As a health and exercise professional working with older adults, you can meet patients with dementia. Alzheimer's disease is the fifth most common cause of death in older adults and the most common neurodegenerative disease, where the deterioration of the nervous system is progressive and irreversible. According to the Alzheimer's Association, there are currently an estimated 5.7 million Americans with Alzheimer's disease and 96% of those over 65 years old.
The cognitive symptoms of the disease, such as memory disorders and weakness, confusion and disorientation, usually develop slowly and become worse over time. Changes in the brain can occur decades earlier, as symptoms such as memory loss occur. Let's look at the changes in the structure of the brain as well as the function of the brain.
What happens to the brain?
One of the First Things to Occur in the Brain Alzheimer's disease is a progressive loss of nerve cells (specialized cells that process and transmit information via chemical and electrical signals) in areas such as the entorhinal cortex and hippocampus to support the memory. As the disease progresses, neurons are also lost in the cerebral cortex, which is responsible for language, reasoning and social behavior.
There are two main suspects in the loss of neurons: an accumulation of amyloid plaques and neurofibrillary tangles. Plaque forms when beta-amyloid (protein pieces) combine to block cell-to-cell communication and cause the immune system to trigger an inflammatory response. Tangles are abnormal accumulations of a protein called tau, which accumulates in neurons. In the brain affected by Alzheimer's disease, there is an abnormal chemical change in tau that causes it to adhere to other tau molecules, causing entanglements within the neuron that result in the loss of the neuron (Bender et al., 2005).
These structural changes in the brain lead to functional differences for the individual. Alzheimer's disease can cause memory or concentration problems in older adults. When more damage occurs in the brain, the older adult may enter the longest stage of Alzheimer's disease (known as the middle stage) and may have difficulty expressing thoughts and performing routine tasks. In the final stage, people lose the ability to respond to their environment, have a conversation, and ultimately control the movement. Unfortunately, Alzheimer's disease is deadly.
Research has shown that the risk of brain dysfunction and Alzheimer's disease is increased by obesity, diabetes, hypertension, hypercholesterolemia, and chronic inflammation (Morris et al., 201
What is the relationship between exercise and brain health?
Most studies support a relationship between exercise and brain health derived from studies of aerobic exercise. A recent meta-analysis of 19 research studies found that aerobic exercise can delay the decline in cognitive function among people at risk for Alzheimer's disease (Panza et al., 2018). In animal studies, aerobic exercise has been shown to be a promising approach for the reversal of hippocampal damage and cognitive deficits caused by Alzheimer's disease (Intlekofer and Cotman, 2013). In addition, exercise appears to stimulate neurogenesis or promote the development of neurons (van Praag et al., 1999).
There is limited data on the role of resistance exercises in promoting brain health; However, some studies show promising results. Liu-Ambrose et al. (2010) found that resistance training benefited leaders' cognitive function in selective attention and conflict resolution among older women. Nagamatsu et al. (2012) found that resistance training in cognitive impairment is associated with modest cognitive benefits.
Factors to Consider When Designing Exercise Programs for Patients with Alzheimer's
When working with a patient who has Alzheimer's Disease, focus on aerobic activities Individuals are familiar. Start slowly and walk slowly. Remember that what the customer may one day achieve can be very different from what he can achieve on another day. Keep in mind that your customer may have difficulty balancing due to visual perception and coordination. Therefore, it is recommended to add neuromotor control activities. Make sure that the training area is free of interference and good lighting is guaranteed. It is also recommended to consider the movement and noise of the peripherals, which can be uncomfortable for the customer. New skills such as resistance training require specific instructions and repetitions. The cueing of activities should only ever convey one instruction.
Notice to the Health and Exercise Specialist
As a health and exercise specialist, you need a little more patience and understanding if you need something to work with a patient with Alzheimer's disease, especially because of them experience both good and bad days. Helping these clients to participate in an exercise program with a set program and schedule can improve their quality of life. For example, maintaining or improving muscle strength and endurance and balance can help your clients by improving their ability to carry out activities of daily living. It can also be an important help for their caregivers. Getting up from sitting or getting out of bed becomes easier for the client as the strength increases, leaving the person somewhat independent and supporting the caregiver, who may not be physically strong enough to actually lift his loved one. In addition, with regular exercise, caregivers can observe improved behavior and memory as well as better communication skills.
Working with this population can be very rewarding, as your knowledge and your skills to improve the quality of life are greatly appreciated by both customers and their loved ones. To learn more about Alzheimer's disease, contact the Alzheimer's Association and the National Institute on Aging.
Bender, L.I. et al. (2005). Dew, Tangles and Alzheimer's disease. Biochimica et Biophysica Acta, 1739, 216-223.
Intlekofer, K.A. and Cotman, C.W. (2013). Motion counteracts the decrease in hippocampal function in aging and Alzheimer's disease. Neurobiology of Disease, 57, 47-55.
Liu-Ambrose, T. et al. (2010). Resistance training and executive functions: a 12-month randomized controlled trial. Archives of Internal Medicine, 170, 2, 170-178.
Morris, J.K. et al. (2014). Is Alzheimer's disease a systemic disease? Biochimica et Biophysica Acta, 1842, 1340-1349.
Nagamatsu, L.S. et al. (2012). Resistance training promotes cognitive and functional brain plasticity in seniors with likely mild cognitive impairment. Archives of Internal Medicine, 172, 8, 666-668.
Panza, G.A. et al. (2018). Can Exercise Improve the Cognitive Symptoms of Alzheimer's Disease? Journal of American Geriatrics Society, 66, 3, 487-495.
Scarmeas, N. et al. (2009) . Physical activity, diet and risk of Alzheimer's disease. Journal of the American Medical Association, 302, 6, 627-637,
by Praag, H. et al. (1999). Running improves neurogenesis, learning and long term potentiation in mice. Proceedings of the National Academy of Sciences of the United States of America 96,23, 13427-13431.