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Published by May-Ann Low

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Published by: May-Ann Low on Jul 12, 2011
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12/27/2012

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The case of Mr. R.

Alzheimer¶s Disease

R. MMSE 24 in 2005).Mr. CVA. HT. NESB ‡ PMHx T2DM (neuropathy + L) retinopathy).o. male. PVD. ‡ 89 y. daughter is neighbour . IHD. Alzheimer¶s (7-8yrs. B12 def. chol ‡ SHx: Lives with wife in SSH x FA: x 3 steps (L ascending rail) + 1 threshold step (nil rail) x BA: x 3 steps (L ascending rail) 3 children very supportive.

redness cellulitis R) 2nd toe amputated + R) angioplasty 18/5/11 T/F GEM 26/5/11 x Increase endurance. furniture walked. s/v outdoors.Mr. ‡ PMM: nil aid. pain. nil falls reported ‡ HOPC adm 13/5/11 to St V¶s x 2/7 foot pain + 1/7 R) 2nd toe swelling. improve mob & function x D/C planning + supports . R. mainly housebound.

Alzheimer·s Disease ‡ Most common form of dementia (50-70%) ‡ Two different types Sporadic Alzheimer¶s disease x Any age usually >65 years x Most common form x ApoE14 Familial Alzheimer¶s x Usually in 40s or 50s x Very rare x 50% inheritance if a parent has a mutated gene .

nih.http://www.htm .gov/Alzheimers/Resources/HighRes.nia.

gov/Alzheimers/Resources/HighRes.nia.http://www.htm .nih.

htm .Alzheimer·s Disease http://www.nia.nih.gov/Alzheimers/Resources/HighRes.

blood & urine tests Clinical diagnosis 80-90% accuracy . 2005) Detailed medical Hx.Aetiology ‡ Unknown! ‡ ? environment. thorough physical & neuro exam. psychiatric Ax. test of intellectual function. biochemical disturbances. immune processes ‡ Clinical diagnosis through process of elimination (Alzheimer¶s Australia.

2011) ‡ Lapses in memory ‡ Difficulty word finding for everyday objects ‡ Persistent & frequent memory difficulties.Symptoms (National Institute on Aging. especially of recent events ‡ Vagueness in everyday conversation ‡ Apparent loss of enthusiasm for previously enjoyed activities ‡ Taking longer to do routine tasks ‡ Forgetting well-known people or places ‡ Inability to process questions & instructions ‡ Deterioration of social skills ‡ Emotional unpredictability .

Behaviour Changes ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Aggressive Agitated Anxious Depressed Disinhibition Hallucinations & false ideas Sundowning Wandering .

wide BOS. decreased trunk rotation. flexed posture ‡ s/v 3 x steps + bilateral rail ‡ 1 x assist to 1 x threshold step with 4WW .Physiotherapy Assessment ‡ T/F Supine sit with s/v Sit stand with 1 x assistance to ensure correct use of frame & arms ‡ Amb with 4WW + 1 x min assist to steer & ensure correct use Slow gait pattern.

depression.g.Management ‡ No cure Drugs that appear to provide some stabilisation in cognitive function in pts x Cholinesterase inhibitors x Glutamate regulator Drugs for 2° symptoms e. restlessness. sleep disturbance .

improve gait & balance impairments. modify environmental hazards reduced falls by 31% in 1 year (Tinetti et al. 1998) RCT: Rx orthostatic hypotension.. 1994) . 1988) Impaired central processing due to structural & neurochemical degeneration ‡ Psychotropic medications ‡ Incontinence ‡ Neurocardiovascular instability e.& sex-matched controls (Tinetti et al. rationalise medications.g.Falls Prevention ‡ 2x rate of falls in cognitively normal elderly population ‡ Greater than expected impairments of gait & balance compared with age. postural hypotension ‡ Multi-factorial nature of falls multi-disciplinary intervention (Shaw & Kenny.

pointing. 2010) ‡ Short & simple sentences one idea at a time ‡ Allow plenty of time for processing ‡ Use body language gestures. facial expressions. demonstrating ‡ Avoid competing noises ‡ Stay still whilst talking and in their line of vision ‡ Everyone use the same approach repeating the same message ‡ Be flexible. behavioural acceptance .Communication Strategies (Alzheimer·s Australia.

Physiotherapy ‡ Progress mobility/gait re-education ‡ Programs with greater effect include exercises that challenge balance. use a higher dose of exercise. do not include a walking program al. 2008) (Sherrington et ‡ Edu of carer to safely assist pt mobility & complete exercise program ‡ Provision of hip protectors & 4WW ‡ Practice on/off floor transfers (Sherrington et al. 2008) ..

armchair. chairs. lock doors. bottle Organise location & instalment of rails Recommendations on how to make environment safer e. recommend PCA ‡ Home visit Measurements of steps. thermostat . edu of carer.Occupational Therapy ‡ Ax of ADLs. remove automatic door closer. spaces that require clearing. remove rugs.g. bed Provision of OTT chair.

Social Work ‡ Organise services ± EACH package ‡ Liaise with TCP ‡ Family meeting .

Prognosis ‡ Varies individually ‡ Leads eventually to complete dependence death ‡ Average 7-10 years with Alzheimer¶s .

New England Journal of Medicine. & Close. Tinetti. Herbert.E. 56. 2011. (1998).. 2234-2243.T. R. D. Alzheimer¶s Disease Education & Referral Center.D. 331.R. 319.. Speechley. Retrieved June 20. from http://www. Sherrington. Whitney.au/understanding-dementia/alzheimers-disease. M. S. J. & Kenny. R. et al.C.nia.alzheimers. 27.E. Cumming.G..nih. ‡ ‡ . Retrieved June 21. Retrieved June 20.E. S. (1988). 1701-1707.au/services/managing-changes-in-communication. G. & McAvay. Managing changes in communication.F.. (2008). from http://www.medicinenet. R. J.S.alzheimers.gov/Alzheimers/AlzheimersInformation/Symptoms/ Tinetti. New England Journal of Medicine.htm Alzheimer¶s Australia (2005). What is Alzheimer¶s disease? Help sheet. from http://www. 12.org. The Journal of the American Geriatrics Society.References ‡ ‡ ‡ ‡ ‡ ‡ http://www. C. 2011..A.I. 2011. M.aspx Alzheimer¶s Australia (2010). Shaw F.. 7-9. Can falls in patients with dementia be prevented? Age and Ageing. M.aspx National Institute on Aging (2011). (1994). Lord. 821-827.C.com/alzheimers_disease_causes_stages_and_symptoms/article. Baker. & Ginter. A multifactorial intervention to reduce the risk of falling among elderly people living in the community.org. Risk factors for falls among elderly persons living in the community. Effective exercise for the prevention of falls: a systematic review and meta-analysis.

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