ACE Alzheimer's Fitness Specialist cheat sheet

Dementia is an umbrella term for acquired cognitive decline severe enough to interfere with independence in daily function; Alzheimer's disease causes roughly 60-80% of dementia cases.

Alzheimer's disease is defined by amyloid-beta plaques and hyperphosphorylated tau neurofibrillary tangles, with neuron loss beginning in the medial temporal lobe and hippocampus.

Typical progression follows mild (independent but impaired), moderate (needs assistance with instrumental and some basic activities), and severe (dependent in self-care) stages.

The hippocampus is affected early, so short-term declarative memory and new learning fail before remote memory and procedural (motor) memory.

Procedural memory and motor learning are relatively preserved, so repetition, demonstration, and consistent routine outperform verbal instruction.

Vascular dementia shows stepwise decline tied to cerebrovascular events; frontotemporal dementia presents with early behavior or language change rather than memory loss.

Delirium is an acute, fluctuating disturbance of attention and awareness; it is a medical emergency and must not be mistaken for dementia progression.

Reversible contributors to cognitive change include depression, B12 or thyroid abnormalities, sleep apnea, medication effects, and dehydration.

Common behavioral symptoms include apathy, agitation, wandering, and sleep disturbance; apathy is among the most prevalent and is linked to low activity.

Pre-participation should confirm medical clearance, current medications, comorbidities, fall history, and stage of disease before exercise testing or prescription.

Cognitive screening tools include the Mini-Mental State Examination and Montreal Cognitive Assessment; the MMSE is scored out of 30 with lower scores indicating greater impairment.

Functional assessments should target gait speed (usual 4- or 10-meter walk), Timed Up and Go, 30-second chair stand, and balance (e.g., Berg Balance Scale) because these predict fall and dependency risk.

Exercise prescription follows the FITT-VP framework: frequency, intensity, time, type, volume, and progression, with progression slower than in cognitively intact older adults.

Use rate of perceived exertion and talk-test methods as primary intensity anchors when heart-rate response is confounded by medications (e.g., beta-blockers).

Aerobic target is typically 150 minutes per week of moderate intensity accumulated in short bouts, plus 2 or more days of resistance and balance training at least 3 days weekly.

Baseline measures should be repeated at regular intervals (e.g., every 8-12 weeks) using the same protocol, because day-to-day variability is high in this population.

Document the client's best time of day, familiar cues, and caregiver presence; these become programming variables that improve adherence and safety.

Program design should combine aerobic, resistance, flexibility, and balance/mobility components; multicomponent programs show the strongest functional benefit.

Resistance training typically starts at 1-2 sets of 8-12 repetitions at 40-60% of one-repetition maximum for major muscle groups, 2-3 days per week.

Balance training should be progressive and challenging (e.g., reducing base of support, eyes closed only when safe, dynamic weight shifts) at least 3 days per week.

Progression rule: advance one variable at a time (volume, then intensity, then complexity) and hold each level for several sessions before advancing.

Session structure should be short and repetitive: a 5-10 minute warm-up, 20-30 minutes of main work in brief bouts, and a cool-down, with rest breaks as needed.

Use errorless learning and chaining: demonstrate one step, cue it, practice to success, then add the next step, rather than correcting multiple errors at once.

Dual-task and cognitive-motor activities (e.g., walking while naming or carrying) can be included once basic gait is safe, but fall risk must be monitored.

Therapists should plan for decline: keep a maintenance level of intensity and volume so that function is preserved when progression stalls.

Behavior is communication: agitation, resistance, or withdrawal should be assessed for unmet needs such as pain, fatigue, hunger, toileting, or overstimulation.

Communication rule: use one instruction at a time, short sentences, the person's name, eye contact, and a calm tone; allow 5-10 seconds of processing time before repeating.

Demonstrate rather than describe; pair verbal cues with visual modeling and physical guidance only as needed and with consent.

The ABC model (antecedent, behavior, consequence) is used to identify triggers and design environmental changes rather than to punish behavior.

Environmental strategies include reducing noise and clutter, consistent scheduling, familiar staff, adequate lighting, and structured routine.

Caregiver collaboration includes education on safe exercise, transfer technique, fall prevention, and reporting of changes in behavior or function.

Caregiver burden is common; screening for strain and offering respite, support resources, and realistic home-program expectations are part of the plan.

Red flags requiring medical referral include sudden behavioral change, new falls, acute confusion, pain at rest, or unexplained weight loss.

Behavior is communication: agitation, resistance, or withdrawal should be assessed for unmet needs such as pain, fatigue, hunger, toileting, or overstimulation.

Communication rule: use one instruction at a time, short sentences, the person's name, eye contact, and a calm tone; allow 5-10 seconds of processing time before repeating.

Demonstrate rather than describe; pair verbal cues with visual modeling and physical guidance only as needed and with consent.

The ABC model (antecedent, behavior, consequence) is used to identify triggers and design environmental changes rather than to punish behavior.

Environmental strategies include reducing noise and clutter, consistent scheduling, familiar staff, adequate lighting, and structured routine.

Caregiver collaboration includes education on safe exercise, transfer technique, fall prevention, and reporting of changes in behavior or function.

Caregiver burden is common; screening for strain and offering respite, support resources, and realistic home-program expectations are part of the plan.

Red flags requiring medical referral include sudden behavioral change, new falls, acute confusion, pain at rest, or unexplained weight loss.