Sharon M. Arkin

Student-led exercise sessions yield significant fitness gains for Alzheimer's patients.

At a time when they are losing skills in virtually all arenas of life, persons with Alzheimers disease can experience significant, esteem-building achievements in physical fitness and mood through supervised participation in an exercise program. The effects of physical exercise plus cognitive and social stimulation on persons with early stage Alzheimers disease were assessed in a longitudinal study. Twenty-four such individuals, aged 54 to 88 at program entry, participated in 16 to 20 exercise sessions and 10 community activity sessions per semester for two to eight semesters. Half of the weekly exercise sessions included memory and language stimulation activities. Students, supplemented by family caregivers, supervised the sessions. Exercise sessions consisted of flexibility, balance, aerobic, and weight resistance activities. Preparticipation and semiannual post-testing of aerobic fitness and duration and upper and lower body strength was done. Highly significant fitness gains (p < .001) were achieved in the six-minute walk test, upper and lower body strength, and duration of aerobic exercise. Five participants, aged 86 to 91, completed six to eight semesters and were doing 27 to 45 minutes of aerobics per session at programs end. Five participants scored within the normal range for age-matched healthy active adults on the sixminute walk test at baseline. Nine others achieved and three exceeded the normal range during treatment. Cognitive decline was slowed and mood improved. Firstyear cognitive outcomes have been published elsewhere. 1-4 An article reporting final cognitive outcomes is in preparation; Outcome data is summarized on the project website: www.u.arizona.edu/~sarkin/elderrehab.html. The benefits of physical exercise can be made available at nominal cost to Alzheimers patients and other elderly persons by using students to provide transportation, supervision, and the motivational support that is key to exercise adherence. Further research is needed to determine the relative contributions of each program component to the positive outcomes.

Language-Enriched Exercise Plus Socialization Slows Cognitive Decline in Alzheimer’s Disease

This article reports the effects of language-enriched physical fitness interventions provided by University of Arizona undergraduate students to 24 mild-to moderate-stage Alzheimer’s disease patients (AD Rehab group). Socialization experiences consisted of supervised volunteer work and cultural/recreational activities. Changes in global functioning and neuropsychological test performance were tracked and compared to those of a similar group of untreated patients from the Consortium for the Establishment of a Registry for Alzheimer’s Disease (CERAD). Cohorts completing 4 semesters or longer showed no significant between-year changes after their first year on the Clinical Dementia Rating, a measure of global functioning, and on 5 or 6 of the cognitive and language measures. Comparisons with the CERAD sample suggested a slower rate of decline for the AD Rehab group. The stabilization of global and cognitive performance was not apparent among participants who completed only 2 semesters. Significant physical fitness and mood outcomes were previously reported in this journal.

Insight in Alzheimer's patients: Results of a longitudinal study using three assessment methods

Three direct measures of dementia insight were administered to 20 participants in a longitudinal Alzheimers disease (AD) rehabilitation research project 1 and to subsets of these participants that completed one (N = 19), two (N = 12), and three (N = 6) years of program participation. The measures were: (1) responses to a discourse prompt question about AD (ADPQ); (2) endorsements of seven items on the Geriatric Depression Scale 2 (GDS) about the effects of dementia (separate analyses were done for two of the seven items that related specifically to memory and thinking); and (3) a sentence-completion exercise. Responses to measures 1 and 2 and the subset of 2 were quantified, tracked over time, and subjected to correlational analyses with age, Mini-Mental State Exam 3 (MMSE) score, and depression, as measured by total GDS score, and with each other. Major findings: There were no decreases in insight from baseline to year 1, 2, or 3, as measured by free responses to the AD prompt question. There was a significant decline in insight from baseline to year one on the GDS measure, but no change from year 1 to year 2 and a return to baseline level at year 3. There was no correlation between insight and baseline age, between insight and MMSE score at any time point, between MMSE score and depression, as measured by total GDS score, or between MMSE score and depression score, except for the year 3 completers, where depression score was negatively correlated with MMSE score at year 3 only. GDS insight and ADPQ scores were not correlated. Several participants that showed no insight on the quantified measures did so on the sentence completions.

Effects of Four Years of Exercise, Language, and Social Interventions on Alzheimer Discourse.

UNLABELLED This article describes a comprehensive cognitive-linguistic intervention program for mild to moderate Alzheimers disease (AD) patients that provided communication skills practice in the context of health-enhancing and esteem-building community-based activities: physical fitness training and supervised volunteer work. The interventions were administered by undergraduate students who completed academic work, received faculty supervision, and earned three credits for one semester of participation. Effects of the interventions on the discourse of four participants who completed all 4 years of the program are reported in detail. The maintained or improved performance on multiple discourse outcome measures provides powerful rationale for making such interventions more widely available and preliminary support for their effectiveness in preserving communicative function. An additional role for speech-language pathologists (SLPs)--as trainers and supervisors of non-professional rehab partners for persons with dementia--is proposed. LEARNING OUTCOMES From this article, participants will be able to (1) list specific language tasks that can be used to assess discourse in individuals with AD; (2) identify several cognitive-linguistic interventions appropriate for use with AD patients; and (3) understand how long-term cognitive-linguistic interventions may affect the language performance of individuals with AD.

Volunteers in partnership: An Alzheimer's rehabilitation program delivered by students

This article describes a “partnered volunteering,” student-delivered language, and memory stimulation program for Alzheimer patients that is easy to replicate and administer low in cost, and beneficial to the patients, students, family members, and participating community agencies involved. The program took place during two consecutive semesters at the University of Arizona. Positive pre- to post-test patient language changes and improvements on memory test performance are reported. Twelve early stage Alzheimer patients-six each semester-were matched with 12 undergraduate speech and hearing and psychology students. The pairs were each assigned to 10 one-hour weekly sessions of volunteer service or other community activity meaningful to the patient. During each session, students engaged partners in 30 to 40 minutes of structured conversation-stimulating activities. During the second semester, four patients also worked with biographical memory tapes and quizzes produced and administered by their student partners.1-2 Parallel discourse samples were taken of subjects before and after participation. Small to massive gains in number of substantive on-topic statements produced were achieved by seven out of 11 subjects who completed the program: 9 percent, 14 percent, 48 percent, 58 percent, 93 percent, 161 percent, and 238 percent over baseline, respectively. Eight subjects improved on picture description and eight on proverb interpretation tasks. Three of the four patients who worked with biographical memory tapes substantially improved performance from pre- to post-training. All participants-patients, students, and caregivers-benefited effectively and socially.

Alzheimer rehabilitation by students: Interventions and outcomes

This article advocates proactive Alzheimer treatment, describes rehab interventions implemented by students, and reports positive first year outcomes for 11 mild to moderate Alzheimers disease (AD) patients who experienced these interventions in a longitudinal Alzheimer rehabilitation research programme. Students supervised physical fitness training and volunteer work sessions for all participants and administered specific memory and language stimulation exercises to 7 of them (experimental group). Outcomes were measured by standardised and project-related tests before and after two semesters (about 28 weeks) of participation. It was hypothesised that (1) the experimental group would outperform the control group at post-testing on standardised and project-specific cognitive and language measures; that both the experimental and control group would (2) maintain or improve the quality of their spontaneous discourse, (3) improve on measures of mood, and (4) improve on measures of physical fitness. Hypothesis 1 was only partially supported. The experimental group improved significantly from pre- to post-test on two measures, substantially on one measure, and showed no change on eleven measures. The control group declined significantly on three measures and showed no change on eleven measures. However, between group differences were only significant on one measure. Hypotheses 2, 3, and 4 were supported. The major conclusion was that: multi-modal interventions by students can temporarily maintain or improve cognitive, language, social, and physical functioning of Alzheimers patients.

Implicit and explicit learning gains in Alzheimer's patients: Effects of naming and information retrieval training

The purpose of this study was to examine the effects of repeated exposure to words from a target category on implicit and explicit learning of seven mild to moderate Alzheimers patients. Following 18-20 baseline fluency tests on the target category, subjects participated in eight sessions of a picture naming exercise and related quiz (study task) which exposed them to 33 words from the target category (exposure words). One hour after each study task session, the fluency test used at baseline was administered again (experimental fluency test). All subjects increased correct responses on the study task, demonstrating significant explicit learning. Six subjects produced exposure words on the experimental fluency tests that they had never named during the multiple baseline tests and all subjects unexpectedly named novel words (not exposure words and not produced at baseline) on the experimental fluency tests. Taken together, these results provide evidence of implicit and explicit learning and semantic activation. Implications for management and direction for future research are discussed.

Memory training in early Alzheimer's disease: An optimistic look at the field

The purpose of this article is to encourage caregivers and treatment providers of early Alzheimer patients to try various memory stimulation strategies since, as this article will show, some patients do benefit cognitively, while most-caregivers and patients-benefit emotionally and psychologically from the cooperative effort. This article will review three published studies with encouraging results or elements, five with negative results, and three studies involving work with other populations that would seem to have applicability to early stage Alzheimer patients. This author will also describe two unpublished memory training interventions for early Alzheimer patients that have had promising results, but are not yet published. Related research and encouraging trends will be summarized, and treatment and rehabilitation strategies suggested by these and other published literature will be presented.

Individuals with Alzheimer's disease achieve implicit and explicit learning: Previous success replicated with different stimuli

Background: This study is a replication and extension of a verbal learning experiment reported in this journal (Arkin, Rose, & Hopper, 2000) with individuals who had Alzheimers disease (AD). Those participants demonstrated implicit and explicit learning of exemplars from an inanimate semantic category (items people wear). Aims: The purpose of this study was to examine the effects of repeated exposure to animal exemplars on implicit and explicit learning of 13 individuals with mild to moderate dementia due to AD (of which 7 also participated in the earlier study). Methods and Procedures: Following 18–20 60‐second baseline fluency tests of the target category “animals”, participants engaged in eight sessions of a picture naming and related quiz exercise (study task) that contained 34 words from the target category (exposure words). One hour after each study task session, the fluency test used at baseline was re‐administered (experimental fluency test (EFT)). Outcomes and Results: On the study task, the group achieved a significant improvement in the number of correct answers from the first to their best and to their eighth trial (evidence of explicit learning). On the EFTs, 10 of the 13 AD participants produced one or more exposure words never named during the baseline fluency tests (evidence of implicit learning), and 12 out of 13 participants produced novel words that were not exposure words and not produced at baseline (evidence of spreading activation). Additionally, the explicit learning performance of the seven individuals who participated in our earlier study and in this study were compared for the “items people wear” (nonliving) and “animals” (living) categories. This comparison revealed a significantly greater improvement in naming performance from the first to the best study task trials for the “items people wear” (nonliving) category than for the animals (living) category. Conclusions: Results suggest that repeated exposure to and practice in retrieving category exemplars facilitate short‐term (over a 1‐hour time interval) implicit and explicit learning and semantic activation in AD participants with very mild to moderately severe dementia. Future directions include exploring the length of time over which this explicit and implicit learning is maintained post‐intervention. The differential learning curve for living versus nonliving exemplars observed here is suggestive and requires further investigation under more rigorous conditions.