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Dementia/Alzheimer’s

Dementia is the term used to describe a set of symptoms that occur when the brain is affected by disease. Most of us are at least somewhat familiar with Alzheimer’s disease. It is the most common type of dementia, but it is only one of many forms. Each type of dementia has a different cause and affects people in different ways. It may be difficult to tell which type of dementia a person has because they all have some symptoms in common. A thorough doctor’s examination is needed to make a correct diagnosis.

The most common types of dementia can be explained in brief by the following:

Alzheimer’s disease
Alzheimer’s is by far the most widespread form of all dementias. It affects memory first and later progresses to affect other cognitive (brain) abilities, such as speech, ability to reason, and movement. Current treatments for Alzheimer’s disease can help boost the levels of chemical messengers in the brain, which can help with some of the symptoms.
Vascular Dementia
Second only to Alzheimer’s, vascular dementia is another commonly diagnosed form of dementia. It occurs when there is an interruption in the blood flow to the brain often caused by a stroke, heart disease or diabetes. Onset of vascular dementia is often sudden. Symptoms depend upon area of brain affected, but often memory and other cognitive functions, such as decision-making, are impaired.
Lewy-Body Disease (LBD)
Dementia with Lewy bodies (DLB) is a type of dementia that shares symptoms with both Alzheimer’s disease and Parkinson’s disease. It may account for 10-15 per cent of all cases of dementia. It occurs as the result of protein deposits that build up on nerve cells in the brain stem. It results in muscle rigidity, behavioural issues, cognitive decline, hallucinations and tremors.
Frontotemporal Dementia
Another form of dementia, Frontotemporal impacts the front and side portions of the brain. The result can be impaired speech, memory impairment, and behavioural problems. It often causes a loss of inhibition that is difficult for family caregivers to control.
Parkinson’s Dementia
When Parkinson’s disease (PD) progresses, it can lead to dementia. This causes memory loss and other typical dementia symptoms in addition to the already tough symptoms of PD.
Huntington’s Disease
Huntington’s disease is a genetic disease that is associated with or may lead to dementia. Huntington’s disease generally begins earlier in life, between ages 30 and 45, and is characterized by mood swings, lack of coordination, and involuntary movement of the head, trunk and limbs. Also, people with Huntington’s may develop dementia symptoms as the disease progresses.
Mixed Dementia
Mixed dementia is when a person has two different types of dementia. Many researchers believe a significant portion of people who live with dementia suffer from more than one type. The most common combination is Alzheimer’s disease and vascular dementia.

How can we help?

A commonly asked question is how can a person with Alzheimer’s disease or dementia benefit from rehabilitation when they don’t even recognize their own family or places that should be familiar to them?

Physical therapy, occupational therapy and speech-language therapy services can be beneficial to the person with dementia as well as their family and caregivers at various stages of Alzheimer’s or dementia.

In the early stages, rehabilitation services can help your loved one be as functional as possible for as long as possible. The focus of physical therapy (PT) with dementia care is to improve balance, muscle strength, and mobility and provide pain management. Another goal of PT treatment is preventing falls. People with Alzheimer’s or dementia are at greater risk of falls and mobility problems due to muscular weakness, history of falls, gait, balance deficits and cognitive impairment. Safe physical activity, including exercise, will maintain strength, balance, ability to walk and ability to get into or out of a chair or car.

Both the physical and occupational therapist may assist you in changing and enhancing your loved one’s environment to improve function and safety. Environmental modifications such as adding signs on bathroom doors and labelling drawers for socks and shirts may allow a person with dementia to function at the highest level possible for as long as possible.

In the mid-stages of Alzheimer’s and dementia, challenging behaviours are most often present during bathing, toileting, dressing and eating – all areas of expertise for an occupational therapist. Occupational therapists can provide instruction on how to manage these daily tasks safely and with as minimal stress as possible. Even if you believe your loved one now has a limited ability to learn new things, occupational therapy treatment can be helpful.

Physical therapy can assess one’s ability to walk safely, the risk of falls, and other functional tasks. The therapist will develop a treatment program, including exercise, to help maintain your loved one’s current abilities, which also has the effect of reducing the burden on the caregiver. A person does not need to remember having engaged in an exercise program to reap the benefits of exercise – they just must participate.

In the late stages, the role of physical, occupational and speech therapies change yet again. Rehabilitation therapists can recommend and help you obtain a custom wheelchair to maximize comfort and function for seating and positioning. Skilled therapists can also help prevent and manage the shortening of muscles or joints, and train you in overall care for your family member at the end-stages, including proper feeding.

Speech-language pathologists have a primary role in the assessment, diagnosis and treatment of swallowing disorders associated with dementia. These specialists also can assess a person’s cognitive and communication abilities and recommend strategies to help manage difficulties.

Rehabilitation services have much to offer at all stages in the disease process to maximize function, manage day-to-day activities, reduce the burden of care, reduce caregiver stress and improve the quality of life for all.

How can we help?