Alzheimer disease (AD) is a common neurologic disorder, with more than 4 million persons affected in the United States. AD is more common in older populations, with no clear answer on prevention of the disease. Provided below is information on AD, & what we can do as massage therapists caring for clients with AD.
AD is a progressive neurodegenerative disease that produces a typical profile of mental deterioration. This deterioration involves most areas of the brain, particularly the frontal and occiput regions, which affect processes of thinking, memory, & communicating. Alzheimer disease is also called Alzheimer dementia.
The clinical picture for AD is loss of memory, inability to concentrate, impairment of reasoning, apathy, and changes in personality. The course of the disease is highly variable and may extend up to 10 years; the average is 8 years from diagnosis to death. These deaths are not directly related to AD but rather to decreased resistance to infection that normally occurs with age.
The exact cause is unknown, but AD is associated with advancing age. Genetic factors are present in 5% to 10% of cases. AD is characterized by the presence of abnormal clumps called senile plaques and irregular knots called neurofibrillary tangles on nerves located in the brain; these structures disrupt impulse transmission.
The New York University Medical Center on Aging and Dementia Research classified AD into seven stages, which are used by professionals and caregivers to chart the decline of persons with AD. Although these stages provide a blueprint for disease advancement, the length of time in and between stages varies widely. In fact, caregivers often report that their loved ones appear to be in two or more stages at once.
No specific treatment for AD has been developed. Most measures are supportive and include pharmacotherapy to treat depression, anxiety, and behavioral problems. Psychotherapy is usually not recommended because it contributes to the person’s mental confusion. Affected persons eventually require long-term care and rehabilitation services.
Massage Therapy and Alzheimer Disease – Hand massage combined with calming music (1) or with favorite music (2), as well as hand massage used alone (2), reduced agitation in persons with dementia. Touch-based therapies such as healing touch and therapeutic touch reduced restlessness and vocalizations, decreased cortisol levels, and reduced stress in persons with dementia (3, 4). Rowe and Alfred (5) found that massage decreased behaviors such as pacing, wandering, and resistance, but did not find reduced vocalizations as in other studies (i.e., 3,4). Nursing home residents diagnosed with dementia reported enjoying the massage and that it improved their ability to communicate with other residents (6). Massage also decreased aggressiveness (7).
Tailor the massage to the stage of disease, with very few adjustments needed in earlier stages to significant modifications for later stages. Patience and acceptance of behavior is needed, given that these individuals experience personality changes. Consider consulting a person with whom the client is familiar in case he or she becomes disoriented and anxious about appropriate protocols. Many persons with AD become agitated when confronted about their confabulations or confusion, especially if they are constantly redirected or reoriented. Again, family members or friends of the client are a good information source to find ways to handle these situations.
Later-stage adjustments may include massage using light pressure and slower speed. An example of light pressure is approximately a 3 on a 10-pt pressure scale. These adjustments are even more appropriate when the client’s physical condition & ability to communicate deteriorate.
Table courtesy of Susan Salvo’s “Mosby’s Pathology for Massage Therapists, 4th edition”
Articles and Journal Referenced:
- Remington, R. (2002). Calming music and hand massage with agitated elderly. Nurs Res. 51(5):317-23.
2. Hicks-Moore, S. L., & Robinson, B., A. (2008). Favorite music and hand massage: Two interventions to decrease agitation in residents with dementia. Dementia, 7(1), 95-108.
3. Woods, D. L., Beck, C., Sinha, K. (2009). The effect of therapeutic touch on behavioral symptoms and cortisol in persons with dementia. Forsch Komplementmed. 16(3):181-9
4. Woods, D. L., Craven R. F., Whitney J. (2005). The effect of therapeutic touch on behavioral symptoms of persons with dementia. Altern Ther Health Med. 11(1):66-74.
5. Rowe, M., Alfred, D. (1999), The effectiveness of slow-stroke massage in diffusing agitated behaviors in individuals with Alzheimer’s disease. J Gerontol Nurs. 25(6):22–34.
6. Sansone, P., Schmitt, L. (2000). Providing tender touch massage to elderly nursing home residents: A demonstration project. Geriatr Nurs. 21(6). 303-8
7. Cohen-Mansfield, J. (2013). Nonpharmacologic treatment of behavioral disorders in dementia. Curr Treat Options Neurol. 15(6):765-85.
Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at firstname.lastname@example.org.