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81: ALZHEIMER’S DISEASE

Mollie Venglar, DSc, MSPT, NCS

CONDITION/DISORDER SYNONYM

  • Alzheimer’s dementia

ICD-9-CM CODE

  • 331.0 Alzheimer’s disease

ICD-10-CM CODE

  • G30.9 Alzheimer’s disease, unspecified

PREFERRED PRACTICE PATTERN

  • 5E: Impaired Motor Function and Sensory Integrity Associated with Progressive Disorders of the Central Nervous System1

PATIENT PRESENTATION

Physical therapy has been requested for a 78-year-old woman with Alzheimer’s disease. She is presently calm, she speaks only when spoken to, she moves only when asked to move. On questioning she is unable to accurately report the day of the week, the month, or the year. She states she is in a medical building but cannot be more specific. Her husband reports that she seems to walk around the house fairly well, but when he takes her to public places such as their church, a restaurant, or a grocery store, she seems to struggle with her balance while walking and she gets somewhat agitated and very confused. He is unable to adequately calm her until they return home and she returns to sitting in her favorite chair. Upper and lower quarter screens reveal slightly decreased strength bilaterally but no loss of range or motion.

KEY FEATURES

Description

  • A degenerative neurologic disorder characterized by progressive dementia

  • Results in inability to care for oneself or interact in the environment

Essentials of Diagnosis

  • Insidious onset

  • Gradual development of forgetfulness that degenerates into other failures of cerebral function

  • Concise pathology that accounts for 50% of all dementia cases2

General Considerations

  • Definitive diagnosis is made upon autopsy

  • Imaging in late stages of the disease reveals hippocampal and frontal lobe atrophy3

  • Early in the disease process, all other possible causes of dementia are ruled out to diagnose Alzheimer’s disease

FIGURE 81-1

Comparison of a normal neuron and one with abnormalities associated with Alzheimer’s disease. The cytopathologic hallmarks are intracellular neurofibrillary tangles and extracellular senile plaques that have a core of β-amyloid peptides surrounded by altered nerve fibers and reactive glial cells. (From Kandel ER, Schwartz JH, Jessell TM, Siegelbaum SA, Hudspeth AJ, eds. Principles of Neural Science. 4th ed. McGraw-Hill; 2000.)

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FIGURE 81-2

Relationships of risk factors, pathogenic processes, and clinical signs to cellular abnormalities in the brain during’s Alzheimer disease. (From Kandel ER, Schwartz JH, Jessell TM, Siegelbaum SA, Hudspeth AJ eds. Principles of Neural Science. 4th ed. McGraw-Hill; 2000.)

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Demographics

  • Onset primarily occurs at age 60 years and older

  • Women three times more likely than men

  • Weak genetic link; most commonly idiopathic

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