Physical Therapy in the treatment of Alzheimer’s Disease

Studies indicate that 5 percent of people over age 65—about 5.2 million—and more than 40 percent of those over the age of 85 have Alzheimer's disease. As they battle the challenges of memory loss and other cognitive problems, these people can find the simple tasks of daily living to be increasingly difficult.

The physical therapist can play an important role in helping Alzheimer’s sufferers.  Partnering with families and caregivers, physical therapistscan help patients with Alzheimer’s disease keep moving safely and, through exercise, delay worsening of the condition.

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 brain disorder that causes a decline in memory and the ability to perform daily activities, and is  the fifth leading cause of death among adults over age 65 in the United States — after heart disease, cancer, stroke, accidents, and respiratory disease.

There are 10 reliable and important warning signs of possible Alzheimer's disease.  Look for:

  • 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 may get restless and wander, especially in the late afternoon and evening (known as "sundowning"). They may withdraw from family and friends or see or hear things that are not there. They may be suspicious that others are lying, cheating, or trying to harm them.

In the later stages of the disease, Alzheimer's sufferers may develop difficulty performing simple tasks of daily living.  Eventually, they may need assistance with feeding, bathing, toileting, and dressing. Usually, they will retain the physical ability to walk until the very last stage of the disease; however, they may need supervision or an assistive device to help them get around safely.

 How can a physical therapist help? 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 loss of later-stage patients’ ability to perform activities

In the early and middle stages of the disease, physical therapists will focus on keeping people mobile and help them continue to perform their roles in the home and in the community. In the later stages, physical therapists can help patients to keep doing their daily activities for as long as possible, which reduces the burden on family members and caregivers.

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 Alzheimer’s –related conditions. The therapist may use various teaching methods, techniques, 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.
  • Mirroring: With this technique, the physical therapist serves as a "mirror," standing directly in front of the person to show them how to move.
  • Task breakdown: Physical therapists give step-by-step instruction by breaking down the task into short, simple "pieces" to be completed separately.
  • Chaining: The physical therapist can provide step-by-step instructions by linking one step to the next step in a more complicated movement pattern.
  • Hand-over-hand-facilitation: The physical therapist takes the hand or other body part of the patient and moves that body part through the motion of completing a task or motion.

Alzheimer’s sufferers usually can walk well into the late stages of the disease, but balance and coordination problems may lead eventually 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.

The family and caregiver may need instruction in how to safely move, lift, or transfer the  Alzheimer's patient to prevent injury to the caregiver as well as the patient. In addition to hands-on care, physical therapists provide caregiver training to improve safety and to decrease the risk of injury.  

Research has found that physically active people are less likely than sedentary people 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.