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The Physical Performance Test Predicts Aerobic Capacity Sufficient for Independence in Early-Stage Alzheimer Disease

Vidoni, Eric D. PT, PhD1; Billinger, Sandra A. PT, PhD2; Lee, Charesa DPT2; Hamilton, Jenna DPT2; Burns, Jeffrey M. MD, MS1

Journal of Geriatric Physical Therapy: April/June 2012 - Volume 35 - Issue 2 - p 72–78
doi: 10.1519/JPT.0b013e318232bf61
Research Reports

Background: Early identification of physical impairment related to Alzheimer disease (AD) is increasingly identified as an important aspect of diagnosis and care. Clinically accessible tools for evaluating physical capacity and impairment in AD have been developed but require further characterization for their effective use.

Purpose: To assess the utility of the Physical Performance Test (PPT) for identifying functionally limiting aerobic capacity in older adults with AD and without dementia.

Methods: Secondary analysis of a dataset of community dwelling older adults, 70 without dementia and 60 with early-stage AD. Participants were administered the PPT and performed a graded maximal exercise test. The clinical utility of 2 versions of the PPT was described by determining sensitivity and specificity to functionally limiting aerobic capacity.

Results: The 9-item PPT is predictive of diminished aerobic capacity in older adults with AD. A score of 28 or less indicates likelihood of functionally limiting aerobic capacity that would limit independent function with 67% sensitivity and 67% specificity. The 4-item mini-PPT demonstrates improved capability for identifying impaired functional aerobic capacity with 85% sensitivity and 62% specificity. The PPT was not useful for identifying impaired functional aerobic capacity in older adults without dementia.

Conclusions: The PPT, which incorporates basic and instrumental activities of daily living as test items, and the mini-PPT which focuses on basic activities of daily living and simple physical functions, are both clinically useful tool for the evaluation for individuals in the earliest stages of AD and both provide important information about functional performance. The mini-PPT additionally inform the clinician as to whether or not individual with early-stage AD is likely to have insufficient aerobic capacity to perform instrumental daily functions.

1Department of Neurology and KU Alzheimer's Disease Center.

2Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City.

Address correspondence to: Eric D. Vidoni, PT, PhD, Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1063, Kansas City, KS 66160 (

E.D.V. is supported, in part, by a fellowship from the Foundation for Physical Therapy and by the Heartland Institute for Clinical & Translational Research, University of Kansas Medical Center's CTSA, KL2 RR033177 & UL1 RR033179f2. Kansas Partners in Progress, Inc supported S.A.B., C.L., and J.H. The Brain Aging Project was supported by grants R03AG026374 and R21AG029615 from the National Institutes of Aging, grant K23NS058252 from the National Institute on Neurological Disorders and Stroke to J.M.B. J.M.B is also supported in part by R01AG033673 and R01AG034614. The University of Kansas General Clinical Research Center (M01RR023940) and University of Kansas Alzheimer's Disease Center (P30AG035982) provided essential space, expertise, and nursing support.

The authors declare no conflicts of interest.

Copyright © 2012 the Section on Geriatrics of the American Physical Therapy Association
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