Americans and Hispanics are more likely to be afflicted with dementia than older Caucasians. Factors associated with these disparities do not appear to be genetic and may instead be explained by differential rates of conditions such as hypertension and diabetes among the groups, socioeconomic disparities associated with education and access to medical care, and underdiagnosis in these ethnic subgroups. ● History of head trauma: A significant brain injury or repeated minor brain injuries (concussions) have been linked to increased risk for AD or AD-like dementia (i.e., chronic traumatic encephalopathy). Increasingly, evidence demonstrates the cognitive protective effect of a lifetime of physical activity and mental engagement (Phillips, 2017), and neuroimaging studies have confirmed some of the neural plastic effects of both active lifestyles and activity interventions. Expansion or diminished atrophy of the prefrontal The diagnosis of AD and related neurocognitive disorders is important for several reasons. Most importantly, many conditions that cause symptoms that mimic those of AD may be treatable. Prompt identification and management of a treatable condition that mimics AD may totally resolve the problem. The Alzheimer’s Association has championed a campaign for early detection and diagnosis of AD. Early diagnosis may give individuals with AD an opportunity to take medications that may slightly slow the progression of symptoms during the early stages. Pragmatically, the sooner an individual with AD and his Diagnostic criteria and guidelines Currently, there is no definitive test to diagnose AD, and there continues to be some disagreement within both the research and clinical worlds as to the optimal diagnostic criteria for AD (Morris et al., 2014). In 2011, the NIA, the Alzheimer’s Association, and experts from around the world synthesized information on the pathophysiological and clinical aspects of AD and issued new criteria and guidelines for diagnosis. These core clinical criteria identify three stages of AD: preclinical, mild cognitive impairment (MCI) due to AD, and dementia due to AD (Jack et al., 2011). These criteria, as mentioned, highlight that Alzheimer’s disease begins before dementia is apparent in the mild or early stage and can be diagnosed by biomarkers (i.e., anatomical, biochemical, and physiological measures). The preclinical criteria are useful for research purposes only and additional research is needed to better understand biomarkers and the progression of AD. The criteria were developed to be flexible for use in general practice without immediate access to neuropsychological testing, advanced imaging, or other lab testing used in the diagnosis of dementia. The guidelines include core clinical criteria that are useful in all clinical settings for the diagnosis of dementia, ranging from the mildest to the most severe stages, and for diagnosing probable and possible AD dementia. The core clinical criteria for dementia include: 1. Interference with vocational or routine activities. 2. Decline from previous levels of functioning. 3. Cognitive impairment that is detected via input from the person and an informed other, and an objective cognitive assessment – neuropsychological testing need only be performed if diagnostically warranted. 4. Cognitive or behavioral impairment involving two or more of the following domains: a. Impaired ability to acquire or remember new information. b. Impaired reasoning and handling of complex tasks, or poor judgment. c. Impaired visuospatial abilities. d. Impaired language functions. e. Changes in personality, behavior, or comportment. (McKhann et al., 2011)
cortex and hippocampal brain regions in individuals who engage in high levels of physical activity have been demonstrated (Erickson, Weinstein, & Lopez, 2012). While a lifetime of physical activity and fitness is ideal, it is never too late to begin a training or activity regimen. Targeting those with a genetic risk for AD or those with mild cognitive impairment (which often transitions to dementia) for activity interventions may be promising for impacting the course of disease progression (Öhman, Savikko, Strandberg, & Pitkälä, 2014; J. C. Smith et al., 2014). Rehabilitation professionals who are committed to health and wellness have a responsibility to educate colleagues in health care, and patients or clients and their families, about the power of physical activity. Physical therapists, with their expertise in movement systems and activity prescription, are uniquely positioned to have a significant impact on the mobility, functionality, and health of older adults.
DIAGNOSIS OF ALZHEIMER’S DISEASE
or her family know the diagnosis, the more time they have to make future arrangements, handle financial matters, establish a durable power of attorney, deal with other legal issues, create a support network, and make plans to join a research study. However, because there is no cure or even a substantially effective treatment for AD, some individuals and their families intentionally delay a diagnostic workup for as long as possible, thinking they would rather be unsure of the diagnosis than to know definitively that the individual has a condition for which there is no cure. The core clinical criteria for probable AD include all of the core clinical criteria for dementia previously noted, along with: 1. Insidious onset. 2. Evidential history of worsening cognition. 3. Initial and most prominent cognitive deficits present in history and examination in one of the following categories: a. Amnestic symptoms, including impairment in learning and recall of recent information. b. Nonamnestic symptoms involving language, visuospatial cognition, or executive dysfunction. 4. No evidence of cerebrovascular disease, features of either FTD or LBD, features of progressive aphasia or neurological disease, or a non-neurological comorbidity or medication that could affect cognition. (McKhann et al., 2011) In the psychiatric nomenclature, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (American Psychiatric Association, 2013) issued a new classification system for the diagnosis of AD and other dementias. The DSM-5 is widely used by psychiatrists and other mental health practitioners and is mapped to the International Classification of Diseases (ICD) codes that are widely used by insurance companies. In the DSM‑5, the conditions that were previously referred to collectively as dementias are now termed neurocognitive disorders (NCDs) to distinguish diseases such as AD from psychiatric disorders that have cognitive impairment as a symptom rather than a defining feature. Although the American Psychiatric Association acknowledges that the term dementia is acceptable and likely will continue to be widely used in clinical practice, the usage of the new diagnostic term is intended to encourage identification of the etiology or origin of the cognitive decline. Specific subtypes of NCDs are further noted in the DSM-5 (e.g., AD, frontotemporal lobar degeneration, LBD, vascular disease). In addition, the DSM-5 recognizes that symptoms range along a spectrum from major to minor. Criteria for the diagnosis of major NCD due to AD are met when NCD (dementia) is present, there is a gradual progression of impairment, and AD is determined to be probable based on: 1. Evidence of an Alzheimer’s genetic mutation from family history or testing.
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