a checkbook

  • Experience short-term memory loss (for instance, misplacing objects & being unable to follow multistep instructions)

  • Have trouble communicating (often substitute simple words for more complex words; some patients with AD eventually become completely noncommunicative)

Circulation

Considerations

• Most patients with AD are elderly & often have high blood pressure unrelated to the disease

Assessment - Assess for

• BP, HR, & edema in supine, sitting, & standing

• BP & HR at rest & during & after activities

Environment, Home, and Work Barriers

Considerations

• Check environment, home, & ...