WITH DEMENTIA: USING A STRENGTH … · WITH DEMENTIA: USING A ... • Depression • Delirium...

FPTA Annual ConferencePT Management of Dementia

September 26, 2015

Nicole Dawson, PT, PhD, GCSUniversity of Central Florida 1

PT MANAGEMENT OF PATIENTS WITH DEMENTIA: USING A STRENGTH & FUNCTIONALLY

BASED APPROACH

Nicole Dawson, PT, PhD, GCSFPTA Conference – Orlando

September 26, 2015

LEARNING OBJECTIVES

• The Participant will be able to: describe the constructs affected during pathological cognitive aging

distinguish the different types of dementia and their symptomology

recognize the progression of dementia and appropriate treatment goals for each stage

contrast differences between strength‐based approach and traditional medical model

LEARNING OBJECTIVES

• The Participant will be able to: appraise remaining strengths and domains requiring compensation in patients with dementia

outline current evidenced‐based interventions and best practices in literature

utilize effective communication strategies and person‐centered care to maximize outcomes


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COGNITION

• “thinking”

•Mental activity in the brain

when a person is processing

information

Introduction Communication Strategies Treatment Facilitators Research Summary

COGNITION & FUNCTION• Hierarchical relationship linking cognition and function (Marshall et al., 2011; Njegovan et al., 2001)

• More complex tasks require higher levels of cognitive ability

• Link between gait and executive function (Ijmker& Lamoth, 2012; McGough et al., 2011)


BASIC COGNITIVE PROCESSES

• Sensory functioning

• MemoryWorking memory

Short‐term memory

Long‐term memory

• Attention Inhibition



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HIGHER‐ORDERED COGNITIVE PROCESSES

• Problem‐solving

• Decision making

• Judgment

• Reasoning & Logic

• Reading

• Language

• Orientation

• Visuospatial functioning

• Prospective memory


COGNITIVE PROCESSES• Implicit processing The use of unconscious and automatic processing for learning and retrieving information

• Explicit processing The use of conscious and effortful processing for learning and retrieving information

Can be considered ‘intentional’ learning/retrieval

• Meta‐cognition Higher‐level processing skills used in goal‐directed behavior

Goal selection, planning, initiation, self‐monitoring


Ciccarelli & White, 2009, p. 225

EXPLICIT LEARNING AND MEMORY


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Ciccarelli & White, 2009, p. 235

OTHER TYPES OF MEMORY

• Prospective memory Remembering to execute an action planned for the future

Time based or event based

• Emotional memory Ability to retrieve memories that are emotionally relevant or charged


DEMENTIA


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DEMENTIA

• Not a specific disease, classifies range of symptoms

• Symptoms must be severe enough to interfere with daily activities

• Serious mental decline is NOT a part of normal aging


SIGNS & SYMPTOMS OF DEMENTIA

• Memory loss

• Communication & language deficits

• Focus & attention deficits

• Difficulty with reasoning & judgment

• Visual perception deficits

• Behavioral disturbances

• Personality or affective changes


DEMENTIA VS. NORMAL AGING

SIGNS OF DEMENTIA** TYPICAL AGE‐RELATED CHANGES

Poor judgment & decision making Making a bad decision once in a while

Inability to manage budget Missing a monthly payment

Losing track of the date or the seasonForgetting which day it is & remembering later

Difficulty having a conversationSometimes forgetting which word to use

Misplacing things and being unable to retrace steps to find them

Losing things from time to time

Alzheimer’s Association, 2012**NOTE: compared to usual behavior


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CAUSES OF DEMENTIA

• Variety of illnesses and conditions that may lead to symptoms of dementia

• Irreversible Neurodegenerative disorders

• Reversible Depression

Delirium


IRREVERSIBLE DEMENTIAS • Alzheimer’s disease


ALZHEIMER’S DISEASE• Most common type of dementia

• 5.4 millions Americans with AD, expected to triple over next 50 years

• Americans 65+, 1 in 8 has Alzheimer’s; and nearly half of people aged 85 and older have the disease

• Risk factors Age, low education, genetic (APOe4), lifestyle

• Pathobiology & Etiology

• Gradual and progressive course

Grossman, Bergmann & Parker, 2006


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PROGRESSION OF ALZHEIMER’S PATHOPHYSIOLOGY (Sperling et al., 2011)

Sperling et al., 2011

IRREVERSIBLE DEMENTIAS

• Alzheimer’s disease

• Vascular dementia



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VASCULAR DEMENTIA

• 2nd most common form of dementia Represents 10‐20% of cases in U.S.

• Over 4 million Americans have vascular dementia

• Prevalence is 9 times higher in patients who have had a stroke

• Risk factors Stroke, diabetes, hypertension

• PathologyGrossman, Bergmann & Parker, 2006




• Lewy body dementia


DEMENTIA WITH LEWY BODIES

• Primarily affects the basal ganglia

• Pathologic aggregations of alpha‐synuclein

• 0.7% prevalence rate

• No risk factors have been identified

• Progressive decline of cognitive function



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DEMENTIA WITH LEWY BODIES

• Core features Fluctuations

Visual hallucinations

Agitation & aggression later in disease

Spontaneous parkinsonism

• Often present in mixed dementias (with AD)

• Strong similarities with PD dementia 12‐month rule (<12 months Lewy bodies)






• Frontotemporal lobar degeneration


FRONTOTEMPORAL DEMENTIA (FTD)

• Also known as Pick’s disease

• Prevalence of 3.6 – 15.0 in 100,000

• Age of onset 45‐65

• 4‐6 year duration of illness til death

• Most common presentation Profound changes in personality & social conduct



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FRONTOTEMPORAL DEMENTIA (FTD)

• Unaware of consequences

• Cognitive decline Attention, abstraction, planning & problem solving

Memory, language, spatial functions well preserved

• Gross atrophy in frontal and temporal lobes found on neuroimaging and autopsy

• Only moderate correlation between clinical & pathological findings


IRREVERSIBLE DEMENTIAS • Alzheimer’s disease



• Frontotemporal lobar degeneration

• Mixed dementia

• Parkinson’s disease

• Creutzfeldt‐Jacob disease

• Huntington’s disease

• Wernicke‐Korsakoff Syndrome

REVERSIBLE DEMENTIAS

• Depression



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DEPRESSION

• Affective disorder

• Loss of ability to enjoy usual activities

• More likely to manifest somatic symptoms, hyperactive agitated behavior and delusions (Johnson, Sims & Gottlieb, 1994)

• Pseudodementia Cognitive impairment due to depression

True pseudodementia is rare, usually coexist

Consider pattern of onset and level of severity


• Depression

• Delirium


DELIRIUM

• Acute disturbance of consciousness

• Decreased attention and change in cognition

• 10‐15% of all hospitalized & surgical patients (Johnson, Sims & Gottlieb, 1994)

• Disorientation to time & place

• Hallucinations may be presents leading to possible behavioral outbursts

• Hypoactive form may lead to lethargy


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• Depression

• Delirium

• Normal pressure hydrocephalus

• Brain tumor


DIFFERENTIAL DIAGNOSIS• Not mutually exclusive Prevalence of delirium superimposed on dementia ranged from 22‐89% (Fick et al., 2002)

44% were missed by medical professionals

• Exclude concurrent metabolic, endocrine, infection, drug effects

• Acute vs. insidious onset

• Need for interdisciplinary cooperation and assessment Physical therapist, occupational therapist, speech therapist, nursing, physician, social worker, psychologist, patient, family

Insel & Badger, 2002

PERSONHOOD

• Dementia not always just about decline & loss

• Growth can be facilitated by others in areas of coping skills, compensatory mechanisms, creativity, and emerging personality

• A “survivor” struggling to maintain personal identity

Ryan et al., 2005



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PERSONHOOD

• Care provider must have skills and attitude to relate to the “person” instead of reacting to the disease

• Person‐centered care vital to successful dementia interventions

• Care provider also has weaknesses, possibly interpersonal skills or lack of patience

Ryan et al., 2005


FDA‐APPROVED TREATMENTS

• Cholinesterase inhibitors Donepezil (Aricept)

Galantamine (Razadyne)

Rivastigmine (Exelon)

Tacrine (Cognex: discontinued in U.S.)

• N‐methyl‐D‐aspartate (NMDA) receptor antagonistMemantime (Namenda)

Raina et al., 2008


DEMENTIA & REHABILITATION


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CAN PATIENTS WITH DEMENTIA BENEFIT FROM REHABILITATION?

YES!Patients with dementia can participate in therapy!

Patients with dementia can improve!

Persons with dementia can learn!


COMMON BARRIERS

• Difficulty following directions

• Conversational barriers

• Limited follow through

• Family interference


DEMENTIA & REHABILITATION

• Motor function prior to a hip fracture was the most important predictor of motor gain after hip fracture, not cognitive level (Beloosesky et al., 2002)

• Participation in rehabilitation to be the mediatorbetween cognitive impairment and functional outcomes (Lenze et al., 2004)



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ROLES OF THERAPY SERVICES• Early stages (GDS Stage 4) Maintain functional status Fall prevention

• Mid‐stages (GDS Stages 5‐6) Maintain ADLs Compensatory strategies Family education & training

• Later stages (GDS Stage 7) Family training Positioning Contracture management


STRENGTH‐BASED APPROACH

Yarry, Dawson & Judge, 2011

BENEFITS OF STRENGTH‐BASED APPROACH

• Provide challenge and meaning

• Present with tasks that can be successfully completed

• Lack of activity = distressed mood, frustration, problematic behaviors

• Activity = reduced isolation, increased self‐esteem, sense of control

Yarry, Dawson & Judge, 2011



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REMAINING STRENGTHS• Focused attention remains intact (Chamberlain et al., 2011;

Perry & Hodges, 1999; Nebes & Brady, 1989)

• Procedural (implicit) memory relatively intact (Beaunieux et al., 2012; Machado et al., 2009; Mahendra et al., 2011)

• Reading remains intact until late in disease (Chamberlain

et al., 2011; McGurn et al., 2004)

• Aspects of language remains intact until late in disease (McGurn et al., 2004)

• Left/Right orientation remains intact, unless it requires mental rotation (Lezak, 2004)

• Emotional memory (Moayeri et al., 2000)


REQUIRES COMPENSATION

• Short‐term memory deficits occur very early

• Problem‐solving difficulty

• Orientation is compromised early

• Prospective memory deteriorates early


Strength‐Based Approach

For Therapists

Communication Strategies

As Treatment Facilitators

Errorless Learning

Learning by Modeling

External Memory Aids

Spaced‐Retrieval


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COMMUNICATION STRATEGIES

• Patience & acceptance Understanding communication issues that affect patient

Allowing enough time for response or action

• K.I.S.S. (Keep It Short and Simple) Avoid unnecessary details or fillers during directions

Judge, Yarry & Orsulic‐Jeras, 2010



• Rephrasing questions Stating questions that focus on immediate rather than short‐term memory

Instead of “Did you have any pain over past few days?”, ask “Are you having pain right now?”

• Redirection with verbal and/or physical cues Repeating information or using physical cues to direct attention

Displaying a bright sign on the bathroom

Guiding hands to arms of chair during transfer




• Narrowing choices Asking questions that can be answered in a few words

“Do you want to toss a ball in here or walk around outside?”

• Connecting with others Questions that encourage conversation

“What advice would you give to a young couple that wanted to get married?”




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DEMENTIA & LEARNING

• Errorless learning and learning by modeling resulted in better learning than trial & error learning in IADL (Dechamps et al., 2011)

• Motor learning is similar to healthy controls (Eslinger & Damasio, 1986)


EXTERNAL MEMORY AIDS

• Calendars

• Signs and labels

• Lists

• Notebooks

Yarry, Dawson & Judge, 2011; Judge et al., 2010


EXTERNAL MEMORY AIDS• Accessible Should be placed somewhere that will be seen

• Bright Bright and bold with adequate contrast

• Legible Large, easy to read font or handwriting

• Explicit Detailed and providing adequate explanation

• Done A way to demonstrate objective completed will be more useful

Crossing off list; check box



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SIGNS & LABELS

TAKE YOUR CANE WITH YOU PLEASE


LISTS

Getting up out of chair

1. Scoot forward

2. Feet flat on floor

3. Hands on arm rests

4. Push up to stand

5. Hands on walker for balance


LISTSRemember to Check box when done

1. Take pills with breakfast

2. Take pills with dinner

3. Take pills at bedtime

4. Do exercises at bedtime

Appointments Check box when done

1. Dr. Lucas at 2:00 pm

2.

Other

1.

2



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SPACED‐RETRIEVAL

• Capitalizes on maintenance of implicit or procedural memory

• Method of learning and retaining information by recalling that information over increasingly longer periods of time (Camp et al., 1996, p.196)

• Participants were able to learn to use external aids using both strategies (Bourgeois et al., 2003)

Camp et al., 1996; Cherry et al., 1999


APPLICATIONS OF SPACED‐RETRIEVAL

• Physical Therapy Safety issues Remembering to lock wheelchair brakes, push off from arms of wheelchair, or feel chair on back of legs before sitting

Gait training Choose most important component

Step length, stay within boundaries of

assistive device, sequence with cane

Brush & Camp, 1998b



• Speech‐Language PathologyCompensatory techniques for anomia

Teaching client to describe function or attribute of object when cannot think of name

Compensatory swallow techniques

Facilitate follow‐through with alternating sips & bites

Brush & Camp, 1998b



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• Speech‐Language Pathology Dysarthria

Enable patient to recall correct tongue placement, proper rate of speech, and/or breathing techniques

Voice Training

Help remind patient to use proper placement of voice, use adequate breath support, or maintain proper pitch

Brush & Camp, 1998b



•Occupational TherapyAdaptive equipment

Helps patients to remember to use new equipment

Activities of daily living Enable patient to remember one step or many steps in sequence

Brush & Camp, 1998b



• Staff or family memberRepetitive questioningDetermine the answer the patient would

like to hear; teach the patient the

information

Word finding difficulty

Teach the names of important objects or people

Brush & Camp, 1998b



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• Staff or family member Times, numbers, and other important information

Enable patients to remember birthdates, a room number, anniversary

Location of a message or use of a calendar

Teach the patient where to look for information

Brush & Camp, 1998b


SPACED‐RETRIEVAL TECHNIQUE

• Begin with prompt question for the target behavior

• Train the client to recall the correct answer

• When retrieval is successful, the interval preceding the next recall test is increased

• If a recall failure occurs, the participant is told the correct response and asked to repeat it

• The following interval length returns to the last one at which recall was successful


SPACED‐RETRIEVAL TECHNIQUE

• To begin next session, the participant will be asked the target question

• If correct, there is no further training that session

• If incorrect, provide immediate correct answer, ask for immediate recall then ask for recall after the amount of time for the longest successful interval from the last session

Brush & Camp, 1998b; Camp et al., 1996; Cherry et al., 1999


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• If that is answered incorrectly, the correct answer will be provided immediately and a step backwards will be warranted until the correct response is given

• SUCCESS achieved when participant correctly remembers at the beginning of 3 sessions



• Identify goal

• Target question and responseMust be meaningful for patient

Choose cue that has been successful

Rely on long‐term memory



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SPACED‐RETRIEVAL

• Successful integration of SR into a clinical speech therapy setting with significant results (Brush & Camp, 1998a)

• Efficacy of SR for eating difficulty and ability (Lin et al., 2010)

• Spaced Retrieval TherAppy



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“I don’t know who you are but I know your name is Jennifer. I don’t know

how I know it. Your name is Jennifer”.

Brush & Camp, 1998b

RESEARCH IN DEMENTIA

CURRENT RESEARCH ON DEMENTIA

• New Diagnostic Criteria and Guidelines for Alzheimer's Disease Dementia due to Alzheimer’s disease (McKhann et al., 2011)

Mild cognitive impairment due to Alzheimer’s disease (Albert et al., 2011)

Preclinical Alzheimer’s disease (Sperling et al., 2011)

Neuropathic assessment of Alzheimer’s during an autopsy (Hyman et al., 2012)



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COGNITIVE STIMULATING TASKS & DEMENTIA

• Frequent participation in cognitively stimulating tasks reduce risk for Alzheimer’s disease (Wilson et al., 2002)

• Late life cognitive activities influence cognitive reserve independently of education (Hall et al., 2009)

• For those with lower education, engaging frequently in cognitive activities showed significant compensatory benefits for episodic memory (Lachman et al., 2010)


FITNESS, COGNITION & AGING

• Women with greater physical activity levels at baseline, less likely to experience cognitive decline (Yaffe et al., 2001)

• Fitness level at baseline predicted higher levels of cognitive performance six years later (Barnes et al., 2003)

Kramer, Colcombe et al., 2005


FITNESS, COGNITION & AGING

• Physical activity may have protective effects on cognition

• Physical activity level associated with lower risk of cognitive impairment, Alzheimer’s disease or any dementia (Laurin et al., 2001)

Kramer, Colcombe et al., 2005



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DEMENTIA & EXERCISE

• Overall, evidence is mixed on efficacy of exercise for IWDs Due to heterogeneity of methodology and outcomes

Lack of clear theoretical or conceptual framework


DEMENTIA & EXERCISE

• Important to follow exercise science guidelines Physical Stress Theory (Mueller & Maluf, 2002)

Principle of specificity (vanBeveren & Avers, 2012)

• Adding techniques to improve implementation and adherence with IWDs Strength‐Based approach

Ensuring pleasure and enjoyment (Costello et al., 2011)

Tailoring programs to individual (Costello et al., 2011)


STRENGTH‐BASED APPROACH & EXERCISE

• Using familiar and functional activities Rely on procedural long‐term memory

Avoid unfamiliar exercises and equipment

• Allowing individual to choose activity

• Encouraging continuation of enjoyed activitiesMay require adaptation



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Dawson, 2015

DEMENTIA & FALLS

• Risk factors for fallsMusculoskeletal & mobility deficits

Medications or medical condition

History of falls

Fear of falling

Environmental hazards

Cognitive impairment


DEMENTIA & FALLS

• Tinetti et al. (1988) Low prevalence but very high correlation

• Rubenstein reviews (1994, 2006) Cognitive deficits in addition to musculoskeletal, visual deficits, and hypotension



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DEMENTIA & FALLS

• Current assessment tools may be difficult due to complex instructions or multi‐step directions (Nordin et al., 2006)

• Studies demonstrating reliability

• Few studies have assessed predictive validity Use of Berg Balance Scale provides mixed evidence (Kato‐Narita et al., 2011; McGough et al., 2013)

7‐item Physical Performance Test did not relate to falls (Farrell et al., 2011; Ryan et al., 2011)


TOP 5 TIPS TO FACILITATE SUCCESS

•Assume your patient will succeed

• Listen, stop & listen again

• Slow down

•Use multiple modes of cuing

• If you get frustrated or sense your patient is frustrated, walk away


TOP 5 RULES FOR PERSONHOOD

• Your patient is a person, a human‐being

• Your patient deserves to be treated with respect and dignity

• Your patient has the right to be involved in his/her care

• Your patient expects you to give your best

• Your patient needs your help



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COMMON BARRIERS• Difficulty following directions K.I.S.S. Multiple modes of cuing Learning by modeling External memory aids

• Conversational barriers Patience & acceptance Rephrasing questions Narrowing choices

• Connecting with others Limited follow through External memory aids Family/staff training

• Family interference Educating family members on techniques Involving patient and family as active participant

CASE STUDY, age 85, Left CVA

• 85 year old male, lived with wife

• Home P.T., O.T., S.T. following CVA with 2 week hospital and rehab stay

• Residual R hemiparesis

• Hypertension, CHF, vascular dementia

• Moderate to severe anomia, mild dysarthria, short‐term memory loss, impaired judgment

• Unsteady gait, shortness of breath, impaired balance, poor endurance

STRENGTH‐BASED ASSESSMENT

• Able to follow 1‐2 step commands with familiar tasks

• His wife is healthy and ambulatory

• History of daily “mall walking” with his wife

• Hobbies included woodworking, playing checkers, and fishing

• Retired high school math teacher


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CASE STUDY, age 87, dementia

• 87 year old female, referred for recurrent falls

• Lives in secure dementia unit (7 years)

• Parkinson’s disease, COPD, chronic depression

• Wanders and furniture walks in unit

• Difficulty following 2‐step commands, poor balance, decreased functional ambulation

STRENGTH‐BASED ASSESSMENT

• Appears very social and friendly with residents and staff

• Hobbies included playing card and board games, scrapbooking

• Daughter and grandchildren visit weekly

• Owned and operated dry cleaning business for 25 years

THANK YOU!Questions?

Email: [email protected]

References FPTA Conference

Albert, M. S., DeKosky, S. T., Dickson, D., Dubois, B., Feldman, H. H., Fox, N. C., . . . Petersen, R. C. (2011).

The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7(3), 270-279.

Alzheimer's Association. (2012). 2012 Alzheimer’s disease facts and figures. Alzheimer's & Dementia, 8(2), 131-168.

Barnes, D. E., Yaffe, K., Satariano, W. A., & Tager, I. B. (2003). A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults. Journal of the American Geriatrics Society, 51(4), 459-465.

Beaunieux, H., Eustache, F., Busson, P., De La Sayette, V., Viader, F., & Desgranges, B. (2012). Cognitive procedural learning in early Alzheimer's disease: Impaired processes and compensatory mechanisms. Journal of neuropsychology, 6(1), 31-42.

Beloosesky, Y., Grinblat, J., Epelboym, B., Weiss, A., Grosman, B., & Hendel, D. (2002). Functional gain of hip fracture patients in different cognitive and functional groups. Clinical rehabilitation, 16(3), 321-328.

Brush, J. A., & Camp, C. J. (1998). Using spaced retrieval as an intervention during speech-language therapy. Clinical Gerontologist, 19(1), 51-64.

Camp, C. J., Foss, J. W., O'Hanlon, A. M., & Stevens, A. B. (1996). Memory interventions for persons with dementia. Applied Cognitive Psychology, 10(3), 193-210.

Chamberlain, S. R., Blackwell, A. D., Nathan, P. J., Hammond, G., Robbins, T. W., Hodges, J. R., . . . Sahakian, B. J. (2011). Differential cognitive deterioration in dementia: a two year longitudinal study. Journal of Alzheimer's Disease, 24(1), 125.

Cherry, K. E., Simmons, S. S., & Camp, C. J. (1999). Spaced retrieval enhances memory in older adults with probable Alzheimer's disease. Journal of Clinical Geropsychology, 5(3), 159-175.

Ciccarelli, S. K., & White, J. N. (2013). Psychology: an exploration: Pearson. Costello, E., Kafchinski, M., Vrazel, J., & Sullivan, P. (2011). Motivators, barriers, and beliefs regarding

physical activity in an older adult population. J Geriatr Phys Ther, 34(3), 138-147. Dawson, N. T. (2015). Examining the Effects of A Moderate-Intensity Home-Based Functional Exercise

Intervention on Cognition and Function in Individuals with Dementia. Cleveland State University. Dechamps, A., Fasotti, L., Jungheim, J., Leone, E., Dood, E., Allioux, A., . . . Rikkert, M. G. O. (2011).

Effects of different learning methods for instrumental activities of daily living in patients with Alzheimer’s dementia: a pilot study. American journal of Alzheimer's disease and other dementias, 1533317511404394.

Eslinger, P. J., & Damasio, A. R. (1986). Preserved motor learning in Alzheimer's disease: Implications for anatomy and behavior. The Journal of Neuroscience, 6(10), 3006-3009.

Farrell, M. K., Rutt, R. A., Lusardi, M. M., & Williams, A. K. (2011). Are scores on the PPT useful in determination of risk of future falls in individuals with dementia? Journal of geriatric physical therapy (2001), 34(2), 57.

Fick, D. M., Agostini, J. V., & Inouye, S. K. (2002). Delirium superimposed on dementia: a systematic review. Journal of the American Geriatrics Society, 50(10), 1723-1732.

Grossman, H., Bergmann, C., & Parker, S. (2006). Dementia: a brief review. The Mount Sinai journal of medicine, New York, 73(7), 985-992.

Hall, C., Lipton, R., Sliwinski, M., Katz, M., Derby, C., & Verghese, J. (2009). Cognitive activities delay onset of memory decline in persons who develop dementia. Neurology, 73(5), 356-361.

Hyman, B. T., Phelps, C. H., Beach, T. G., Bigio, E. H., Cairns, N. J., Carrillo, M. C., . . . Masliah, E. (2012). National Institute on Aging–Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease. Alzheimer's & Dementia, 8(1), 1-13.

Insel, K. C., & Badger, T. A. (2002). Deciphering the 4 D's: cognitive decline, delirium, depression and dementia–a review. Journal of advanced nursing, 38(4), 360-368.

Johnson, J., Sims, R., & Gottlieb, G. (1994). Differential diagnosis of dementia, delirium and depression. Drugs & aging, 5(6), 431-445.

Judge, K. S., Yarry, S. J., & Orsulic-Jeras, S. (2010). Acceptability and feasibility results of a strength-based skills training program for dementia caregiving dyads. The Gerontologist, 50(3), 408-417.

Kato-Narita, E. M., Nitrini, R., & Radanovic, M. (2011). Assessment of balance in mild and moderate stages of Alzheimer's disease: implications on falls and functional capacity. Arquivos de neuro-psiquiatria, 69(2A), 202-207.

Kramer, A. F., Colcombe, S. J., McAuley, E., Scalf, P. E., & Erickson, K. I. (2005). Fitness, aging and neurocognitive function. Neurobiology of Aging, 26(1), 124-127.

Lachman, M. E., Agrigoroaei, S., Murphy, C., & Tun, P. A. (2010). Frequent cognitive activity compensates for education differences in episodic memory. The American Journal of Geriatric Psychiatry, 18(1), 4-10.

Laurin, D., Verreault, R., Lindsay, J., MacPherson, K., & Rockwood, K. (2001). Physical activity and risk of cognitive impairment and dementia in elderly persons. Archives of neurology, 58(3), 498-504.

Lenze, E. J., Munin, M. C., Dew, M. A., Rogers, J. C., Seligman, K., Mulsant, B. H., & Reynolds, C. F. (2004). Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. International journal of geriatric psychiatry, 19(5), 472-478.

Lezak, M. D. (2004). Neuropsychological assessment: Oxford university press. Machado, S., Cunha, M., Minc, D., Portella, C. E., Velasques, B., Basile, L. F., . . . Ribeiro, P. (2009).

Alzheimer's disease and implicit memory. Arquivos de neuro-psiquiatria, 67(2A), 334-342. Mahendra, N., Scullion, A., & Hamerschlag, C. (2011). Cognitive-Linguistic Interventions for Persons With

Dementia: A Practitioner's Guide to 3 Evidence-Based Techniques. Topics in Geriatric Rehabilitation, 27(4), 278-288 210.1097/TGR.1090b1013e31821e35945.

Marshall, G. A., Rentz, D. M., Frey, M. T., Locascio, J. J., Johnson, K. A., & Sperling, R. A. (2011). Executive function and instrumental activities of daily living in mild cognitive impairment and Alzheimer's disease. Alzheimer's & Dementia, 7(3), 300-308.

McGough, E. L., Kelly, V. E., Logsdon, R. G., McCurry, S. M., Cochrane, B. B., Engel, J. M., & Teri, L. (2011). Associations between physical performance and executive function in older adults with mild cognitive impairment: gait speed and the timed “up & go” test. Physical therapy, 91(8), 1198-1207.

McGough, E. L., Logsdon, R. G., Kelly, V. E., & Teri, L. (2013). Functional mobility limitations and falls in assisted living residents with dementia: physical performance assessment and quantitative gait analysis. J Geriatr Phys Ther, 36(2), 78-86.

McGurn, B., Starr, J., Topfer, J., Pattie, A., Whiteman, M., Lemmon, H., . . . Deary, I. (2004). Pronunciation of irregular words is preserved in dementia, validating premorbid IQ estimation. Neurology, 62(7), 1184-1186.

McKhann, G. M., Knopman, D. S., Chertkow, H., Hyman, B. T., Jack, C. R., Kawas, C. H., . . . Mayeux, R. (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7(3), 263-269.

Moayeri, S. E., Cahill, L., Jin, Y., & Potkin, S. G. (2000). Relative sparing of emotionally influenced memory in Alzheimer's disease. Neuroreport, 11(4), 653-655.

Mueller, M. J., & Maluf, K. S. (2002). Tissue adaptation to physical stress: a proposed “Physical Stress Theory” to guide physical therapist practice, education, and research. Physical therapy, 82(4), 383-403.

Nebes, R. D., Brady, C. B., & Huff, F. J. (1989). Automatic and attentional mechanisms of semantic priming in Alzheimer's disease. Journal of clinical and experimental neuropsychology, 11(2), 219-230.

Nordin, E., Rosendahl, E., & Lundin-Olsson, L. (2006). Timed “Up & Go” Test: reliability in older people dependent in activities of daily living—focus on cognitive state. Physical therapy, 86(5), 646-655.

Perry, R. J., & Hodges, J. R. (1999). Attention and executive deficits in Alzheimer's disease. Brain, 122(3), 383-404.

Raina, P., Santaguida, P., Ismaila, A., Patterson, C., Cowan, D., Levine, M., . . . Oremus, M. (2008). Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline. Annals of internal medicine, 148(5), 379-397.

Rubenstein, L. Z. (2006). Falls in older people: epidemiology, risk factors and strategies for prevention. Age and ageing, 35(suppl 2), ii37-ii41.

Rubenstein, L. Z., Josephson, K. R., & Robbins, A. S. (1994). Falls in the nursing home. Annals of internal medicine, 121(6), 442-451.

Ryan, E. B., Byrne, K., Spykerman, H., & Orange, J. (2005). Evidencing Kitwood’s personhood strategies: Conversation as care in dementia. Alzheimer talk, text, and context: Enhancing communication, 18-36.

Ryan, J. J., McCloy, C., Rundquist, P., Srinivasan, V., & Laird, R. (2011). Fall risk assessment among older adults with mild Alzheimer disease. J Geriatr Phys Ther, 34(1), 19-27.

Sperling, R. A., Aisen, P. S., Beckett, L. A., Bennett, D. A., Craft, S., Fagan, A. M., . . . Montine, T. J. (2011). Toward defining the preclinical stages of Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7(3), 280-292.

Tinetti, M. E., Speechley, M., & Ginter, S. F. (1988). Risk factors for falls among elderly persons living in the community. New England journal of medicine, 319(26), 1701-1707.

vanBeveren, P. J., & Avers, D. (2012). Exercise and physical activity for older adults. In A. A. Guccione, D. Avers & R. Wong (Eds.), Geriatric Physical Therapy (pp. 64-85). St. Louis: Elsevier Health Sciences.

Wilson, R. S., De Leon, C. F. M., Barnes, L. L., Schneider, J. A., Bienias, J. L., Evans, D. A., & Bennett, D. A. (2002). Participation in cognitively stimulating activities and risk of incident Alzheimer disease. Jama, 287(6), 742-748.

Yaffe, K., Barnes, D., Nevitt, M., Lui, L.-Y., & Covinsky, K. (2001). A prospective study of physical activity and cognitive decline in elderly women: women who walk. Archives of internal medicine, 161(14), 1703-1708.

Yarry, S. J., Dawson, N., & Judge, K. (2011). A Strength-Based Cognitive Rehabilitation Approach for Individuals with Dementia. Paper presented at the 64th Annual Scientific Meeting of the Gerontological Society of America, Boston, MA.

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