Alzheimer's

What is Alzheimer’s?

Right now, roughly 750,000 (15%) of Canadians aged 65 or older are living with Alzheimer’s disease or some other form of dementia. By 2031, some estimates suggest that number will double. Those suffering directly from the disease are not alone; the physical and psychological toll on caregivers is immense.

Alzheimer’s causes patients to gradually lose their memory, and over time, lose physical functions as well. It can rob individuals of their dignity and independence. Medicine can help, but there is no cure. Studies show that regular exercise is a key part of living with the disease. It helps maintain motor skills, reduces the risk of falls, and has been shown to slow the rate of mental decline.

The following is reprinted from the American Physical Therapy Association’s (APTA) guide on Alzheimer’s disease. You can read their full guide here.

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.

What are the 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 Physio can help

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.

How Physiotherapists can help 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).

Please read the American Physical Therapy Association’s (APTA) full guide on Alzheimer’s disease here.