1. The Use of Discourse Analysis to verify the effects of Exercise on Alzheimer’s Disease Jennifer Cleary May 8, 2006 GRNT 5050

2. What intervention is currently being used to improve functioning in those with Alzheimer’s Disease? Decision is based on need to improve cognitive, communicative, and swallowing difficulties Intervention that improves dysphagia (evaluation and treatment services) Why? – It is reimbursed by Medicare – Increases body weight, nutritional needs, and meal consumption – Reduces coughing and aspiration risk (Mahendra & Arkin, 2003)

3. What should the intervention be treating? Should improve: – Orientation – Amount of meaningful communication – Recall of autobiographical information – Decrease frequency of disruptive vocalizations – Mood – OVERALL QUALITY OF LIFE What non-pharmacological treatment does this? – EXERCISE (Mahendra & Arkin, 2003; Arkin & Mahendra, 2001)

4. What can be used to verify the effects of exercise? ….Discourse analysis Why Discourse Analysis? Decline in language function is an early and common symptom of Alzheimer’s disease Identifies patients ability to use language It is the basic unit of social communication (Mahendra & Arkin, 2003; Arkin & Mahendra, 2001) The use of colloquial fixed phrases, extenders, and metonymy in the speech of individual’s with Alzheimer’s disease is similar to the usage in unimpaired speech (Maclagan, Davis, &Lunsford, 2006)

5. Discourse Deficits with AD Empty speech Few relevant units of information Reduced informational content Word finding, lexical retrieval difficulties, frequent circumlocutions, paraphasias Use of higher proportion of pronouns without antecedents Reduced cohesion/coherence Ideational perseveration Poor topic maintenance, frequent shifting Excessive verbosity Difficulty with comprehension of abstract language (Arkin & Mahendra, 2001)

6. Elder Rehab/Alzheimer’s Rehab Program Four year study included: – 2-hr sessions consisting of Volunteer work in the community or community activity 30-50 min. of verbal fluency and conversation stimulation – 2-2.5 hr sessions of Physical exercise including – Treadmill – Bicycle – Resistance training to improve ADLs – Balance, ambulation, & ROM exercises (Mahendra & Arkin, 2003; Arkin & Mahendra, 2001)

7. Outcome Variables of Interest Mini-Mental State Exam Arizona Battery for Communication Disorders of Dementia % of Topic Comments:Topic Utterances % of Different Nouns:Total Nouns % of Vague Nouns:Total Nouns # of Information Units on an ADP Grocery Store Picture

8. Discourse Battery Eight stimulus prompts or questions of topics relevant to mature adults Five-item proverb interpretation Picture description task of a grocery store Results…. – Long-term cognitive-linguistic interventions can improve or maintain language performance (Mahendra & Arkin, 2003)

9. Figurative Language Familiar proverbs were easily interpreted compared to unfamiliar proverbs in those with mild dementia Van Lancker (1990) suggests familiar proverbs are stored in semantic memory as a single unit of meaning – The semantic memory may not be degraded in mild dementia – Repetitive stimulation of figurative language able to learn meaning (Mahendra & Arkin, 2003)

10. Picture Description Normally, over a four year period those with mild dementia decrease production of information units In the Elder Rehab Study, although mental status declined over four years, the subjects in the study were able to produce the same number of information units as baseline (Mahendra & Arkin, 2003)

11. Exercise Heyn et al. (2004) displayed that exercise does improve cognitive functioning in persons with cognitive impairment – Dementia – Alzheimer’s Disease Exercise participants significantly improved on cognitive tasks and functional performance measures compared to the control group Cognitive tasks evaluated by: MMSE Functional performance evaluated by: arm and leg strength, grip strength, and flexibility tests

12. How does exercise maintain cognitive functioning? Studies indicate those less active (mentally and physically) have a 250% increased risk of developing Alzheimer’s Disease Exercise decreases the risk of Alzheimer’s Disease by 60% How? (Adlard et al., 2005)

13. How does exercise maintain cognitive functioning? Improves cerebral blood flow in cortex and hippocampus Increases oxygen delivery Increases proteasome activity in brain which reduces amyloid in the brain Induces fibroblast growth factor in hippocampus Reduces loss of hippocampal brain tissue with age Reduces the incidence rate of dementia when exercising three times a week or more, 15-30 minute sessions (Larson et al., 2006)

14. How does exercise maintain cognitive functioning? Beta-Amyloid Substance – Degenerates nerve cells and gum-ups synapse – Impairs short-term memory, reason, and language function Adlard et al. (2005) Mice Study (Voluntary Exercise) – Exercise reduces the amount of beta-amyloid load in the frontal and hippocampus cortex of the brain – Promotes resistance to the neuropathy of Alzheimer’s Disease – Prevents loss of cognitive function – Future studies to link these results from mice to humans (Adlard et al., 2005)

15. Exercise Guidelines American College of Sports Medicine – Guidelines for exercise testing and prescription for those with Alzheimer’s Disease – Studies show exercise is helpful to reduce or slow the progression of the disease U.S. Surgeon General recommends 30 minutes of physical activity a day – Therefore, physical activity should be made to be more accessible to older adults, i.e. walking paths, senior fitness centers, & education

16. Why is this important? Identifies exercise as an intervention that may help improve, maintain, or slow the progression of Alzheimer’s Disease Allows discourse analysis to be utilized for assessing treatment outcome and disease progression Discourse is able to serve as a benchmark that may be used for comparison of language performance over time (Mahendra & Arkin, 2003; Arkin & Mahendra, 2001)

17. References Adlard, P.A., Perreau, V.M., Pop, V., & Cotman, C.W. (2005). Voluntary exercise decreases amyloid load in transgenic model of Alzheimer’s Disease. The Journal of Neuroscience, 25 (17), 4217-4221. Arkin, S., & Mahendra N. (2001). Discourse analysis of Alzheimer’s patients before and after intervention: Methodology and outcomes. Aphasiology, 15(6), 533-569. Heyn, P., Abreu, B.C., & Ottenbaucher, K.J. (2004). The effects of exercise training on elderly persons with cognitive impairment and dementia: A meta-analysis. Archives of Physical Medicine and Rehabilitation, 85, 1694-704. Maclagan, M., Davis, B., & Lunsford, R. (2006). Fixed phrases, extenders, and metonymy in the speech of people with Alzheimer’s Disease Mahendra, N., & Arkin, S. (2003). Effects of four years of exercise, language, and social interventions on Alzheimer discourse. Journal of Communication Disorders, 36, 395-422. Marshall, V.W., & Altpeter, M. (2005). Cultivating social work leadership in health promotion and aging: Strategies for active aging interventions. Health and Social Work, 30 (2), 135-144. Larson, E.B., Wang, L., Bowen, J.D., McCormick, W.C., Teri, L., Crane, P., & Kukull, W. (2006). Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Annals of Internal Medicine, 144, 73-81.