Community Physiotherapy Services
Capital Cognition and Dementia:
An adapted approach
Private Home Visits
Dementia actually covers over a hundred types of diseases/ symptoms and 90, 000 people in Scotland are currently living with Dementia. There are however, more common types with Alzheimer’s Disease accounting for the diagnosis in 62% of people with a Dementia, followed by Vascular Dementia accounting for 20%, and Mixed type (Alzheimer’s and Vascular) at 20% again.
While each type of Dementia tends to present slightly differently, there are overarching features/symptoms regardless of specific diagnosis. These include:
A bias on short term memory loss
Recognition issues (of people, places and objects)
Change in ability when undertaking activities of daily living reliably, repeatedly, safely and in a timely manner
There can also be a change in some people’s usual personality and behaviours
Additional to managing the issues raised from cognitive dysfunction, many people with Dementia have needs falling into the scope of Physiotherapy. They may be at risk of mobility decline and falls, either associated with Dementia processes, generic aging processes, or deconditioning from a sedentary lifestyle. Indeed, 14% of hospital admissions for people with Dementia are linked with falls. Vestibular changes affecting balance (and known to increase falls risk) are discussed further with specific regard both to aging and Dementia processes in this blog post.
While the majority of Dementia types will involve symptom progression in the long term, research indicates that measurable benefits can be achieved through strength and balance training. Approaches to rehabilitation are tailored to the presentation and needs of the individual but commonly involve communication adaptation and modification of teaching approaches when working with people living with Dementia.
Pain is also something which can be missed in people who have Dementia and struggle to articulate what they are feeling. However, unless identified and managed, pain will have secondary effects on a person’s cognition, mood, behaviour and engagement levels. As such, is particularly important to screen for in those with advanced presentations of the disease.
Physiotherapy can adapt approaches used in the mainstream population to help identify pain, provide a clinical impression on what is causing it, and lead on the management of pain.
Finally, with consideration that the majority of people with Dementia are older, additional regard needs to be given to the management of comorbidities, including cardiovascular problems and Osteoporosis, which again can be targeted by Physiotherapy led exercise interventions.