Can Mental Exercise Prevent Alzheimer's Disease?
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Definition

What Is Alzeimer's Disease?
http://nihseniorhealth.gov/alzheimersdisease/whatisalzheimersdisease/video/a6_na.html?intro=yes (Retrieved from Alzheimer's Association Organization)
http://www.youtube.com/watch?v=9Wv9jrk-gXc (Retrieved from YouTube)
Alzheimer's is a type of dementia that is irreversible and disrupts an individuals memory, thinking and overall behavior. It has been noted that Alzheimers mainly targets elderly individuals that are commonly 65 and older, and is a progressive disease that worsens over time, and eventually leads to death. The Image retrieved from (Google Images) below shows the comparison between a normal aged brain (left) and the brain of a person with Alzheimer's disease (right)
800px-Alzheimer%27s_disease_brain_comparison.jpg

Background and Myths About Alzheimer's Disease

Parliament Research Branch. (1993,May) Brassard, Daniel. Retrieved April 3, 2014 from, http://publications.gc.ca/collections/Collection-R/LoPBdP/BP-e/bp335-e.pdf


Alzheimer’s is an age-related disease that progressively decreases a person’s memory and thinking skills over time, which makes it difficult for the person to carry out effortless daily routine tasks. It is also described as loss of cognitive performance and behavioural abilities so severely that it interferes with a person’s daily life and activities. Some mild forgetfulness is usual as people get older but Alzheimer’s is a serious disease which even makes it difficult for a person to carry on daily tasks such as driving, shopping etc.
Alzheimer’s is a complex disease that progresses over many years, similar to diabetes or heart disease. A number of factors may play a role in increasing or decreasing the odds of developing the disease. These include genetics, environment or lifestyle. Some of these risk factors can be controlled while others cannot be controlled. Research shows that this disease causes changes in the brain much before the first symptoms appear.

Alzheimer’s disease is the progressive degenerative disorder of the Cerebral Cortex that produces dementia in the middle to late life. It is mostly found in people 65 and older and is the main cause of dementia. Dementia affects your use of cognitive functions such as attention, judgment, memory and critical thinking. There are three common abnormalities that are found in Alzheimer’s disease patients such as Plaques, Tangles and Loss of nerve cell connections. Alois Alzheimer examined the first case of the disease on November 26, 1901. After years of extensive research the definitive cause of the disease has not been determined and no effective treatment for the disease has been developed.

Myths

Alzheimer Society Canada.(2012,April 10.)Alzheimer. Retrieved April 3, 2014 from, http://www.alzheimer.ca/en/About-dementia/Alzheimer-s-disease/Myth-and-reality-about-Alzheimer-s-disease


The Alzheimer’s Society of Canada outlines the following common myths associated with Alzheimer’s disease:

Myth 1: Some people believe that just because their family member’s have Alzheimer’s disease, they will get it too. While genetics do play a role in the disease, only five to seven percent of the cases are actually connected to genes. In some cases however if a parent or a sibling has sporadic Alzheimer’s disease they may have a higher chance of getting the disease.

Myth 2: Some people believe that Alzeimer’s is an old people disease, but actually this disease is not considered as part of aging. There have been cases where people in their 40’s or 50’s were diagnosed with a form of the disease.

Myth 3: Some people believe that there is a cure for Alzheimer’s disease. While there has been significant advancements in treating and medications for the disease over the years, there has been no cure discovered yet.

Myth 4: Some people believe that memory loss means that they have Alzheimer’s. Memory loss is one of the symptoms of Alzheimer’s disease, but it does not necessarily mean that you have it. If you have memory loss combined with other symptoms such as lack of judgment and communications, you may be developing early stages of the disease.

Myth 5: Some people believe that Alzheimer’s can be prevented, however there is no treatment that can actually prevent Alzheimer’s. Researchers suggest that you can lower the risks of developing the disease by living a healthy and active lifestyle like exercising, keeping your brain challenged, reducing stress, etc.
Reality: No treatment can prevent Alzheimer’s disease. Researchers are learning, however, that lifestyle choices that keep mind and body fit may help lower the risk of developing the disease. These choices include being physically active; eating healthy foods including fresh fruits, vegetables and fish; keeping your brain challenged; reducing stress, keeping an eye on your blood pressure, blood sugar and cholesterol levels; avoiding traumatic brain injury; and keeping socially active.

Myth 6: Some people believe that vitamins, supplements and memory boosters can prevent Alzheimer’s, but many studies have shown mixed findings and have therefore been inconclusive.

Myth 7: Some people believe that if you are diagnosed with Alzheimer’s disease, your life is over. However many people who have Alzheimer’s still live rich and meaningful lives. Due to increased research and technological advancement, there have been many medical developments that help control it’s symptoms. It is also important to make sure that people with Alzheimer’s have the necessary support and help in order to enrich their quality of life.

Myth 8: Some people believe that patients with Alzheimer’s disease are usually violent and aggressive. However it is necessary to consider that the disease affects each person differently. A lot of the causes of aggression and violent are brought on by fear and uncertainty of the environment. In order to avoid such violent and aggressive situations, the patients must be constantly communicated to adopted to surroundings.

Myth 9: Some people believe that Alzheimer’s patients don’t understand what is going on around them, but actually people with Alzheimer’s are just not capable of making sense what goes on around them. Alzheimer’s affects each person differently; therefore it also affects how they communicate. We need to treat every patient with dignity and respect because they are still the same person.

Myth 10: Some people believe that Alzheimer’s disease is not fatal, but actually it destroys brain cells and memory. This causes the body to forgets what to do in order to survive and may cause fatal results.

Effects and Causes

Alzheimer's Association.(2014,January 5.)Alz.Org.Retrieved March 24,2014 from, http://www.alz.org/alzheimers_disease_causes_risk_factors.asp


According to the Alzheimer's Association Organization they believe that scientists found the greatest causes of Alzheimer's disease to be age, family history and hereditary genes.

  • Age: Majority of the infected individuals are 65 or older, after age 85 the risk reaches 50%
  • Family History: When the disease tends to run in families, such as hereditary genes it can play a role in increasing your chances of receiving the disease as well.
  • Genetics: There are two types of genes known as risk genes and deterministic genes. Risk genes don't guarantee the disease will occur but deterministic genes are inherited and will show the disease is present in the individual.
  • Scientists also believe that head injuries, or trauma could encourage a loss of consciousness and lead to Alzheimer's as well.

Stages of Alzheimer's Disease

Alzheimer's Association.(2014,January 5.)Alz.Org.Retrieved March 24,2014 from, http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp


Barry Reinsburg, M.D clinical director of York University's School of Medicines Silberstein Aging and Dementia Research Center has developed several studies he believes a common individual with Alzheimer's disease will experience.

Stage One: Stage one is referred to as 'no impairment'. In this stage the individual will act normal, and will not experience any memory problems or differences in behavior.

Stage Two: Stage two is referred to as 'Very mild cognitive decline'. The individual may be struggling with memory lapses due to old age or due to the disease. This can include forgetting familiar words, or the placement of certain objects, important dates etc.

Stage Three: Stage three is referred to as 'Mild cognitive decline'. The individual may be struggling, and families or close friends may begin to notice these difficulties. Doctor's can detect problems with memory of concentration through tests. The individual may experience for example; trouble with names after meeting someone, misplacing objects on a regular basis, forgetting material that has just been read, and difficulty planning events or organization.

Stage Four: Stage four is called ' Moderate cognitive decline'. In this stage you can detect a change in the individuals personality, as they might become more moody, or socially withdrawn. They can become forgetful of their own life, or past history, and can experience a greater difficulty paying bills and accomplishing normal day to day activities.

Stage Five: Stage five is referred to as " Moderately severe cognitive decline'. In this stage gaps in memory thinking and responsiveness are noted and obvious. Individuals in stage five begin to forget their phone number, address, the current date or year, and may need help choosing appropriate clothing for the season. In this stage the affected person can still remember significant details about themselves and their family.

Stage Six: Stage six is referred to as 'Severe cognitive decline'. In this stage family members begin to become the most affected as personality change, and they require extensive assistance with daily activities. These individuals struggle with personal history, experience a change in sleeping patterns, trouble with names, and faces and need assistance handling toileting. Those affected may start to wander or get lost easily.

Stage Seven: Stage 7 is referred to as 'Very severe cognitive decline'. This is the final stage of the disease, and the individual has lost full ability to converse, or hold a conversation, respond to the environment or control movement. Individuals need constant care, and help with daily personal activities such as eating and using the bathroom. Reflexes become abnormal, lifting up their head and swallowing usually become impaired.

Younger and Early Onset Alzheimer's

Alzheimer's Association.(2014,January 5.)Alz.Org.Retrieved March 24,2014 from, http://www.alz.org/alzheimers_disease_early_onset.asp


Alzheimer's is not just a disease of old age, it can also affect people younger than 65, usually people in their early 40's and 50's. It is noted that "early-onset AD is associated with a greater pathological burden than late onset AD" (Marshall et al.,2007). Diagnosing early-onset Alzheimer's can be difficult to detect because health care providers tend to overlook the disease in younger individuals. Getting an accurate answer can be a long and frustrating process. The causes of early-onset could include genetics or rare genes that developed into symptoms.

Diagnosis

Alzheimer's Association.(2014,January 5.)Alz.Org.Retrieved March 24,2014 from, http://www.alz.org/alzheimers_disease_diagnosis.asp


You can't be evaluated by a physician, there is no specific test to prove that an individual has Alzheimer's Disease. A physician will examine patient's medical family history, possibly do a neurological exam and a mental status testing. It is important to diagnose the disease early because it can't be reversed, although the patient could benefit from the treatment, and gives the caregiver and the family more time to plan for the future.

Case Study


In the world journal of Biological Psychiatry, Ilh et all (2011) article it is mentioned that there are no treatments to cure Alzheimer's disease itself, however it is possible to keep the symptoms of Alzheimer in check. A few drugs that tend to be helpful in the moderate phase of Alzheimer's is Donepezil, Galantamine, Memantine, Rivastigmine. Vitamin E or Ginko Biloba tend to have some positive effect on Alzheimer in early stages.
However, none of these treatments can keep the symptoms of Alzheimer in check for very long, much less cure them. The drug brings a marked improvement for 3-6 months to a year and as time goes on, the improvement is much less. After 3 years of taking the drug patient's condition tend to go back to the baseline.
More important than treatment is prevention and Alzheimer has quite a few risk factors and possible causes, because there is no sure way yet to tell that everyone who has a particular gene or condition is absolutely likely to have Alzheimer in the future.

Alzheimer affects the life of people and there are many aspects to human life. The first case study is a research project done by McDaniel et all (2001) about impact of dining room environment on nutritional intake of Alzheimer residents. 16 Alzheimer residents at a care facility where evaluated how they reacted towards the difference of sound and lighting in the two rooms in two separate phases of 1 week. Alzheimer residents tend to show lack of initiative or forget to eat-depending in which phase they are and therefore this test was executed to check if a certain change in the environment could have a positive reinforcement on the patients to take their needed nutrition. The results were that the preferred room was the one with increased lighting and decreased sound. Increased visibility and a more quiet space was less stressful. The differences were not that huge however and this experiment would have to be done on a larger scales or with more variables to truly be able to attest if such reinforcement can be used.

Another case study was about a married couple and the female in the relationship had developed Alzheimer. Daniels et all (2007) mentions that they preferred to study both the care taker and the one affected by Alzheimer. Mostly these two are studied separately, however this article tries to observe them together to get a more holistic picture of the situation. There were 4 points that were evaluated:
1. Perspectives & preparation for the future
2. family influence and social support
3. life evaluation
4. experiences with Alzheimer's

Throughout the interviews with the married couple it was seen that positive reflections and life long commitment to another was a recurring theme. Also remaining positive despite the circumstances was one of the coping mechanisms executed mostly by the caretaker.
This case studies showcases apart from viewing caretaker and affected family together, there is also an importance of viewing the person behind the Alzheimer and not just the generalization of that person as representing Alzheimer. However, this research was done in spanning around 6 months and 3 interviews were done, perhaps if a research like this is done on a much longer time frame, the experiences of Alzheimer on marital relationship can be better gauged.

There are other case studies of how music affects those with Alzheimer, in Gagnon et all (2009). The patient's emotive reactions to music seems to have diminished, but music did bring some improvement to general condition. The one thing that was observed however, was that the loss of interest was less due increase in apathy and more a loss in (taking) initiative.
In Pakhomow et all ( 2010) how the complexity of the syntactic writing of Irish author Iris Murdoch had changed the farther she progressed into the disease. The more the disease progressed the more limited and messy the writing became

In Rainville et all (2001) finding one's way around familiar and unfamiliar places are among the first clinical signs of Alzheimer in the early and intermediate phases. Their verbalization during the route were recorded to reveal patterns of decision making. The patients still had the ability to deal with decisions considered basic and concrete. However, decisions based on higher intellectual abilities were much more difficult. Through this research it can be questioned if these sort of exercises could help patients with Alzheimer to try and rebuild a few connection between neurons.

In Small et all (2006) they did a 14 day trail to test out how healthier lifestyle of diet and mental- and physical exercise affects those with Alzheimer. The ones who did the experiment did better in the tests at the end than in the beginning of the trail.

In Fernandez et all(2006) a single case study is done on a patient. This study evaluates how a patients ability to remain (relatively) self-sufficient is maintained or improved depending on the (change of) the treatment drug. Sometimes combining certain drugs together tends to have a positive effect, but it depends on the patient. Long-term use of the drugs seems to diminish the effectiveness of the drug, switching to another drug tends to help in this case at times. An overall improvement was sometimes seen when these switches took place, however, it can be that the patient has been tested so many times on the same test that he has become adapt at it- to a certain extent.

As you can see Alzheimer affects varying parts and senses of one's life. How music affects you, memory and cognition, and even how you react to an environment can change when a patient has Alzheimer.

Treatments


In the world journal of Biological Psychiatry, Ilh et all (2011) article it is mentioned that there are no treatments to cure Alzheimer's disease itself, however it is possible to keep the symptoms of Alzheimer in check. A few drugs that tend to be helpful in the moderate phase of Alzheimer's is Donepezil, Galantamine, Memantine, Rivastigmine. Vitamin E, Ginko Biloba and Virgin coconut oil tend to have some positive effect on Alzheimer in early stages and at times middle stages
However, none of these treatments can keep the symptoms of Alzheimer in check for very long, much less cure them. The drug brings a marked improvement for 3-6 months to a year and as time goes on, the improvement is much less. After 3 years of taking the drug patient's condition tend to go back to the baseline.
In articles such as Larson (2010) where it studies the importance of social interaction or Small et all (2006) where it studies how diet, exercise ( both physical and mental) can help in improving your cognitive function. As to how much the effect is depends on how advanced the Alzheimer's is, it is not seen as a cure, but more of a way to give a the Alzheimer patient a fulfilling and independent life for as long as possible. Alzheimer patients who lead a healthier lifestyle and exercise their mind are better off in holding back the Alzheimer symptoms then their less active and healthier counterparts. More research will have to be done on the exact and definite cause for an actual treatment to come to light. That's why more important than treatment is prevention, because Alzheimer has quite a few risk factors. Therefore there is no sure way yet to tell that everyone who has a particular gene or condition is absolutely likely to have Alzheimer in the future. Best is to follow healthier and active lifestyle to decrease your chances of possibly getting Alzheimer and even when someone develops Alzheimer, a healthier lifestyle can help keep the symptoms at bay- how long depends on each individual person and with combinations of drugs such as mentioned above.

Prevention and Link to Exercise:


Unlike age and genetics certain health and lifestyle factors associated with Alzheimer’s disease can be controlled and modified in order to prevent the progressing of Alzheimer’s. Scientists are constantly investigating whether or not exercise, playing brain games or diet can prevent Alzheimer’s or not. They are also investigating whether certain medical conditions such as high cholesterol, blood pressure or sugar level can prevent Alzheimer’s. Clinical trials do not support the use of any medication or supplementary diet to prevent Alzheimer’s.
Mental and physical exercise of any sort has many benefits. Studies show that they are good for our heart, waist lines and ability to carry out many daily tasks. Studies and some intervention show that physical activity might play a role in reducing risk for Alzheimer’s disease and any other age related cognitive decline.

Animal Studies points to why physical activity can reduce the risk. Morphologically, exercise increased both the number of tiny blood vessels that provide blood to the brain and the number of connections among nerve cells in older rats and mice. In addition researchers have found that exercise raises the level of a nerve growth factor in an area of brain that is important to memory and learning. It has also shown that exercise can stimulate the human brain’s ability to maintain old network connections and make new ones that are vital to healthy cognition. Several other clinical trials are exploring further the effect of physical and mental activity on Alzheimer’s and cognition decline. Findings from these and other clinical trials will definitely show whether physical or mental exercise has an effect of the impairment of brain.

A number of studies suggest that eating certain foods may help keep the brain healthy. A diet that includes lots of fruits and vegetable and whole grain can reduce the risk of many chronic diseases including heart/cardiac arrest or type II diabetes. Research is continuing whether a healthy heart can prevent memory and cognition decline. While some foods may decrease cognitive decline, others foods such as saturated fats and refined carbohydrates may pose problem. In one study, one scientist fed a rat a diet rich in carbohydrate and fats while the other rat was fed with low fat and minerals. The results were that the rat that fed the high energy performed significantly worse on certain memory tests compared to the other rat.
Age linked diseases and conditions such as vascular diseases, high blood pressure and heart disease and diabetes may raise the rate of memory loss and cognitive decline. Many studies are looking at whether this risk can be reduced by preventing or controlling these disease and conditions through medication and changes in diet. Much of this evidence about possible ties between vascular diseases comes from observational studies.

In Low (2009) article it was investigated the recognition of dementia and beliefs regarding prognosis, cause, and risk reduction in the Australian public. Here you can see a more detailed survey about possible risk factors. Low mentions that many Australian residents did not believe cardiovascular health and Alzheimer had a strong or particularly relevant connection.

Keeping cognitively active throughout life, via social engagement or logical stimulation—is associated with a lesser risk of Alzheimer’s disease. Several observational studies link sustained cognitive health with social engagement through work, volunteering, or living with someone. Mentally stimulating activities such as reading books and magazines, going to lectures, and playing games are also linked to keeping the mind sharp. In a large study of healthy older people, researchers found a relationship between more regular social activity and better cognitive function. It is not clear whether improved cognition resulted from the social interaction itself or from related factors, such as increased rational stimulation, that generally accompany social interaction. Other studies are exploring these relationships.

In Larson (2010) it mentions how social network is important to help improve you cognitive health and how having a higher education may also play a factor in diminishing your chances of getting Alzheimer

Rationally stimulating activities may also reduce the risk of Alzheimer’s, studies show that one large observational study looked at the impact of regular activities like listening to the radio, reading newspapers, playing puzzle games, and visiting museums. Investigators asked more than 700 older nuns, priests, and religious brothers to describe the amount of time they spent doing these activities. After 4 years, the risk of developing Alzheimer’s disease was 47 percent lower, on average, for those who did the activities most often than for those who did them least frequently.

In Small et all (2006) A short-term healthy lifestyle program combining mental
and physical exercise, stress reduction, and healthy diet was associated with significant effects on cognitive function and brain metabolism.
[http://www.youtube.com/watch?v=8q7rGPwiYrc ]

Relationship between active brain and Alzheimer’s:

The reasons for the apparent link between social engagement or intellectual stimulation and Alzheimer’s risk aren’t entirely clear, but scientists offer these possibilities:

• Such activities may protect the brain by establishing “cognitive reserve” the brain’s capability to control effectively even when it is damaged or some brain function is disrupted.
• These activities may help the brain become more adaptable in some mental functions, so it can compensate for declines in other functions.
• People who engage in these activities may have other lifestyle factors that protect them against Alzheimer’s disease.
• Less engagement with other people or in intellectually stimulating activities could be the result of very early effects of Alzheimer’s rather than its cause.

Other Prevention Factors:

Scientists are studying hormones especially those taken by older women as menopausal hormone therapy for their potential ability to avoid or delay Alzheimer’s disease and age-related cognitive decline. Several clinical trials are testing forms of estrogen as well as testosterone and other hormones in both healthy older adults and those with MCI. Hormones such as estrogen and progesterone have important effects on the brain, many of which could relate to cognitive aging and Alzheimer’s disease. Over the years, research has led to conflicting reports as to whether menopausal hormone therapy can prevent cognitive decline in postmenopausal women.

The idea of a vaccine to prevent Alzheimer’s disease is under study as well. Early vaccine studies in mice were so successful in sinking deposits of Alzheimer’s-related proteins in the brain and improving performance on memory tests that investigators conducted beginning clinical trials in humans with Alzheimer’s disease. These studies had to be stopped, because life threatening brain inflammation occurred in some participants.

In Korol et all ( 2013) it studies how the hippocampus is affected in Alzheimer patients given mental and physical exercise and also which affect estrogen can play in slowing down Alzheimer In mental exercises it is also studied how priming can play a part in helping with cognition and memory.

Documentary


http://www.pbs.org/theforgetting/watch/

References


Alzheimer's AssociationAlzheimer's Association .(2014,January 5.)Alz.Org.Retrieved March 24,2014 from, http://www.alz.org/alzheimers_disease_causes_risk_factors.asp

Alzheimer's Association.(2014,January 5.)Alz.Org.Retrieved March 24,2014 from, http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp

Alzheimer's AssociationAlzheimer's Association .(2014,January 5.)Alz.Org.Retrieved March 24,2014 from, http://www.alz.org/alzheimers_disease_early_onset.asp

Alzheimer's Association.(2014,January 5.)Alz.Org.Retrieved March 24,2014 from, http://www.alz.org/alzheimers_disease_diagnosis.asp

Alzheimer Society Canada.(2012,April 10.)Alzheimer. Retrieved April 3, 2014 from, http://www.alzheimer.ca/en/About-dementia/Alzheimer-s-disease/Myth-and-reality-about-Alzheimer- s-disease

Daniels, K. J. , Lamson, A. , Hodgson, J. American Psychological Association. 2007.

Fernandez, A. L. , Manoiloff, L. M. V. , Monti, A. A. Long-term cognitive treatment of Alzheimer’s disease: A single case study. NEUROPSYCHOLOGICAL REHABILITATION. 2006, 16 (1), 96–109.

Gagnon, L. , Gosselin, N. , Provencher, V. , Bier, N. Perception and Emotional Judgments of Music
in Dementia of the Alzheimer Type: A Short Case Study. Emotion and Dementia of the Alzheimer Type. Page 509- 519 2012.

Ihl, R. , Frolich, L. , Wingblad, B. , Schneider, L. , Burns, A. , Moller , H. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Alzheimer ’ s disease and other dementias. The World Journal of Biological Psychiatry. 2011; 12: 2–32.

Korol, D. , Gold, P. E. , Scavuzzo, C. J. Use It and Boost It With Physical and Mental Activity. HIPPOCAMPUS. 23:1125–1135 (2013).

Larson, E. B. Prospects for delaying the rising tide of worldwide, late-life dementias. International Psychogeriatrics. (2010), 22:8, 1196–1202

Low, L. , Anstey, K. J. Dementia literacy: Recognition and beliefs on dementia of the
Australian public. Alzheimer’s & Dementia. vol 5 pgs 43–49 2009.

McDaniel, J. , Hunt, A. , Hackes, B. , Pope, J.F. Impact of dining room environment on nutritional intake of Alzheimer's Residents: A Case Study. American Journal of Alzheimer’s Disease and Other Dementias. Volume 16, Number 5, September/October 2001

Pakhomov, S. , Chacon, D. , Wicklund, M. , Gundel, J. Computerized assessment of syntactic complexity
in Alzheimer’s disease: a case study of Iris Murdoch’s writing. Psychonomic Society, Inc. 2010

Parliament Research Branch. (1993,May) Brassard, Daniel. Retrieved April 3, 2014 from, http://publications.gc.ca/collections/Collection-R/LoPBdP/BP-e/bp335-e.pdf

Rainville, C. , Passini, R., Marchand, N. A Multiple Case Study of Way®nding in Dementia of the
Alzheimer Type: Decision Making. Aging Neuropsychology and Cognition. Vol. 8, No. 1, pp. 54-7 2001.

Small, G. W. , Silverman, D. H. S. , Siddarth, P. , Miller, K. J. , Lavretsky, H …..Phelps, M. E. Effects of a 14-Day Healthy Longevity Lifestyle Program on Cognition and Brain Function. Am J Geriatr Psychiatry. 14:6, June 2006.

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