We are all primary care physical therapists.
By Ali G. Schoos, PT, OCS
It is time to recognize the physical therapist’s role in the tsunami of Alzheimer’s disease coming our way. We need to up our game as primary care physical therapists, taking full responsibility for understanding our whole patient, and how best to manage that person’s musculoskeletal care and its impact on brain health.
About four years ago my mom was diagnosed in the early stage of Alzheimer’s disease. When Dad passed away two years ago, Mom was unable to safely be alone. Over the next six months, my siblings and I learned about caregivers, about angry parents not wanting to give up their freedom, about patience, and how to laugh versus cry.
During this time, Mom’s low back pain worsened, and she stopped taking her semiweekly walks. She lives 2.5 hours from me in a little town. I had her go to a physical therapist. She saw someone different almost every visit. She received limited hands-on care, although this was something that helped her a lot. She did exercise every time she went, but it mostly consisted of walking on a treadmill, and walking made her back hurt. I called to discuss Mom’s care. The therapist had no idea my mother had cognitive issues. The therapist adjusted her treatment, and my mom improved. She was discharged at the end of the usual 2 times a week for 5 weeks. No follow-up visit was recommended. No communication was initiated with me or her caregiver about her home exercise program. No community-based program was recommended. Mom couldn’t remember her exercises on her own. Her back pain worsened; her gait became more limited and shuffling. She told me that she couldn’t go back to therapy as her benefits had run out. I knew they had not.
The amount of treatment my mother received seemed arbitrary, rather than thought out as to what might keep her most functional. It wasn’t suggested she be seen intermittently to prevent a downward slide and keep her more active. She could be seen two times a month for the whole year and be within her benefits. No one recognized her cognitive decline and its impact on her care, or took into consideration the effects of that decline on her ability to follow directions for the follow-up care that was not recommended.
In 2015, 5,300,000 Americans were living with Alzheimer’s, with projected growth to 13.8 million by 2050. The cost of care for those with Alzheimer’s and dementia was $226 billion in 2015, with expected growth to over $1 trillion by 2050. Caring for those with Alzheimer’s represents nearly 1 out of every 5 Medicare dollars, and is projected to go to 1 out of 3 dollars by 2050. This represents a fivefold increase for both the government as well as individuals.1
The cause of Alzheimer’s is unknown. It builds over years, and there is no cure. Controlling the risk factors associated with cardiovascular disease correlates with the things we should be doing to prevent Alzheimer’s disease.2 Diet is a big part of that,2-4 as is exercise.
Those who strictly follow the Mediterranean or the DASH (dietary approaches to stop hypertension) diet, or who at least moderately adhered to the MIND (Mediterranean-DASH intervention for neurogenerative delay) diet, had a 35 to 54 percent lower risk for developing Alzheimer’s.3 How easy would it be to put together a single handout with the 10 foods to eat and the 5 food groups to avoid, and make the MIND diet available to all of our clients/patients?
One of the measures most commonly cited in the literature as having a preventive effect on Alzheimer’s, delaying the onset, reducing the cognitive decline associated with Alzheimer’s, and definitely improving one’s function with activities of daily living, is exercise.2,5 As the gurus of exercise, with 13.8 million people coming down the pike anticipated to develop cognitive decline, our profession should be hearing alarm bells going off for this underserved patient population.
We need to take the reins here and educate ourselves about Alzheimer’s and dementia. We should know how to look for and recognize the signs and symptoms of dementia. We should use our reasoning skills and judgment when we prescribe treatment programs for those we know will have poor follow-through at home or will need ongoing management to prevent or slow their physical decline.
We are the medical professionals most qualified to develop, prescribe, and deliver appropriate exercise programs aimed at brain health and disease prevention. I believe we can and should be the leaders in exercise and education to positively impact the cognitive decline that is Alzheimer’s.
1. Alzheimer’s Organization. 2015 Alzheimer’s Disease Facts and Figures.
2. Baumgart M, Snyder HM, Carillo MC, et al. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: a population-based perspective. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. 2015;11(6):718-726.
3. Morris M, Tangney C, Wang Y, et al. MIND diet more predictive than DASH or Mediterranean diet scores. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. 2014; 10(4):166.
4. Shakersain B, Santoni G, Larsson S, et al. Prudent diet may attenuate the adverse effects of Western diet on cognitive decline. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. 2016;12(2):100-109.
5. Radak Z, Hart N, Koltai E, et al. Exercise plays a preventive role against Alzheimer’s disease. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. 2010; 20(3):777-783.
Ali G. Schoos, PT, OCS, is a PPS member and owner of Peak Sports and Spine Physical Therapy in the greater Seattle area. She can be reached at firstname.lastname@example.org.