Case Study- Late Onset Moderate Alzheimer's Disease
Abstract
Client Characteristics/comorbidity: Mary Johnston is an 80-year-old female diagnosed with Late-Onset Dementia Alzeimer’s disease who lives alone and has been referred by her family physician to be assessed to improve balance following a fall that occurred 6-months prior causing her to require hip surgery. This fracture could have been attributed with her osteoporosis that she was diagnosed with after the fall had occurred.
Disease Phenotype/ Examination Findings: Her moderate stage, with cognitive symptoms as well as limiting physiological symptoms such as forgetfulness, irritability, and problems with gait. A complete subjective, objective analysis was collected and limitations in balance, gait speed, and strength were noticed.
Outcome measures: The outcome measures used were the BERG balance scale (BBS), the 30-second sit to stand test (30CST), and the 6 minute walking test (6 MWT).
Problem List: The problems obtained were structured around the international classification of functioning, disability and health (ICF) model and focused on the limitations in balance, gait speed, and strength.
Clinical Hypothesis/impression: The patient’s diagnosis is poor mobility and function due to general lower limb weakness along with a mild deficit in balance which is related to the LOAD diagnosis. She has a fair prognosis with physiotherapy and could benefit from it by focusing on muscle strength, aerobic endurance and walking speed to help improve ADLs, participate in social activities outside the home and maintain as much independence for as long as possible.
Intervention: Resistance strength exercises (60 minutes, 3 sets of 15 reps per exercise using a medium resistance elastic band 3 days a week for 4 months and an aerobic walking program was prescribed (45 minutes per session, 4 times a week, for 4 months at an intensity of 40% heart rate reserve (HRR) and slowly progress up to 80% HRR). As there is conflicting evidence incorporating virtual reality in the treatment of patients with moderate Alzheimer’s, there may be a benefit to including it into treatment if the technology and resources are readily available. However, there may or may not be any benefit to doing so.
Outcome: The patient had a clinically significant improvement in their BBS of 3 points. She can now perform 2 full sit-to-stand during the 30-second sit-to-stand without using her hands for support. However, we cannot conclude whether this improvement is clinically significant due to the lack of research in this population. Finally, she had no improvement in distance covered, but demonstrated an increase in confidence during the test. Common healthcare professionals involved in care: It was recommended to refer out to an occupational therapist, neurological psychologist, and a social worker.
