Early-Onset Alzheimer's: A Case Study

Abstract

Alzheimer's is the most common cause of dementia. It is characterized by a gradual degradation of various physical and cognitive functions 1. The current case study is about a 42 year old female with early onset Alzheimer’s Disease (EOAD) seeking physiotherapy treatment. Evaluation findings include gait abnormalities, decreased balance and decreased cognition. She presented with forward head posture with slight postural kyphosis and palpable muscle tightness in upper trapezius. Slight weakness in lower extremities, and decreased shoulder flexion bilaterally. The physiotherapy intervention component includes education, home based exercise programs addressing aerobic and strengthening deficits. Following the physiotherapy intervention, Mrs. S improved her AROM, muscular strength, postural control and gait all the while decreasing overall fatigue and risk of falls. Throughout the treatment plan there were no changes in cognitive function. Mrs. S will continue to be involved in interprofessional care to maintain her quality of life. The physiotherapist’s role in EOAD cases is to maximize independence to help prevent the progression of physical and cognitive decline2. In the future, more research must be conducted to determine the adequate frequency, intensity, and duration of treatment for patients with EOAD 3,4.

Introduction

Alzheimer's is “a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks” 1. Literature shows that physical activity has been repeatedly found to improve the ability of patients with dementia to perform activities of daily living (ADLs)5. However, it seems that the frequency, intensity, and duration of exercises prescribed in order to elicit benefits varies widely between studies 5. On the other hand, research regarding the effects of physical activity on the cognitive function of patients with dementia are inconclusive. A review conducted by McDonnell et al., stated that there is a small effect of aerobic exercise programs on improving cognitive function 6. However, another review states that an exercise program combining aerobic and strength conditioning evokes no effects on cognitive function7. The current case study describes a patient with EOAD who presents with mild difficulties with her ADLs as well as other symptoms such as reduced balance, gait abnormalities, reduced aerobic capacity, and cognitive decline. This report strives to document the changes in the patient’s symptom presentation throughout her involvement in physiotherapy.

Client Characteristics

Mrs. S, a 42 year old female with a 1 year history of EOAD presents to the clinic. She previously worked as a full time administrator at a real estate office. She is recently unemployed due to the worsening of her condition in the last 3 months. Various progressive cognitive symptoms such as memory deficits and confusion have rendered her unfit to continue to work. Mrs. S sought for physiotherapy in order to delay the physical progression of the disease. Her chief complaints include mild difficulties with gait, balance, and being fatigued easily. She noted that she has stumbled and tripped several times in the past 3 months but was fortunately not hurt. She has also noticed the increasing difficulty she is having with fine motor skills such as writing and doing up her buttons when dressing. With the diagnosis of EOAD, the patient is at an increased risk of various secondary conditions such as osteoporosis and falls.

Examination Findings

SUBJECTIVE

Patient Profile (PP): 42 y/o female

History of Present Illness (HPI): Diagnosed with EOAD 1 year ago, presenting with mild cognitive and physical deficits, not currently receiving treatment interventions from PT.

Past medical history: Depression

Medications: Celexa (citalopram) 20mg/day, donepezil (aricept) 10mg/day

Health Habits: Non-smoker, 1 glass of red wine per week, no other substances

Family History: Mother passed away from complications of EOAD in 2001

Social History: Recently resigned from full time position as administrator at a real estate office due to cognitive difficulties. Lives alone in a bungalow with her pet dog. Family lives in the next town over (25 minute drive). Currently spends majority of her day walking her dog and babysitting her neighbours’ kids.

Imaging: Magnetic resonance imaging (MRI), Positron Emission Tomography (PET), Single-Photon Emission Computed Tomography(SPECT)

Precautions/Contraindications: Slight confusion with short term memory, risk of agitation, current unemployment, and depression.

Objective

Vitals: HR: 80 bpm, BP: 120/80 mmHg, RR= 20 bpm.

Observation: Forward head posture (protracted) along with slight increased postural kyphosis. Palpable muscle tightness in upper trapezius. Patient appears to be slightly deconditioned.

- Cervical AROM= slightly limited in extension - Shoulder AROM= bilateral shoulder flexion decreased. - All other UE AROM= WNL - U/E sensation intact - L/E AROM= limited trunk extension, all other WNL - L/E sensation intact

Jeanie