Table 7: MDC Scores for Specific Outcome Measures Outcome Measure Timed Up-and-Go (TUG) Mobility assessment of the time it takes to rise from a chair, walk 3 meters, turn, and walk back to the chair, and sit down (measured in seconds)
MDC Values for Individuals With AD or Dementia (Reference Article)
Mean MMSE Score for Subject Population (Standard Deviation)
MDC 90 = 4.09 seconds (Ries et al., 2009) MDC 95 = 5.88 seconds (Blankevoort et al., 2013)
13.1 (8.2)
19.2 (4.4)
MDC 95 = 2.42 seconds (Suttanon, Hill, Dodd, & Said, 2011)
21.4 (5.0)
MDC 95 = 3.44 seconds (Muir-Hunter et al., 2015) MDC 90 = 6.4 points (Conradsson et al., 2007) MDC 95 = 7.7 points (Conradsson et al., 2007) MDC 95 = 16.7 points (Muir-Hunter et al., 2015) MDC 90 = 33.5 meters (Ries et al., 2009) MDC 90 = 37.1 meters (Hesseberg et al., 2015) MDC 95 = 0.27 meters/second (Blankevoort et al., 2013) MDC 90 = 0.09 meters/second (Ries et al., 2009)
20.0 (5.5)
Berg Balance Test 14-item balance test with transitional movements, variable base of support, and functional standing tasks (4-point scale per item for max score of 56)
17.5 (6.3)
17.5 (6.3)
20.0 (5.5)
Six-Minute Walk Test Functional assessment of distance walked in 6 minutes (measured in meters) Gait Speed (6-Meter Walk) Steady state speed of gait using stopwatch for 6-meter course (measured in meters/second) Gait Speed (GAITRite ® Walkway) Steady state speed of gait using computerized, sensored walkway (measured in meters/second)
13.1 (8.2)
24.3 (4.0)
19.2 (4.4)
13.1 (8.2)
MDC 95 = 0.11 meters/second (Wittwer, Andrews, Webster, & Menz, 2008)
22.0 (3.5)
Sit-to-Stand (5 times) Mobility/functional assessment of time required for five sit-to-stand repetitions (measured in seconds)
MDC 95 = 2.73 seconds (Suttanon et al., 2011)
21.4 (5.0)
Caring for the caregiver Caring for individuals with AD creates a physical and emotional toll on families, caregivers, and friends. The changes in a loved one’s personality and mental abilities; the need to provide constant, loving attention for years on end; and the physical and emotional demands of bathing, dressing, and other caregiving duties can be overwhelming. Caregivers juggle many responsibilities and must adjust to new and changing roles. When joining the patient care team, it is important to assess the roles and needs of caregivers because they are key to the successful long-term management of individuals with AD (Sadowsky & Galvin, 2012). The ability to keep an older adult at home (versus in a long-term care facility) is significantly influenced by caregiver burden. Although the majority of people with AD are cared for at home early in their illness, research suggests that increasing perceptions of caregiver stress – physical and emotional – are associated with nursing home placement (Gaugler, Mittelman, Hepburn, & Newcomer, 2010). In working with caregivers, sensitive consideration must be given to cultural beliefs, family roles and expectations, communication Conclusion Evidence continues to mount regarding the physical, functional, cognitive, and behavioral benefits of exercise and activity interventions for individuals with AD and other dementias. By supporting and facilitating mobility, fitness, and safety, physical therapists can impact the quality of life of clients and caregivers. Individuals with dementia have unique interpersonal and therapeutic needs and rehabilitation professionals who are aware of these needs and have a repertoire of strategies to address them will have the best chance of therapeutic success.
patterns, and beliefs about caring for others. As the disease progresses and caring at home becomes increasingly difficult, family members face difficult decisions about long-term care. Interestingly, when individuals with AD participate in exercise programs, caregiver perception of burden may diminish. This is true whether the caregiver is exercising with the person who has AD (the dyad model of both individuals exercising together) or not (Lowery et al., 2013; Stella et al., 2011). Exercise programs designed for dyads of individuals with AD and their caregivers can be an effective mode of intervention and provide structured time that is beneficial for both members of the pair. Caregivers will more successfully keep individuals with AD compliant with their home exercise program if they understand the benefits of exercise and if the program is promoted or supported by the healthcare team (Suttanon, Hill, Said, Byrne, & Dodd, 2012). Therefore, education of the caregiver relative to these issues and awareness of the caregiver’s perceived level of burden should be a priority. This course has provided a review of the pathophysiology and typical progression of AD, as well as a brief review of related dementias and reversible causes of cognitive changes. Movement disorders, albeit subtle, are present early in the course of AD and progress with the severity of dementia; the most common movement disorders were reviewed. Much of this course focused on optimal interactions with individuals who have AD and characteristics of effective interventions. These principles can be integrated into any rehabilitation or exercise environment. The scientific and clinical evidence in support of
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