The US population of individuals aged 65 years or older is expected to more than double, from 43million to 92 million, by the year 2060. The prevalence of dementia and other cognitive impairments is also expected to increase incrementally. Normal aging is accompanied by alterations in brain structure and function, and associated cognitive changes. Some of these cognitive changes may be related to neurodegenerative diseases such as Alzheimer’s disease (AD) and other types of dementia.
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What Is Alzheimer’s Disease (AD)?
Alzheimer’s disease is a progressive condition in which brain cells are damaged, and how we speak, think, and interact with other people are affected. It is the most common cause of dementia. Alzheimer’s disease can cause death, and it is the fifth leading cause of death among adults over age 65 in the United States.
The risk of getting Alzheimer’s disease increases with age; it is rare to get it before age 60. Family history of Alzheimer’s disease raises your risk of getting it, but most people with the disease do not have a family history of it.
Statistics
In the United States, it is estimated that 5 percent of people over age 65—about 5.2 million—have Alzheimer’s disease. In age groups of more than 85 years, more than 40 percent of people have it. Along with memory loss and other cognitive problems, people with Alzheimer’s disease may have difficulty performing simple tasks of daily living.
Signs and Symptoms
These are 10 important warning signs of possible Alzheimer’s disease:
- Memory changes that disrupt daily life
- Difficulty making decisions, especially in planning or solving problems
- Difficulty completing familiar tasks
- Confusion about time and or place
- Trouble understanding visual images or the way things physically fit together (spatial relationships)
- Finding the right words to use when speaking or writing
- Misplacing items and losing the ability to retrace steps
- Poor or decreased judgment about safety
- Withdrawal from work or social activities
- Changes in mood or personality
Physical Activity and Dementia
Aerobic exercise attenuates cognitive impairment and reduces dementia risk. Aerobic exercises have neuroprotective effects and mitigate
cerebrovascular risk. Additionally, aerobic exercises are beneficial in reducing agitated behavior, improving cognitive function, reducing fall risk, and improving mood and fitness levels.
Prevention Is Evident
One study shows that modifying risk factors decreases cognitive decline and risk of dementia. This study states that there are some modifiable factors that contribute to cognitive decline. These factors are diabetes, obesity, smoking, and hypertension. These are same as the cardiovascular risk factors. Regular physical activity to manage these risk factors has been shown to reduce the risk of cognitive decline and may reduce the risk of dementia. (M. Baumgart et al./Alzheimer’s & Dementia 11 (2015) 718-726).
Other studies prove that exercise volume moderates brain atrophy of the medial temporal lobe, key for memory and executive functions. Higher levels of exercise engagement were related to larger superior frontal volumes. Most critically, exercise engagement selectively moderated age-related medial temporal lobe atrophy. Specifically, significant age-related atrophy was observed in older adults who engaged in low levels of exercise, but not for those who engaged in high levels of exercise. (Bugg JM Head D 2011).
People who have the highest levels of physical activity have the lowest relative risk of dementia and AD, according to one study. Physical activity may protect against cognitive decline and neurodegenerative diseases through a number of possible mechanisms. Regular exercise is likely to promote vascular health by lowering blood pressure, lipids, and obesity and inflammatory markers, and improving endothelial function, which are all risk factors for dementia and Alzheimer’s disease. In particular, cerebral circulation appears to be important for cognitive performance, and exercise adaptations may involve improved blood flow and oxygen supply to these areas. Therefore, physical activity reduces the risk of dementia and Alzheimer’s disease by 28% and 45%, respectively (Hamer M Chida Y psychol Med 2009:39(1):3-11).
Improvement Is Possible
Even in frail patients of advanced age, there is improvement in strength and function with resistance training. The improvement was much higher with high-intensity progressive resistance training than low to moderate progressive resistance training.
People with advanced dementia have not consistently demonstrated significant improvement in cognition, although they do consistently show improvement in physical performance, behavior, and mood with exercise interventions.
The hippocampus shrinks in late adulthood, leading to impaired memory and increased risk of dementia, as the hippocampus is critical for memory. It has been shown that one year of cardiovascular exercise has increased hippocampal volumes and better spatial memory and reduced age-related gray matter shrinkage (Fred G 2010).
About 21% (>1.1 million) of AD cases in the United States alone can be attributed to physical inactivity in the elderly. As it is proven above, there is a strong correlation between physical exercise and cognitive performance in older adults.
Skilled Physical Therapy Intervention
Exercise volume, which appeared to be neuroprotective for dementia, is similar to the amount of exercise recommended for all older adults.
Aerobic Exercise
Activity performed for at least three days a week produces health benefits. Duration and variety ofphysical activities are important factors. For duration, adults need at least 2.5 hours (150 minutes) per week of physical activity.
Some examples of aerobic exercises:
– Walking
– Dancing
– Swimming
– Water aerobics
– Jogging
– Aerobic exercise classes
– Bicycle riding (stationary or on a path)
– Some gardening activities, such as raking and pushing a lawn mower
– Tennis
– Golf (without a cart)
Strength Training
At least two days per week, older adults should perform muscle-strengthening activities that involve all the major muscle groups. These are the muscles of the legs, hips, chest, back, abdomen, shoulders, and arms.
When you work on your strength, there are some important components on which you need some skilled advice.
– Intensity: Intensity has to be moderate or high intensity.
– Form and technique: Ensure good form and technique for every repetition to get the most benefit from the exercise but also to avoid any injuries.
– Identify substitution/muscle fatigue.
– Progress as appropriate.
Balance Training
All six balance domains (biomechanical constraints, stability limits, transitions, reactive postural response, sensory orientation, and stability in gait) measured by BESTest became increasingly worse with the severity of cognitive impairment. (Tsngan GG 2014) Balance training for three or more days per week is recommended.
Keys to Success
For the sustainment of your mental health, it is key to engage in regular exercise in late adulthood. There are a lot of ways to involve yourself in exercise, such as joining a gym, attending community group exercises, and receiving physical therapy.
