Symptoms

The early symptoms are mild cognitive impairment, which is easily ignored. Including memory loss, mild memory impairment, decreased ability to think about things, reduced judgment and reasoning skills, and frequent loss of the way. Symptoms are not apparent at this stage. But a single memory impairment does not mean that you have Alzheimer's disease.

As the symptoms progress to the middle stage, the condition gradually worsens, and the symptoms can be identified. The patient has apparent mood and personality behavior changes, distrusts others, and is easily irritable. Severe memory impairment, forgetting recent events, and even forgetting the names of relatives. Self-care ability is inferior, which has a powerful impact on life.

When the symptoms are in the late stage, the patient's memory impairment is more serious, and daily life is ultimately needed for nursing support, and the patient cannot recognize the person, place, time, etc. The patient changes his mood and personality, often has anxiety, delusions, and hallucinations, and cannot live everyday life.

But when the symptoms worsen, the patient can retain skills such as reading, singing, dancing, listening to music, and doing handwork. (Mayo Clinic, 2021; Treatment AD, 2021)

7 2.1.3 Causes and risk factors

The cause of Alzheimer's disease is still unclear, and various reasons may induce it. It is not a normal aging process, but a series of symptoms caused by changes in the brain over the years and loss of brain cell connections. (Basic of AD and Dementia, 2021; What is AD, 2021）

In 1906, Dr. Alois Alzheimer discovered Alzheimer's disease and named it. Dr. Alzheimer studied the brain of a woman who died of a mental illness and found that the critical feature of Alzheimer's disease is many neuron fibers with Beta-amyloid (Plaques) and Tau proteins (angles) together. Another feature is the loss of neuronal connections that transmit

information between brain parts. Eventually, lead to damage to various areas of the brain.

(Basic of AD and Dementia, 2021)

Age is considered the most crucial cause. In people over 60, the higher the age, the higher the incidence, and AD is rare in young people. (Basic of AD and Dementia, 2021; Treatment AD, 2021) As you get older, blood vessels in the brain are damaged, inflammation, atrophy, etc., damage neurons and brain cells. (What is AD, 2021）

Family genetic inheritance is also considered a common cause, which is the cause of some young patients. (Treatment AD, 2021) Patients with Down syndrome will develop symptoms after 40 years old and 10-20 years earlier than the general population. Other living habits, living environment, lack of exercise, and health factors are also considered the cause of the disease. High-risk groups include hypertension, heart disease, obesity, diabetes, etc. (What is AD, 2021; Treatment AD, 2021）

The cause of Alzheimer's disease may also be caused by depression. Excessive drinking and sleep disorders can also increase the risk of Alzheimer's disease. Because women generally live longer than men, women have more cases of Alzheimer's disease than men. (Mayo Clinic, 2021; Treatment AD, 2021)

2.1.4 Treatment

Although medical experts have been studying Alzheimer's disease, there is still no cure, and only some methods can be used to improve the symptoms of the disease. (Basic of AD and Dementia, 2021; Treatment AD, 2021)

8 Medications: Only specialist doctors can prescribe acetylcholinesterase (AChE) inhibitors for patients. Acetylcholine can help nerve cells interact. Patients with early and mid-term symptoms can use donepezil, galantamine, and rivastigmine. It is necessary to continue taking it in the late stage. The side effects of gastrointestinal reactions will be relieved after two weeks of taking medicine.

Patients with moderate and severe AD intolerant to AChE can take memantine, preventing too much glutamate from affecting the brain. Its side effects are temporary dizziness or

constipation.

For the effects of behavioral changes due to AD symptoms, antipsychotic drugs are needed.

Because of the severe side effects of risperidone, haloperidol is used when it is ineffective.

Prevent the risk of harm when using such drugs.

Antidepressants can be used for patients with anxiety symptoms. Other physical therapy methods are also used clinically in addition to drugs. For example, Cognitive Stimulation Therapy (CST) improves the patient's memory and thinking skills.

Professionals, family members, and friends can help the patients increase their daily life abilities. 3. The patient is helped recall the past, or additional tools can be used to help the patient regulate emotions. (Treatment AD, 2021）

2.1.5 Dementia

It is a syndrome that damages various cognitive functions caused by organic damage and has had a severe impact on work, life, and social interaction. Also called progressive memory impairment. Etiology and evaluation. The factors of memory impairment can include temporary causes, permanent sequelae, and advanced brain diseases. Temporary causes include TGA, TIA, transient cerebrovascular accident, mild brain injury, sleep disorders, drugs, drugs, or various mental health diseases. Permanent consequences include brain damage, encephalitis, cerebrovascular accident, hepatic encephalopathy, various mental illnesses, etc. The influencing factors of memory impairment include hypotension, infection, emotional stimulation, metabolic disorders, nutrition, etc. Dementia is divided into mild, moderate, and severe dementia. Symptom: 1. Memory impairment or forgetting recent events. 2. At least one disorder: aphasia, agnosia, apraxia, or interruption of executive ability. 3. Impairment of consciousness, such as looking forward. (What is AD, 2021;

Hallikainen et al, 2021)

9 2.2 Elderly people

The World Health Organization (WHO) defined that a person who has reached 60 years of age as an "elderly person." However, due to people's emphasis on health and the improvement of other living conditions, the population's life expectancy has become an increasing trend. The Higher Population Council on September 30, 2021, called for a redefinition of "elderly people"

and emphasized the improvement of health care and nursing work for the elderly. (Amman, 2021)

2.3 Aerobic exercise

Aerobic exercise means cardiorespiratory activities—for example walking quickly, jogging, running, bicycling, swimming, and dancing; these kinds of exercise stimulate 60–70% of most heart rates for 20 to 30 minutes or more. Effects aerobic exercise help re-synthesis of high energy compounds in the presence of O2, improves circulation, regulates weight, and controls glucose levels. (Miller-Keane Encyclopedia and Dictionary of Medicine, 2003)

Aerobic exercise is these kinds of types: swimming, walking, jogging, cycling, rowing, dance, and golf walking. Regular exercise is one of the best things for our health, and it may benefit, including improving people's overall health and fitness and reducing patients' risk for many chronic diseases. Aerobic exercise increases people's breathing and heart rate; it keeps the heart, lungs, and circulatory system healthy; To improve balance, they make it easier and safer to walk on uneven surfaces and help prevent falls, especially for older people. (Lee, S.

M., Joung, J. & Shin, S. H. 2020; Miller-Keane Encyclopedia, 2003; EBM Guidelines, 2015)

3. Aims and Objectives of this study

3.1 The study aims to explore safe and effective exercise ways to help older with Alzheimer's disease.

Dementia, and one of the primary types of dementia-Alzheimer's disease, are all listed in one of the top 10 death underlines causes worldwide. With the people's lifespan increasing more and more, especially over 65 age, Alzheimer disease numbers also raised quickly worldwide.

They are living with their loved ones, or caregivers, how to help them take efficient methods to prevent or slow down disease deterioration; How to maintain the quality of their life and protect their self-esteem? Modern medicines in the medical institution are the primary choice. Besides medicines, much research confirmed that aerobic exercise could postpone Alzheimer's symptoms worsen, improve balance, and prevent falling risk, keep body

10 foundation ability, stimulate the circulatory system, and even improve chronic diseases and underlying diseases. While what kind of aerobic exercise is suitable, efficient, and safe for older people? These are necessary and urgent problems to result. (NIA, 2021; EBM Guidelines, 2015)

3.2 The objective is to study the effectiveness of aerobic exercise in improving Alzheimer's disease from medical costs and risks.

Whereas it verified that medical treatment after disease might reduce disease progression and mortality, increases in disease prevalence will increase the population's total disease burden and healthcare cost. The modern approach to AD treatment may not be cost-effective in societies with extreme disease rates such as AD. A low-cost, low-risk intervention strategy with dual applicability for older people's prevention is likely advantageous. (International Journal of Alzheimer’s Disease, vol. 2012) Aerobic fitness can become a reliable public health tool to combat AD risk. Such a low-cost, low-risk effective strategy is likely to reduce disease burden and avoid the older adults at increased AD risk. Therefore, this paper aims to enhance scientific discussion on the role of aerobic exercise in the development of AD and related dementias and add clarity to the clinical utility of fitness adaptation in preventing AD in those at risk. (Lu W, et al, Frontiers in Aging Neuroscience. 2020; Asian News International, 2021) 3.3 Research Questions

What Aerobic exercise care for old peoples with Alzheimer’s disease? And what kinds of aerobic exercise can improve elderly people with AD?

4. Methodology 4.1 Data Collection

When searching for materials and documents in this literature review, the primary method is to enter "Laurea LibGuides" through Laurea's school homepage, then enter "Nursing," search for keywords in the trusted information search portal, and then set the time range if 12 months later. The recommended literature titles are screened, and the preliminary screening results are retained.

Searching for the keyword "Alzheimer's Disease" in "EBM Guidelines" yielded 15 results. Three usable results after screening.

11 In "ProQues Central" 5535 results were obtained by searching the keyword "Alzheimer and Aerobic exercise and Elderly people," 541 results were obtained after setting the time, and 6 usable results were obtained by title screening.

Searching for the keyword "definition of elderly" in "ProQuest Central" got 16 results and 1 usable result after filtering by title.

Reliable books and resources from websites are also used to collect materials.

Database Keyword Results Preliminary

accepted

The research method of this literature review is a comprehensive method of descriptive study by collecting literature reviews. The flowchart in Table 2 describes the specific screening method and review process.

First, search by keywords, and include the search range of "titles, keywords, abstracts, full text, periodicals, magazines, newspapers, publishing houses" in the database. Use the time to screen out the available documents in the most recent year and get 547—available

preliminary documents and 10 creditable books and websites after the title screening. Then evaluate the abstract and research methods and use 10 articles and 10 creditable books and websites.

12 Table 2: Database search results

When the resources that can be included in the study are determined, the author, year, and relevant important information are extracted, the subject content and the screening method of summary analysis are used to evaluate the availability of each resource, and a total of 20 resources are available. Among them, the 15 Quantitative articles used the 4 Qualitative articles, and one mixed article was used.

AUTHOR/YEAR SOURCE DATABASE METHODOLOGY

1 Miller-Keane Encyclopedia and Dictionary of Medicine,

2021

Medical dictionary Qualitative

2 SyndiGate Media Inc, 2021 ProQuest Central Quantitative

3 Remes et al. 2020 EBM Guidelines Quantitative

4 Chen et al. 2020 ProQuest Central Quantitative

5 Merja Hallikainen, 2015 EBM Guidelines Quantitative

6 YLE, 2021 Yle Quantitative

13

7 Amman, 2021 ProQuest Central Quantitative

8 Hallikainen et al. 2021 EBM Guidelines Quantitative

9 Fact Sheet, 2021 NIH Quantitative

10 Srinivas et al. 2021 ProQuest Central Quantitative 11 Basic of AD and Dementia,

2021

NIH Quantitative

12 What is AD, 2021 NIH Quantitative

13 Treatment AD, 2021 NHS Quantitative

14 Official Statistics of Finland, 2019

OSF Qualitative

15 Sok S et al. 2021 ProQuest Central Quantitative

16 Thomas O. Obisesan et al.2012

ProQuest Central Quantitative

17 Tao J et al.2017 ProQuest Central Quantitative

18 Kati Juva, 2021 Medical book Duodecim Qualitative&

Quantitative 19 Publisher: People's Sports

Publishing House, 2009

Book Qualitative

20 Parle M, 2005 Book Qualitative

Table 3: Analysis of the Data included in table

14 5. The effect of Aerobic exercise for older adults

5.1 Dance

Dance can improve brain volumes, a reach from the 6-month intervention for over 65 people that produced higher cognitive functions, such as operating memory and concentration, hence attenuating the age-related cognitive decline. Dance among older adults showed more

significant brain volume improvements, which focused on aerobic exercises, anaerobic strength, and stretching exercises. The result could be attributed to the multi-faceted nature of dance, encompassing spatial orientation, movement coordination, balance, endurance, interaction, and communication. Six months of dance intervention was performed for a group of elders. There were remarkable changes in terms of attention and cognition between the intervention and control groups. The corticospinal tracts in the group developed that underwent intervention (Gulyás B, Brain Scicen, 2021). Dance training is excellent for repeated physical exercise in inducing brain plasticity in the elderly.

5.2 Swimming

Swimming is a great aerobic activity, whatever older adults or children are benefited from it.

Regular swimming stimulates the maintenance and promotion of brain functions. The

underlying physiological mechanism for the improvement of memory appears to be the result of enhanced neurogenesis. Through a group of rodent’s animals’ investigation, that

underwent swimming regularly for 30- days. These research findings reinforce the concept that a well-planned exercise program would greatly help the aged citizens with or without Alzheimer’s disease improve their cognitive functions. (Parle M, 2005)

5.3 Fumanet

Fumanet, or square stepping exercise (SSE) is a type of fumanet task stepping one by one;

Fumanet, or square stepping exercise (SSE), is a task that steps one by one. It was influential in balance, gait, lower extremity muscle strength, memory recall, and concentration in the elderly with dementia or mild cognitive impairment. (Kim M. Effects of Cognitive, 2021) SSE includes multiple directional step patterns played on a small mat partitioned into squares 25 cm2 each and may include toe walking or a complex walking pattern as a progression.

People can also operate indoors, so it certainly appears beneficial over unidirectional and outdoor walking, which is less beneficial for fall prevention. SSE strengthens both legs' quadriceps and hamstring muscle and enhances balance.

15 Figure 1. The basic and task steps of humanet exercise. (mdpi.ijerph.18157848)

Physical-cognitive dual-task interventions for older people have proven efficacy in improving physical health (lower extremity muscle strength) and cognitive function (especially

executive function). Fumanet also promotes health status, decreases depression, and

increases life satisfaction by preventing and delaying dementia and balancing growth. (Kim M.

Effects of Cognitive, 2021)

16 Figure 2. The composition of cognitive/exercise dual-task program.

(mdpi.ijerph.18157848)

The span and frequency of application of SSE to obtain advantages were at 8 to 12 weeks, twice a week, and 40 to 50 min per session in previous studies. (Kim M. Effects of Cognitive, 2021)

5.4 Tai Chi Chuan and Baduanjin

Tai Chi, a national intangible cultural heritage, is based on the traditional Chinese Confucian and Taoist philosophy. Tai Chi has multiple functions, such as temperament maintenance, physical fitness, combat. Tai Chi combined with the internal and external, soft, slow, light, and flexible, rigid, and soft.

Ba Duan Jin is a set of independent and complete fitness exercises. It has been recorded as early as the Northern Song Dynasty, and it has a history of more than 800 years widely spread.

Chinese people loved it so much. Through the practice of Ba Duan Jin and paying attention to

17 the appearance and movement, it is also necessary to cooperate with the mind-keeping, breathing, and the sense of enlightenment of the movement. There are no necessary types of equipment and site requirements to practice Ba Duan Jin. The complete set of exercises is only more than 10 minutes, and people can do it every morning and evening.

A study compared how 12-weeks of Tai Chi Chuan and Baduanjin exercise can change brain structure and memory function in older adults. Conclusions noted that both Tai Chi Chuan and Baduanjin could significantly increase grey matter volume (GMV) in the insula, medial

temporal lobe, and putamen after 12-weeks of exercise. Ba duan jin also advanced cognitive control, attention, touching, and comprehension memory. (Tao J, A brain imaging study.

Alzheimer’s Dis. 2017) The book《Tai Chi Exercise》 elaborates on the physiological health effects of Tai Chi; To prove the health benefits of Tai Chi, Beijing Sports the Institute of Medicine has conducted more detailed medical examinations on older adults aged 50 to 89.

Among them, 32 are regular taijiquan, and 56 are normal elderly. The results of comparative observation prove that the former elderly is in better condition than the average elderly in terms of physique, cardiovascular system function, respiratory function, bone marrow system, and metabolic function." （People's Sports Publishing House, 2009）

6 Discussion and conclusion of study

6.1 Discussion about existing problems currently

This literature review aimed to review the qualitative literature on aerobic exercises profits in Alzheimer's disease with elderly, and how maximum maintain elderly independent body ability foundation and help them prevent falling down risk. The focus of this article was to identify qualitative research in the relationship between exercise and Alzheimer's old people.

Even though some studies and reports involved in the mice with dementia or healthy people over age 60 into experimental, the outcome research is still the valuables for knowing advanced aerobic for dementia, which helps the caregivers know base-evidence knowledge and apply efficient application assistances. This study is the same user for all those living with AD's old people. Besides that, it would be beneficial to warn young people and other age healthy that a healthy lifestyle and regular exercise can delay the cognition degenerating with the increase the age growing and reduce the risk of getting dementia.

18 Investigate the aerobic exercises improves for all people and not focus on only people who have Alzheimer's. The literature review results made it possible to understand the barriers in the rehabilitation, although the number of research studies was small. All studies focused on hoping to find a way to reverse the decline of cognition. However, as far as currently, not enough evidence signed aerobic exercises can cure Alzheimer's.

Although people already know taking regular exercises enhances Physical coordination ability and personal mobility, some obstacles are limiting elderly with AD often exercises.

1) age

Almost 85% of Alzheimer's patients are over 65 years old. During this age, people would like to stay at home or live in a nursing home. They are lack energy and inactivity; fatigue is one of the significant symptoms around them. Alzheimer's older more often with the other primary foundation disease, for example, high blood pressure, diabetes, insomnia; for these reasons, patients must take some drugs, which arouse sleeping or calm dawn. So, it is hard to let an older with Alzheimer's keep in mind exercises and effective implementation.

2) the progression of Alzheimer's disease

Alzheimer's disease is divided into three levers, mild degree, moderate degree, and severe degree. It is worth pointing out that patients with a moderate degree of Alzheimer's disease will experience different hallucinations, difficulties activity in daily living (e.g., dressing, washing). (EBM Guidelines. 2020) Serve degree shows impaired or lost comprehend speech;

limbs stiffen; The ability to walk will deteriorate and be lost; Urinary and fecal incontinence develop.

Epileptic seizures may sometimes occur.

The patient is no longer able to cope with activities of daily living (dressing, washing, toileting, and finally eating). (EBM Guidelines, 2020) because of the above two physical conditions, it is not difficult to imagine that aerobic exercise will encounter great difficulties and even bring injuries to patients. Then, the problem is obvious. The implementation of

The patient is no longer able to cope with activities of daily living (dressing, washing, toileting, and finally eating). (EBM Guidelines, 2020) because of the above two physical conditions, it is not difficult to imagine that aerobic exercise will encounter great difficulties and even bring injuries to patients. Then, the problem is obvious. The implementation of

In document Aerobic exercise care for older peoples with Alzheimer's disease －Literature Review (sivua 6-0)