skip navigation
Welcome! Orthopedics Resources Neurology Resources #PTDOS Physical Therapy Pulse Contributors Store


Dementia Overview







Population Characteristics:1,2

  • 13.9 percent of people 71 years and older have dementia in the US (national estimates of all forms of dementia are unavailable)
  • 5.4 million Americans have Alzheimer's Disease (AD)
    • 5.2 million are 65 or older
      • 3.4 million are women
      • 1.8 million are men
    • 200,000 are younger than 65
  • Increased prevalence in women vs. men is likely due to longer average lifespans of women
  • African-Americans and Hispanics are more likely to have dementia than Caucasians of similar age
  • 1 American is diagnosed with AD every 68 seconds
  • The incidence of dementia is projected to double by 2050 in America


  • Alzheimer's Disease: Likely caused by beta-amyloid (plaque) formation and accumulation within the brain which causes neuronal cell death as well as abnormalities of tau proteins that cause progressive neurodegeneration
  • Vascular Dementia: Caused by vascular lesions (bleeding or vascular blockage) within the brain
  • Frontotemporal Dementia (FTD): Due to nerve cell degeneration and atrophy of the frontal/temporal regions of the brain; likely due to presence of argyrophilic inclusions and swollen cells within these lobes 

Signs and Symptoms:2,6,7

  • Alzheimer's Disease: Memory loss is typically the initial symptom followed by apathy and depression. Confusion, disorientation, judgment difficulty, and difficulty speaking/swallowing become more present as disease course progresses.
  • Vascular Dementia: Impaired judgment and difficulty planning are initial symptoms as opposed to memory loss with AD. Often accompanied by a stroke, symptoms of vascular dementia also include hemiparesis, vision loss, difficulty speaking, and confusion. 
  • Frontotemporal Dementia: Difficulty with language expression as well as personality and behavioral changes with preservation of memory are very common. Executive functioning decline becomes more apparent as disease progresses. Symptoms of parkinsonism may develop as well. 


  • Alzheimer's Disease: Diagnosis includes taking a comprehensive medical/family/psychiatric history including cognitive and neurological setting. Biomarkers to assess the presence and quantity of beta-amyloid and tau proteins in either the CSF or blood are used as well to assist in diagnosis of AD. 
  • Vascular Dementia: Diagnosis requires a comprehensive neruocognitive assessment of judgment/planning/memory, MRI showing vascular compromise or recent stroke, and evidence that the vascular decline is consistent with the impairments being exhibited 
  • Frontotemporal Dementia: Diagnosis requires neuropsychiatric, neuropsychological, and neuroimaging testing and formal assessment of memory/language/attentional deficits. MRI's/CT's are commonly used to assess presence of frontotemporal atrophy. Preservation of memory is commonly used to distinguish FTD from other forms of dementia.  


  • Alzheimer's Disease:
    • AD patients 65 or older on average survive 4 to 8 years after the initial diagnosis
    • Those over 80 years of age have a 75% chance of being in a nursing home
    • On average, a person will spend 40% of their total years with AD in the severest stages of the disease 
  • Vascular Dementia:
    • The prognosis of vascular dementia is highly variable and is directly related to the amount of vascular compromise present
    • On average, those who develop vascular dementia after a stroke survive three years
  • Frontotemporal Dementia:
    • The prognosis of FTD is poor and often results in death between 2 and 10 years after inital onset of symptoms

Physical Therapy Interventions:12

  • Initially an empahsis on strengthening, gait, and endurance training in order to prolong mobility, function, and ambulation
  • As disease course progresses, balance and equipment training become important in order to prevent increasing fall risk
  • Postural education in order to maintain/improve breathing and swallowing mechanics
  • PROM and manual stretching in order to decrease muscle tone and ridigity that can occur (namely with concurrent symptoms of parkinsonism)
  • Pressure relief techniques and family/caregiver training becomes paramount at end of disease course when patient is no longer independent in functional mobility and ambulation








1. Plassman BL, Langa KM, Wallace RB, et al. Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology. 2007;29(1-2): 125-132. 

2. 2012 Alzheimer's Disease facts and figures. Alzheimer's & Dementia. 2012;8(2): 1-72. Available at:

3. Igbal K, Adel AC, Chen S, et al. Tau pathology in Alzheimer disease and other taupothies. Biochim Biophys Acta. 2005;1739(2-3): 198-210.

4. Iemolo F, Duro G, Caruso C, et al. Pathophysiology of vascular dementia. Immunity and Ageing. 2009;6(13): 1-49.  

5. Grossman, M. Frontotemporal dementia: a review. Journal of International Neuropsychological Society. 2002;8: 566-583. 

6. Weder ND, Aziz R, WIlkins K, et al. Frontotemporal dementias: a review. Annals of General Psychiatry. 2007;6(15).

7.  Rascovsky MA, Salmon DP, Lipton AM, et al. Rate of progression differs in frontotemporal dementia and Alzheimer disease. Neurology. 2005;65: 397-403.

8. Vascular dementia. Alzheimer's Association Web site. Available at Accessed April 28, 2014. 

9. Viedugel EE, Chong YK, van der Mast RC. Diagnosing frontotemporal dementia, a chameleon in psychiatry. Tidschr Psychiatr. 2006;48(9): 705-715. 

10. NINDS frontotemporal dementia information page. National Institute of Neurological Disorders and Stroke Web site. Available at: Accessed April 28, 2014. 

11. Hodges JR, Davies R, Xuered J, et al. Survival in frontotemporal dementia. Neurology. 2003;61(3): 349-354. 

12. Radin L and Radin G. What if it's not Alzheimer's? Amherst, NY: Prometheus Books; 2008: 166-173.