Alzheimer’s Disease

1. Alzheimer’s Disease Mirrenda Eaton University of North Carolina at Charlotte

2. Alzheimer's Disease Definition of Alzheimer’s Disease Alzheimer’s disease is a degenerative, progressive disorder that attacks the nerve cells, neurons, in the brain that results in the loss of memory, cognitive skills, and behavior changes (Alzheimer’s Foundation of America [ALZFDN], 2006). Origin of the term Alzheimer’s Disease In the year of 1907, a German neoropathologist by the name of Alois Alzheimer was the first to discover plaques and tangles in a woman patient who was diagnosed with dementia. Alzheimer plaques became the name for the protein, beta-amyliod, that maybe one of the determinants in causing this disease (ALZFDN, 2006).

3. Statistics and Rick Factors • “Alzheimer’s disease has no known single cause, but in the last 15 years scientist have learned a great deal of factors that may play a role” (Alzheimer’s Association [ALZ], 2006). • Alzheimer’s disease is found in approximately 4.5 million Americans (ALZ, 2006). • It is estimated that by 2050, approximately 11.3 million to 16 million Americans will have this disease (ALZ, 2006). • One out of ten Americans who are 65 and older will have this disease and half of Americans who are 85 and over will also (ALZ, 2006). • These individuals will live half as long as a normal aging person (ALZ, 2006). • The number one risk factor is aging (ALZ, 2006). • The second risk factor is family history and genetics. Families that have someone with Alzheimer's have a two to three times great chance of having the disease themselves. (ALZ, 2006). • A person with this disease will spend approximately $174,000 in their lifetime (ALZ, 2006).

4. What are the symptoms and causes of Alzheimer's Disease SYMPTOMS: • Memory loss: A person with Alzheimer's disease will not remember new learned information. They forget more often. Forgetting occasionally is normal,but not all the time (ALZ, 2006). • Difficulty with familiar task: The person has difficulty planning and completing daily tasks (ALZ, 2006). • Difficulty with language: The person forgets simple everyday names of objects like toothbrush. This makes it hard for the person to communicate verbally and written (ALZ, 2006). • Disoriented with time and place: The person becomes disoriented on how they arrived somewhere and are not able to find their way home (ALZ, 2006). • Show poor judgment: The person may dress inappropriately. For example the person may go outside wearing summer clothing when it is a cold winters day (ALZ, 2006).

5. Continuation of symptoms and causes • Difficulty with abstract thinking: The person has problems performing mental task like number problems. The person my forget what a number is used for (ALZ, 2006). • Misplace objects: A person may place objects in the wrong areas like putting a book in the refrigerator (ALZ, 2006). • Moody: The person will experience dramatic mood swings (ALZ, 2006). • Personality change: The person may become very passive and sleep all of the time (ALZ, 2006). CAUSES: Two proteins, beta-amyloid and tau, may be the cause of the disease. Beta-amyloid becomes a plaque what clumps around the brain’s neurons. Tau forms tangles which are twisted stands the accumulate inside the nerve cells. These proteins form insoluble aggregates that clump together and may help the production of acetylcholine which breaks connections between neurons. The disease first destroys the nerve cells in the hippocampus and the cerebral cortex which causes the loss of language and judgment skills (ALZFDN, 2006).

6. Impaired Verb Fluency • Ostberg, Fernaeus, Hellstrom, Bogdanovie, and Wahlund (2005) did a study on the fluency of verbs, noun, and letter-based words. • Their participants were 199 individuals between the ages of 56 to 82 who were diagnosed with subjective cognitive impairment, mild cognitive impairment, and Alzheimer’s disease (Ostberg et al., 2005). • Their hypothesis was “to determine whether verb fluency is distinct from noun and letter-based fluency in this sample, and whether verb fluency is preserved or impaired in mild cognitive impairment, a condition with a high likelihood of parahippocampal region involvement (Ostberg et al., 2005, p. 274). • Mild cognitive impairment is associated with the risk of Alzheimer’s disease which has the tangles that are first seen in the anterior parahippocampal region that is surround by the Brodmann areas of the temporal lobes. These regions of the brain takes care of recognition memory and executive functions which may influence verb fluency (Osterberg et al., 2005). • For the noun fluency task, participants were to think of as many animal names as they could. In the letter-based fluency task, they were to think of as many words that began with F, A, and S. In the verb fluency task, they were to think of as many tasks that people can do. “Proper nouns, numerals, or more than one inflected form of a given lexical item were not allowed” (Osterberg et al., 2005, p. 276). • Results showed that the less correct responses for the verb fluency task was related to dementia. There was a higher noun production and that verb production “differed from noun and letter-based” production (Osterberg et al., 2005, p. 276).

7. Discourse Comprehension Test • Welland, Lubinski, and Higginbotham (2002) did a study comparing comprehension and memory of main ideas to details. • Their participants were 24 individuals that were between the ages of 61 to 89 where 8 of them had early-stages of Alzheimer’s (EDAT), 8 had middle-stages of Alzheimer’s (MDAT), and 8 without brain damage, NBD (Welland et al., 2002). • Their 4 hypothesis were “(A) elders with NBD were expected to obtain significantly higher Discourse Comprehension Test (DCT) scores than EDAT, who in turn were expected to obtain significantly higher scores than the MDAT, (B) DCT subscores for main ideas and details and for stated and implied information were predicted to be significantly higher for NBD than for EDAT and MDAT, and were likewise predicted to be higher for EDAT than for MDAT, (C) NBD, EDAT, and MDAT groups were all expected to show significantly higher DCT scores for stated information than for impaired information and significantly higher DCT scores for main ideas than for details, (D) participants’ scores on working memory and episodic memory measures were expected to be significantly associated with overall scores on the DCT” (Welland, 2002, p. 1178). • Participants did Episodic Memory Tasks that measured story retelling (immediate and recall), and word learning (free and total recall as well as recognition), and Working Memory Tasks (WMT) that measured listening span which is correlated to listening comprehension. In WMT, they were to remember large sets of spoken utterances and then recall as many as they could “utterance-final words”. They also took DCT which included 10 stories with yes-no questions that pertained to the main ideas and details of the stories (Welland et al., 2002, p. 1180).

8. Continuation of DCT • The first hypothesis was partially true. NBD participants scored higher than EDAT and MDAT participants according to the post hoc analyses, but EDAT and MDAT participants did not differ in results (Welland et al., 2002). • The second hypothesis was partially true because “the means were not significantly different between the EDAT and MDAT for any of the four DCT subscores” but there was a significant difference in subscores between NBD and the 2 DAT groups (Welland et al., 2002, p. 1182). • The third hypothesis was proven true. The results showed NBD, EDAT, and MDAT groups made the some responses. The subscores showed better comprehension for main ideas and stated information then for details and implied information. • The four hypothesis was proven true. The results supported working memory being dependent on spoken language comprehension and episodic memory being dependent on narrative comprehension (Welland et al., 2002).

9. Picture Supported Narratives • Duong, Giroux, Tardif, and Ska (2004) did a study on the types of discourse patterns that come from two picture supported narratives. • Their participants were 46 Alzheimer’s patients and 53 individuals diagnosed with no brain impairments whose ages ranged from 65 to 84 and had 4 to 18 years of education. • Their goal was to “provide a detailed description of Alzheimer’s disease (AD) patient’s discourse, to determine the specificity of AD discourse patterns, and to characterize the various discourse patterns using basic cognitive variables” (Duong et al., 2004). • Participants took a neuropsychological assessment that contained “17 subsets on cognitive domains of language, memory, gnosis, and praxis”. They also took two discourse production tasks where in the first task they were shown a picture of a bank robbery and where told to make a story from the picture. The second task they were shown 7 pictures depicting a car wreck and were asked to make a story from what they saw (Duong et al., 2004, p. 177). • A multilayered cognitive model of discourse processing was used to measure discourse samples. It contained the lexical-semantic level (measured the number of words produced, number of complex clauses, and pronoun used) , the conceptual-semantic level (measured predicates and arguments, semantic complexity,and main ideas of a story) and the organizational-semantic level (measured number of elements in narrative schema, mean number of main ideas in an element, and connections between elements) which were represented by nine measures (Duong et al., 2004).

10. Continuation of PSN • Results showed a mix result. Some of the Alzheimer’s patients did poorly on the nine discourse measures while others did good. They concluded that it may be do to pathology or to age and education. Task one results (with the single picture) showed more quantitative and qualitative distinction which was their second goal. The participants did better with the 7 picture task then the 1 picture task. The 7 picture task produced 5 different discourse patterns and the 1 picture task produced 4 different discourse patterns from all of the participants.

11. Interventions on Alzheimer’s Discourse • Mahendra and Arkin (2003) did a study on comprehensive cognitive-linguistic program that involved communication skills in health-enhancing and esteem-building community activities. • Their participants were 24 individuals with mild to moderate Alzheimer’s disease and were aged 54 to 86. The study lasted 1 to 4 years (Mahendra & Arkin, 2003). • Their goal was to “present a detailed description of the multi-component Elder Rehab program and its activities, and attempt to fill the gap in the literature on the effects of direct, longitudinal interventions on the language and discourse of dementia patients” (Mahendra & Arkin, 2003, p. 398). • They used a basic model that had a biological level, daily activities level, societal level (promoted self-worth and identity), interpersonal level (promoted confidence and social role expression), creative level, and symbolic level which promoted self-actualization and self-fulfillment (Mahendra & Arkin, 2003). • Elder Rehab Program (ERP) is a branch off of the Volunteers in Partnership. The only difference is the ERP added a physical exercise activity. Graduate students were chosen to work with the participants and the sessions were done in semesters. The students gave 2 to 2.5 hours of exercise/language stimulation sessions to the participants. While the participants worked out on the treadmill or stationary bicycle, they were given memory and language stimulation activities.The physical fitness activities fulfilled the biological level on the basic model (Mahendre & Arkin, 2003).

12. Continuation of Interventions • The students worked with the participants for one 1.5 to 2.0 on community activity sessions per week for 10 weeks per semester. 10 weekly exercises sessions was observed by a family member (Mahendre & Arkin, 2003). • Participants and students were involved in community activity sessions. The sessions included 20minutes of walking and aerobics which was done 3 times a week (Mahendra & Arkin, 2003). • Participants and students also participated in cognitive-linguistic activities. Students were instructed to record complete responses and to label each one as “during an exercise” or “during rest time”. All task required the participants to focus on the task and to use deep processing for the verbal responses. These task included picture description, car bingo, object description, story recall quiz, and category fluency-naming quiz (Mahendra & Arkin, 2003). • Picture description required the participant to pay attention, use visual scanning, name identification, and narrative discourse for literal and interpretive concepts. The participant is shown a picture and is asked to describe what is happening and what they see in the picture. • The car bingo was done when the participants were being transported back and forth to different destinations. During the car ride, they were shown a big bingo card that had in each square a name of an item that could be seen from the car window. The participants were told to look for those items in the squares. This required orientation, attention, word and phrase comprehension, and procedural memory (Mahendra & Arkin, 2003).

13. Continuation of Interventions • Object description required the participant to identify three objects and then give a description of each. This required lexical and semantic memory (Mahendra & Arkin, 2003). • Story recall required the participants to recall the story the student read and then answer the student’s questions. This requires space retrieval (Mahendra & Arkin, 2003). • Category fluency-naming quiz required the participants to recall list of words (novel and not) and pictures. It contained 60 categories that was administered 18 to 20 times each semester. This required the use of implicit memory and spreading activation (Mahendra & Arkin, 2003). • The results showed that “long-term cognitive-linguistic interventions can maintain or improve aspects of language performance with dementia individuals”. The participants’ results were different in certain areas, but all the participants improved on proverb interpretation and picture description (Mahendra & Arkin, 2003, p 410).

14. References • Alzheimer’s Association. (2006). Retrieved May 3, 2006, from http://www.alz.org • Alzheimer’s Foundation of America. (2006). Retrieved May 3, 2006, from http://alzfdn.org • Duong, A., Giroux, F., Tardif, A., & Ska, B. (2005). The heterogeneity of picture- supported narratives in Alzheimer’s disease. Brain and Language, 93, 173-184. • 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. • Ostberg, P., Fernaeus, S., Hellstrom, A., Bogdanovic, N., & Wahlund, L. (2005). Impaired verb fluency: A sign of mild cognitive impairment. Brain and Language, 95, 273-279. • Welland, R., Lubinski, R., & Higginbotham, J. (2002). Discourse Comprehension Test Performance of Elders with Dementia of the Alzheimer Type. Journal of Speech, Language, and Hearing Research, 45, 1175-1187.