Neurophysiology
called neurotransmitters
A CASE STUDY ON EARLY ONSET ALZHEIMER DISEASE
(EOAD)
The nervous system has two main parts:
The central nervous system - is made up of the brain and
spinal cord.
The peripheral nervous system - is made up of nerves
that branch off from the spinal cord and extend to all
parts of the body.
Nervous System
A nerve cell - often known as a neuron, is the
basic unit of the neurological system. The
human brain has approximately 100 billion
neurons.
 A neuron has a cell body, which comprises the
nucleus, as well as unique extensions known as axons and
dendrites. Nerves are bundles of axons found throughout
the body. Neurons can interact across great distances
because to axons and dendrite
Different types of neurons govern or accomplish
various tasks.
Motor neurons - for example, send messages from the
brain to the muscles to cause movement.
Sensory neurons - sense light, sound,
odor, taste, pressure, and heat and communicate their
findings to the brain.
Involuntary processes – are controlled by other sections
of the neurological system.
 Maintaining a steady heartbeat, releasing
hormones such as adrenaline, opening the pupil
in reaction to light, and controlling the digestive
system are all examples
 When one neuron transmits a message to
another, it sends an electrical signal down its
axon.
 The electrical signal transforms into a chemical
signal at the axon's end. The axon then sends the
chemical
 signal into the synapse, which is the gap between
the end of an axon and the tip of a dendrite from
another neuron, using chemical messengers
 Non-neuron cells called glia are also found in the
nervous system. Glia provides a variety of critical
activities that keep the nervous system running
smoothly.
 Help support and hold neurons in place
 Protect neurons
 Create insulation called myelin, which
helps move nerve impulses
 Repair neurons and help restore neuron function
 Trim out dead neurons
 Regulate neurotransmitters
What is Alzheimer’s disease?
The most prevalent form of dementia is
Alzheimer's disease. It has adverse effects on:
 memory
 thinking
 behavior
What are the symptoms?
Signs of Mild Alzheimer’s disease
 Memory loss that disrupts daily life
 Poor judgment, leading to bad decisions
 Loss of spontaneity and sense of initiative
 Losing track of dates or knowing current location
 Taking longer to complete normal daily tasks
 Repeating questions or forgetting recently
learned Information
Signs of Moderate Alzheimer’s disease
 Increased confusion and memory loss, such as
 forgetting events or personal history
 Withdrawal from social activities
 Inability to learn new things
 Difficulty with language and problems with
reading,
 writing, and working with numbers
 Difficulty organizing thoughts and thinking
 logically
 Shortened attention span
Signs of Severe Alzheimer’s disease
 Inability to communicate
  No awareness of recent experiences or
surroundings
 Weight loss with little interest in eating
 Seizures
 Groaning, moaning, or grunting
 Increased sleeping
 Loss of bowel and bladder control
Pathophysiology
The two pathologic hallmarks of Alzheimer
disease are:
Extracellular beta-amyloid deposits (in neuritic plaques)
Intracellular neurofibrillary tangles (paired helical
filaments)
 Beta-amyloid deposition and neurofibrillary
tangles cause synaptic and neuronal loss, resulting in
gross atrophy of the affected parts of the brain, which
commonly begins in the mesial temporal lobe.
 A sustained immune response and
inflammation have been observed in the brain of patients
with Alzheimer disease. Some experts have proposed
that inflammation is the third core pathologic feature of
Alzheimer disease.
 In accordance to the amyloid hypothesis, the
cumulative accumulation of beta-amyloid in the brain
causes a complicated chain of events that results in
neuronal cell death, synaptic loss, and progressive
neurotransmitter deficiencies
Abstract
 Dementia most frequently results from
Alzheimer's disease. A variety of physical and cognitive
capabilities gradually deteriorate which is how it is
identified.
 The 42-year-old female patient in the current
fictitious case study has EOAD and is looking for
physiotherapy care.
 Gait problems, declining balance, and cognitive
decline are some of the evaluation's results. She
appeared with a forward hunch, a mild postural kyphosis,
and significant upper trapezius tension.
 Reduced shoulder flexion on both sides and a
little weakness in the lower extremities (L/E). The home-
based exercise programs that treat aerobic and
strengthening deficits are part of the physiotherapy
intervention.
 After receiving the physiotherapy intervention,
Mrs. S enhanced her AROM, muscular strength, postural
control, and gait while reducing overall tiredness and fall
risk.
 were no changes in cognitive function over the
course of the therapy. To maintain her quality of life, Mrs.
S will continue to receive care from multiple
professionals.
 To slow the progression of physical and
cognitive loss in EOAD patients, the physiotherapist's job
is to maximize independence.
 The best frequency, intensity, and length of
treatment for EOAD patients will need to be figured out
through further research in the future
Introduction:
 The human brain is the most complex structure
known in the universe.
 This spongy mass of fat and protein weighs an
average of three pounds and is composed of two
categories of cells, glia and neurons, and contains billions
of each.
 Neurons are distinguished by their branch-like
axons and dendrites, which receive and transmit
electrochemical signals.
 Different varieties of glial cells physically protect
neurons and maintain their health, as well as the health
of the brain.
 This intricate network of cells is responsible for
every aspect of our shared humanity. Without the brain,
we could not breathe, play, love, or remember
 The most prevalent cause of dementia is
Alzheimer's disease, which is characterized in part by a
gradual progression of short-term memory loss,
disorientation, and mood fluctuations.
 It is the sixth leading cause of death in the
United States, and its incidence is rising. Approximately
50 million individuals worldwide suffer from Alzheimer's
disease or another form of dementia.
 There are a few medications available to treat
Alzheimer's symptoms, but there is no cure. Researchers
from around the world continue to develop treatments
that could one day eradicate the disease's debilitating
effects.
 Alzheimer's disease is a devastating
neurodegenerative condition that primarily affects older
adults, but it can also manifest at a much younger age,
leading to what is known as early-onset Alzheimer's
disease (EOAD).
 This case study delves into the complexities and
challenges associated with EOAD, examining a particular
patient's journey in order to shed light on the intricate
interplay of genetic, environmental, and clinical factors
that contribute to its onset.
Case Report
 Mrs. S, a 42-year-old female with a
one-year history of early-onset Alzheimer's disease
(EOAD), arrives at the clinic.
 The individual had previously had a full-time
administrative position at a real estate office. The
individual in question has just become unemployed as a
result of the deterioration of her condition over the past
three months
 The individual reported instances of
stumbling and tripping on multiple occasions throughout
the preceding three-month period, although no injuries
were sustained.
 The individual has also observed a progressive
challenge in her fine motor abilities, namely in tasks
involving writing and buttoning clothing.
 Individuals diagnosed with Early-Onset
Alzheimer's Disease (EOAD) face an elevated
susceptibility to a range of secondary diseases, including
osteoporosis and an increased likelihood of experiencing
falls.
Examination Findings (Subjective)
Patient Profile (PP): 42 y/o female
History of Present Illness (HPI): The patient was
diagnosed with Early-Onset Alzheimer's Disease (EOAD)
one year ago. She currently exhibits mild cognitive and
physical impairments and is not currently undergoing any
therapy interventions from a physical therapist (PT).
Past medical history: Depression
Medications: Celexa (citalopram) 20mg/day, donepezil
(aricept) 10mg/day
Health Habits: Non-smoker, 1 glass of red wine per week,
no other substances.
Family History: Mother passed away from complications
of EOAD in 2001
Social History: The person in question has recently
resigned from a full time administrative role at a real
estate firm, citing cognitive challenges as the primary
reason for their departure. Resides independently in a
single-story dwelling, accompanied solely by her canine
companion. The residence of my family is situated in the
adjacent town, which can be reached by a 25-minute
drive. At now, the individual dedicates a significant
portion of her daily routine to engaging in dog-walking
activities and providing childcare services for her
neighboring families
Examination Findings (Objective)
Observation: The individual exhibits forward head
posture characterized by protraction, as well as a minor
increase in postural kyphosis. There is a noticeable
sensation of muscle tension in the upper trapezius
region. The patient exhibits signs of mild deconditioning.
Coordination Tests: The finger-to-nose test was
performed with smooth and controlled
movements, exhibiting minor bilateral dysmetria. There
is a modest bilateral deficit in coordination observed in
finger opposition.
Intervention (Patient Goals)
 Enhance the capacity for reactive postural
control in response to external disturbances as assessed
by the Mini-BESTest, with the objective of achieving
balance recovery within a maximum of two steps, during
a two-month timeframe.
  Enhance the strength of the lower extremities
on the Isokinetic Bilateral Trainer (IBT) by a magnitude of
1 point over a period of 2 months.
 The objective is to enhance motor coordination
and cognition over an 8-week timeframe by developing
the ability to walk and count by increments of 2 without
any hesitation or interruption
 Medical and lifestyle management are practice
areas that the interprofessional care team addresses the
pharmacological management of cognitive function and
behavioral symptoms. In addition, a healthy diet, such as
the Mediterranean Diet (MeDi), may help reduce the
cognitive decline of Alzheimer's disease patients
 Mrs. S should continue physiotherapy treatment
as required to manage the progression of her
musculoskeletal, postural, and gait impairments due to
EOAD, based on her progress and improvements over
the past four months. It is recommended that she
consult her primary care physician in order to be
referred to community balance and healthy aging
programs. Mrs. S would benefit from a referral to an
occupational therapist for a comprehensive home
evaluation, mental health maintenance, and future
assistive device needs. Ms. S would benefit from a
nutritionist or dietitian who can instruct her on healthy
eating practices, such as the MeDi diet, which has been
shown to be beneficial for Alzheimer's patients

Discussion

 Numerous cases of EOAD are characterized by

gait impairments, postural instability, and diminished
musculoskeletal and cognitive function. The function of a
physiotherapist varies with the progression of the
disease, but the ultimate goal is to maximize
independence by enhancing and preserving motor and
cognitive function. Despite the fact that patients with
EOAD share similar symptoms, treatment should be
tailored to each individual. As the disease progresses,
additional emphasis should be placed on reducing the
risk of injuries, managing cognitive decline, and
lightening the load on family and caregivers

 Rehabilitation therapy is ever-changing, and so

are the requirements of each Alzheimer's disease
patient. As the severity and duration of the disease's
progression vary from patient to patient, so too should
their respective treatments. The focus of future research
should be on bridging the literature divide between
disease progression and physiotherapy intervention by
determining the frequency, intensity, and duration of
treatment for this population. The evolution of the
research should center on the selection of a study design
and methodological strategy that will enhance the
external validity and thus permit the transfer of
knowledge to the EOAD cohort

 Mrs. S will receive four months of physiotherapy

to address her postural and gait impairments and
associated fatigue, as determined by her initial
evaluation. Her treatment plan included twice weekly
visits for the first month, followed by visits every three
weeks for the remaining three months. A comprehensive
follow-up evaluation was conducted.