Alzheimer’s Disease (DM)
It is the most common form of Dementia among older people. Dementia is brain disorder that affects person’s ability to carry out daily activities. AD begins slowly. It first involves the parts of brain that control thought, memory and language. People with AD may have trouble in remembering things that happened recently or names of people they know. AD usually begins after age 60. the earliest cause of AD is unique for every individual. The earliest observable symptom are often mistakenly thought to be age related or manifestations of stress.
Causes of AD
AD is caused by reduced synthesis of neurotransmitter acetylcholine. The amyloid(peptides of 36-43 amino acids that appear to be the main constituent of amyloid plaques). .Hypothesis postulated that amyloid beta deposits are the fundamental cause of this disease.
The Tau hypothesis, the idea that “Tau proteins (proteins that stabilize microtubules) abnormalities initiate the disease cascade. Tau begins to pair with other threads of Tau , eventually , they form neurofibrillary tangles inside nerve cell bodies.
Symptoms of AD
Symptoms of AD is divided into four stages
1) Pre-dementia features
2) Early features
3) Moderate features
4) Advanced features
First symptoms are often mistakenly attributed to “aging” or “stress”. These early symptoms can affect the daily living activities. The most noticeable deficit is memory loss, which shows up difficulty in remembering recently learned facts and inability to acquire new information.
Problem with executive functions like planning, flexibility and thinking or impairment in semantic memory (memory of meanings, concept of relationships)occur. Apathy (lack of emotions) can be observed and remain more persistent. Neuropsychiatric symptoms (deals with mental disorders ) are common.
In this difficulty with language perceptual problems or Apraxia(carry out learned purposeful movements) are prominent. AD doesn’t affect all memory capacities equally. Old memories of patient’s life(episodic memory), the memory of body on how to do things(such as using fork to eat) are affected to lesser degree than new memories.
Language problems are mainly affected by decreased word fluency. While performing fine motor tasks such as writing, drawing or dressing are little affected. As disease progress people with AD cannot perform task independently.
In this patient being unable to perform most common activities of daily living. Speech difficulties become evident due to an inability to recall things which may lead to frequent incorrect words. Reading and writing skills are also progressively lost. Long term memory which was previously intact, become impaired. Common manifestations are wandering, irritability and leading to crying, aggression, delusion and urinary continence occurs.
During this patient completely dependent on caregivers. Language is reduced to simple phrases or even single word or may be complete loss of speech. Even if patient looses his speech he can fully understand and return emotional signals. Aggression and Apathy is on extreme. Patient will not able to perform the simplest task without assistance. These patients even lost the ability to feed themselves
Physiotherapy treatment of AD
Physiotherapy will improve independence with everyday activities such as bed mobility, walking and climbing the stairs as well as advising the family and carers about help outside treatment sessions.
Benefits of physiotherapy for AD patients
5) Relieving stiffness
6) reduce risk of falling
7) maintaining independence
Passive or active range of motion should be given to the patient to keep the muscles strong and flexible to make functional activities much easier. Balancing training should be given so that patient attain confidence and hence reduces the risk of falling. Gait retraining should be taught to the patient to increase the mobility. stretching exercises should be given in order to prevent pain. In addition to this strengthening of various muscle groups should be done so as to attain less dependency.