Re: [OTnow] Differences in Alzheimer's and Parkinson's

[Mike]

In my experience, the differences are enormous (a necessary 
generalisation). Cognition is an early and significant problem in 
Alzheimer's while physical difficulties usually present later. People 
with Parkinson's usually present to us fairly early with problems in 
performing certain ADLs and we usually get to know them long before any 
cognitive difficulties manifest themselves significantly. We mostly 
treat difficulties resultant from physical disability rather than 
cognitive disability. We have few PD clients with significant cognitive 
difficulty or Lewy body dementia but that may be because our particular 
OT role has less to offer those with dementia than it does those with 
problems that are more physical in their origin, so that if cognitive 
difficulties become the primary problem the client is more likely to be 
helped by the social work (care management) team than by us.

Having said that, I do often find that people with PD often don't use 
complex pieces of equipment like mattress variators and bath lifts, 
but, strangely, it seems that although they are able to show that they 
know how to use them, they just don't -- it's not at all 
straight-forward and can be difficult to get a handle on.

I would like to think that we don't vary our treatment approach based 
solely on the disease but on our understanding of the problems and 
strengths of each individual -- though we do obviously have to consider 
the likely impact of cognitive loss on the person's ability to use 
equipment, adaptations or new techniques if it is a part of their 
diagnosis. For instance, there would be a need for a thorough risk 
assessment if considering the recommendation of a stair lift for 
someone with either Alzheimer's or Lewy body dementia, even if it's in 
its early stages. We would probably need to be sure that a carer will 
always be on hand to assist with its safe use or ensure that the case 
would be reviewed regularly to ensure the person remains able to use 
the equipment.

For what it's worth, it seems to me that in advanced cases of any 
dementia it is difficult to disentangle the cognitive component of the 
problem from the movement disorder aspect. Don't the two almost always 
coexist?

Bear in mind that the above comments come from a setting where we 
mostly remediate occupational dysfunction using equipment, home 
adaptations or task modification. People with Alzheimer's rarely 
present to us until fairly late, when difficulties in transfers or 
moving and handling issues emerge because whilst there's a role for OT, 
there's not much of a role for OT as it manifests itself in my 
particular service setting and this is largely due to the fact that our 
treatment modalities require the person to be able to understand their 
use and learn new techniques, though adaptations like stair rails and 
toilet frames present themselves fairly intuitively to people with 
cognitive dysfunction.

Cheers,
Mike (London, UK)
On Tuesday, Dec 2, 2003, at 11:59 Europe/London, Ron Carson wrote:

Hello:

What  differences  if  any do you all see in the way that Alzheimer's 
versus
Parkinson's diseases manifest themselves in your clients?

Are your treatment approaches different based solely on the disease?

Thanks,

Ron

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