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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, & work to prevent potential falls (Tab 2)

  • Patients with AD sometimes wander outside ...

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