February 13, 2023

A Physical Therapy Guide to Alzheimer's Disease

Alzheimer's Disease is considered a degenerative neurologic condition, where the brain progressively becomes smaller, and brain cells begin to die. Alzheimer's typically affects people over the age of 65. Initially, people present with difficulty remembering recent events. Eventually, this progresses to difficulty with everyday tasks such as getting out of bed or putting clothes on.

Some studies show, that Alzheimer's Disease can begin in a person's brain up to 20 years before symptoms show.1 Although there is currently no cure for Alzheimer's Disease, there are strategies to prevent and delay symptoms. One of these important preventative measures is exercise.

Alzheimer's Disease is the most common cause of dementia, with approximately 5.8 million people in the U.S. over the age of 65 living with the disease.2 Read on to learn more about the different stages of Alzheimer's Disease, and how CityPT therapists can help prevent and manage symptoms of Alzheimer's Disease.

Table of Contents

Understanding Alzheimer's Disease

Alzheimer's Disease is considered a progressive neurological condition, as symptoms get worse over time. The disease is caused by damaged nerve cells, specifically in the areas that are responsible for memory, thinking, and behavior.

Similar to other neurologic conditions, Alzheimer's Disease will present differently in each person. However, almost everyone will have similar symptoms and patterns of the disease.

Alzheimer's Disease consists of 3 stages according to the National Institute on Aging and Alzheimer’s Association (NIA-AA).1

Stage 1: Pre-Clinical

Symptoms may not be present, however the disease process is in it's initial stages and progressing.

Stage 2: Mild Cognitive Impairment (MCI)

Noticeable difficulty with memory and problem solving are present. A person's day-to-day activities and independence may not be affected yet, however they are more impaired than the average person their age. It's important to incorporate physical activity in this stage of the disease process, as studies show it may help slow changes in the brain.

Stage 3: Alzheimer's Dementia

In the final stage, a person will have significant difficulty with memory, problem-solving, and remembering how to do automatic tasks such as dressing themselves. People are also at a very high risk of falling at this stage. A person with Alzheimer's disease becomes completely dependent on their care-provider at this stage.

Symptoms of Alzheimer's Disease

As the disease progresses, symptoms of Alzheimer's Disease become worse. Symptoms include:1

  • Memory loss
  • Confusion
  • Difficulty recognizing family members
  • Poor judgement
  • Lack of initiation with movement, speech, and functional tasks
  • Personality changes
  • Increased anxiety and wandering outside the home
  • Difficulty with word-finding, reading, and writing
  • Psychological symptoms such as: hallucinations and paranoia
  • Repetitive movements
  • Difficulty completing activities of daily living such as dressing, bathing, and toileting

In the later stages of the disease, where symptoms become severe, people experience difficulty with eating, bowel and bladder control, sleeping, and maintaining weight.

What is the Cause of Alzheimer's Disease?

In most cases, the cause of Alzheimer's Disease (AD) is still unclear. Genetics do play a role in developing AD, especially in a rare type known as Early-Onset AD.

There are two common patterns noted in people who have AD, which contributes to the nerve cell damage and brain shrinking:

  1. Amyloid Beta Proteins: An excess of this particular protein begins to create clusters in the brain. Typically, this protein is meant to break down. This might create an increase in breakdown of nerve cells or stop the communication between the nerve cells.31
  2. Neurofibrillary Tangles: Nerve fibers that are twisted within brain cells, preventing nutrients from moving to other cells.3

Are there Risk Factors for Alzheimer's Disease?

The following factors can increase a person's chances of developing Alzheimer's Disease:21

  • Age: The older the person, the higher likelihood they will be diagnosed with AD
  • Genetics: The risk of developing AD increases if a first degree relative (parent or sibling) has developed AD
  • Diet: Decreased amounts of Vitamin B12, D, and folate in the system4
  • Air pollution4
  • Down Syndrome
  • Traumatic brain injury
  • Excessive alcohol consumption
  • Poor sleep patterns
  • Poor heart health due to lifestyle choices, such as:
    • Obesity
    • Smoking
    • High blood pressure
    • High cholesterol
    • Poorly controlled Diabetes Type 2

Diagnosing Alzheimer's Disease

When the development of Alzheimer's Disease is suspected, there are several tests which are utilized to confirm a formal diagnosis. These include:4

  • A comprehensive neurologic exam to assess memory loss, cognition, function and behavior
  • An MRI to measure signs of shrinking brain size
  • Laboratory blood tests specifically looking for B12 deficiency
  • A comprehensive review of a person's medical and family history
  • Looking for biomarkers through a PET scan or removing fluid around the spinal cord
  • Genetic testing to look for specific genes related to Alzheimer's Disease5

Physicians will also perform a through medical exam to look for any risk factors which may contribute to dementia or other brain disorders.

At the time of diagnosis, CityPT physical therapists specializing in neurologic conditions can gather baseline information on strength, balance, flexibility, and walking patterns. They can then set up a specific exercise program catered to each individual.

What to Expect from Physical Therapy for Alzheimer's Disease

Exercise and physical therapy can make improvements in the lives of people with AD both mentally and physically. Recent studies show that participating in physical activity, especially during the mild cognitive impairment stage of AD, can help to slow the progression and symptoms of AD.1

Physical therapy for people diagnosed with Alzheimer's Disease is very similar to PT for older adults. It involves evaluating a person's function, creating goals, and providing a plan on how to accomplish these goals.6

There is evidence that exercise can protect cognitive function in people who are aging, and some studies show this includes people diagnosed with AD.1 Establishing an individualized exercise program is important, and it should target:

  • Maintaining balance to decrease the risk of falling
  • Strength training to maintain functional mobility and posture
  • Aerobic activity to maintain cardiovascular health
  • Stretching exercises to maintain flexibility

Additionally, a CityPT therapist can:

  • Address impairments in vision, cognition, and memory
  • Screen for other conditions a geriatric patient may face such as joint pain, de-conditioning and weakness, poor sensation, and fall risk
  • Provide education regarding appropriate medical equipment (such as walkers, canes, wheelchairs) a person may need to maintain independent functional mobility
  • Instruct caregivers on strategies to safely move or guard the patient

Overall, CityPT therapists can help to create a plan specific to each person's interests and functional goals.

What about Medications for Alzheimer's Disease?

Currently there is no cure for AD. Medications for people diagnosed with Alzheimer's Disease are broken down into two categories:7

  1. Medications which will slow the progression of the disease
  2. Medications which will decrease the severity of symptoms associated with the disease (specifically with memory, cognition, and behavioral symptoms)

It's important to discuss each medication and their side effects with a physician.

Preventing Alzheimer's Disease

Decreasing the risk of AD involves establishing a healthy lifestyle and routine to improve cardiovascular health, which includes a regular exercise program.

In addition, eating nutritious food, monitoring blood pressure, blood sugars, and cholesterol, and quitting smoking are all important.

Recent studies have shown that an exercise program, which includes walking, may help to reduce the risk of AD.8

Research shows that there is a specific difference between leisure related activity and work related activity in preventing AD.9 It's important to incorporate leisure related activity into your daily routine, and CityPT therapists can help you create a plan and routine.

Is It Time to Seek Treatment?

If you or a loved one has been diagnosed with either a risk of Alzheimer's Disease or the disease itself, it's important to seek treatment as soon as possible. Guidance from CityPT therapists can help establish goals and a plan to address impairments or prevent and delay symptoms.

Book an appointment with a neurological specialist today.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.



  1. Dressendorfer RBs PhD, Snook APMMe. Alzheimer’s Disease and Exercise. Richman S DhsMP, ed. CINAHL Rehabilitation Guide. August 2021. Accessed December 17, 2022. https://search.ebscohost.com/login.aspx?direct=true&db=rrc&AN=T902776&site=eds-live 2 3 4 5 6 7

  2. Alzheimer's disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447. Published February 19, 2022. Accessed December 17, 2022. 2

  3. Causes and risk factors of alzheimer's disease. WebMD. https://www.webmd.com/alzheimers/guide/alzheimers-causes-risk-factors. Accessed December 17, 2022. 2

  4. Breijyeh Z, Karaman R. Comprehensive Review on Alzheimer's Disease: Causes and Treatment. Molecules. 2020;25(24):5789. Published 2020 Dec 8. doi:10.3390/molecules25245789https://pubmed.ncbi.nlm.nih.gov/33302541/ 2 3

  5. Medical tests. Alzheimer's Disease and Dementia. https://www.alz.org/alzheimers-dementia/diagnosis/medical_tests. Accessed December 17, 2022.

  6. Improving the lives of people with dementia. APTA. https://www.apta.org/apta-magazine/2018/03/01/improving-the-lives-of-people-with-dementia. Published March 1, 2018. Accessed December 19, 2022.

  7. Medications for memory, cognition and dementia-related behaviors. Alzheimer's Disease and Dementia. https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory. Accessed December 19, 2022.

  8. Zhang B, Huang X, Wang X, et al. Using a two-sample mendelian randomization analysis to explore the relationship between physical activity and alzheimer’s disease. Scientific Reports. 2022;12(1). doi:10.1038/s41598-022-17207-x. https://www.nature.com/articles/s41598-022-17207-x

  9. Stephen R, Hongisto K, Solomon A, Lönnroos E. Physical activity and alzheimer’s disease: A systematic review. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2017. doi:10.1093/gerona/glw251. https://pubmed.ncbi.nlm.nih.gov/28049634/

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