Clinical Alzheimer Rehabilitation

361 Pages·2008·4.04 MB·English

by  Prem P. Gogia

Clinical Alzheimer
Rehabilitation
Prem P. Gogia, DPT, PhD, has more than 30 years of experience in the
health care delivery systems. He received a Doctor of Physical Therapy
from Drexel University, Philadelphia, Pennsylvania, and a Doctor of
Philosophy in physical therapy from Texas Woman’s University, Hous-
ton, Texas. Dr. Gogia also earned a Master of Health Science degree in
physical therapy from Washington University, St. Louis, Missouri. He
also holds a Master of Business Administration in Management from
Southern Illinois University, Edwardsville, Illinois. Dr. Gogia has pub-
lished 22 research and special interest papers in professional journals. In
addition to contributing a few chapters to books, he is the author of two
books titled Clinical Orthopedic Tests and Clinical Wound Management.
Prior to joining PRS Health System, Inc., as president and CEO, he held
various positions including Clinical Director of Rehabilitation Services
and Wound Clinic at Park Plaza Hospital in Houston, and served as an
Adjunct Assistant Professor in the Department of Physical Therapy at
the University of Texas Medical Branch in Galveston. Dr. Gogia has ex-
tensive management experience in rehabilitation, home health, durable
medical equipment, and assisted living facilities.
Nirek Rastogi ,MD , graduated from Rutgers College with a Bachelor’s
degree in biology with honors and a minor in psychology. He attended
medical school at Ross University School of Medicine where he gradu-
ated with high honors. Dr. Rastogi did his residency training in family
medicine at Overlook Hospital in Summit, New Jersey, and served as
chief resident during his final year of training. Currently, Dr. Rastogi
is working as a private-practice clinician in Phoenix, Arizona. He is a
board certified family physician who holds licenses to practice medicine
in New Jersey and Arizona. He is a member of the American Academy of
Family Physicians and Arizona Academy of Family Physicians.
Clinical Alzheimer
Rehabilitation
PREM P. GOGIA, DPT, PhD
NIREK RASTOGI, MD
N Y
EW ORK
Copyright © 2009 Springer Publishing Company, LLC
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise, without the prior permission of Springer Publishing
Company, LLC.
Springer Publishing Company, LLC
11 West 42nd Street
New York, NY 10036
www.springerpub.com
Acquisitions Editor: Sheri W. Sussman
Production Editor: Julia Rosen
Cover design: Mimi Flow
Composition: Apex CoVantage
08 09 10 11 12/ 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Gogia, Prem P., 1953–
Clinical Alzheimer rehabilitation / Prem P. Gogia, Nirek Rastogi.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8261-1707-6 (alk. paper)
1. Alzheimer’s disease—Patients—Rehabilitation. I. Rastogi, Nirek. II. Title.
[DNLM: 1. Alzheimer Disease. 2. Alzheimer Disease—rehabilitation.
WT 155 G613c 2008]
RC523.G63 2008
616.8'31—dc22 2008016043
Printed in the United States of America by Bang Printing.
This book is dedicated to my father, the late Mr. J. R. Gogia, whose
suffering from Alzheimer’s disease inspired me to study and to share
my experiences with my professional colleagues.
—Prem P. Gogia, DPT, PhD
This page intentionally left blank
Contents
Foreword by Shirley Sahrmann, PT, PhD, FAPTA ix
Preface xi
Acknowledgments xiii
1 Introduction 1
Understanding Alzheimer’s Disease 2
What This Book Can Offer 11
2 Dementia Syndrome 15
What Is Dementia? 15
Types of Dementia 24
3 Causes of and Risk Factors for Alzheimer’s Disease 41
Why Do People Develop Alzheimer’s? 41
Types of Alzheimer’s Disease 42
Causes of Alzheimer’s Disease 43
Risk Factors for Alzheimer’s Disease 52
4 Symptoms of Alzheimer’s Disease 65
The 10 Warning Signs of Alzheimer’s Disease 68
Other Common Warning Signs of Alzheimer’s Disease 71
First Signs of Alzheimer’s Disease 72
The Four A’s of Alzheimer’s Disease 73
Staging Systems: The Progression of Alzheimer’s Disease 74
What Next? 80
5 Diagnosis and Assessment of Alzheimer’s Disease 83
Early Diagnosis 84
Accurate Diagnosis of Alzheimer’s Disease 84
vii
viii Contents
Making the Diagnosis 85
Differential Diagnosis 112
6 Progression of Alzheimer’s Disease 115
Stages of Alzheimer’s Progression 116
Development of Cognitive, Behavioral, and Physical Problems 127
7 Prevention and Treatment of Alzheimer’s Disease 139
Prevention of Alzheimer’s Disease 140
Treatment and Management 146
Latest Research 158
8 Caring at Home for People With Alzheimer’s Disease 159
Falls in People With Alzheimer’s Disease 160
Home Safety Room by Room 171
Caregiving for Alzheimer’s Individuals 176
Home Safety Behavior by Behavior 183
The Caregiver’s Burden 195
9 Long-Term Care of People With Alzheimer’s Disease 205
Making the Decision for Long-Term Care 206
Assisted-Living Facilities 209
Nursing Homes 218
10 Rehabilitation Challenges of People With Alzheimer’s Disease 239
Rehabilitation 240
Physical Therapy 246
Occupational Therapy 254
Speech-Language Pathology 270
11 End-of-Life Care for Persons With Alzheimer’s Disease 283
End-Stage Alzheimer’s Disease Care 284
End-of-Life Care 285
Preparing for the Future 288
Ethical Issues in Alzheimer’s End-of-Life 293
Care at the End of Life 300
References 309
Additional Resources 333
Index 335
Foreword
The aging of baby boomers is a frequent news topic because of the im-
pact on the social-support systems this large group of people reaching
age 65 will have. What is clear is that with the increasing numbers of indi-
viduals living longer the greater the number of people are suffering from
Alzheimer’s disease. As discussed in this book, the incidence of Alzhei-
mer’s disease is 18% in those age 75–85 and then increases to about 47%
in people age 85 and older. Our improved health care has resulted in a
large population of people age 75 and older. These figures speak to the
cost, both emotional and financial, to all of us as the number of individu-
als with Alzheimer’s disease increases. Society must find effective ways
to slow the progression of Alzheimer’s and develop effective and efficient
strategies to meet the needs of those with this challenging disease. Sup-
port of research aimed at preventing the disease should have the highest
priority in government funding but that has not materialized. The lack
of a cure and an effective form of treatment means that every possible
means of slowing the disease and its manifestations must be utilized.
As a physical therapist for 50 years involved in the care of individu-
als with dementia as well as my firsthand experience with family and
friends with Alzheimer’s disease, I am acutely aware of the challeng-
ing aspects of this disease. Drs. Gogia and Rastogi have provided here a
valuable resource to all those involved with individuals with Alzheimer’s
disease. This book provides a very thorough coverage of all aspects of the
disease and is written in a way that meets the needs of the general public
as well as health care professionals.
One of the appealing aspects of the book is that one of the authors
is a physical therapist. At the time of this writing, one of the most ef-
fective forms of treatment for slowing the progression of Alzheimer’s
disease is 30 minutes of aerobic exercise 3 times per week. Yet in the age
group experiencing the disease, being able to exercise has many consid-
erations. Older individuals often have musculoskeletal problems such
ix