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Specialized Movement Verbal Ability Alzheimer Dementia
The Acute Effects of a
Specialized Movement
Program on the Verbal
Abilities of Patients With
Late-Stage Dementia
Ample research exists on the health benefits for
exercise among the elderly, including overall
good physical health, emotional health, and cog-
nitive health. Conversely, little research exists on the po-
tential benefits of exercise or physical activity on elders
experiencing cognitive impairment due to dementia de-
spite the known benefits to unimpaired elders.
1
As early to moderate dementia does not prevent partici-
pation in exercise programs,
2
one cannot attribute the
lack of research in this area to patients’inability to partici-
pate in the research.In fact,deterioration of motor skills is
not usually seen until the later stages of dementia
3
and may
not appear for years after memory decline is noticeable.
For example,an individual with late-stage dementia may be
able to make only nonsense word sounds (if he or she is
able to make any sounds) but may still be able to walk,
dance rhythmically to music, or catch a ball. Perhaps be-
cause of this slower deterioration of motor skills (versus
the more prominent loss of speech), few researchers have
focused on dementia and movement.
4
Furthermore, although existing research purports that
exercise or movement programs result in cognitive bene-
fits for patients with early to moderate dementia, there is
an absence of research concerning whether or not these
benefits extend to late-stage dementia.Existing studies fo-
cus on longer-term effects of physical activity in patients
with dementia and ignore the possibility of immediate
RESEARCH
Little research exists concerning the cognitive effects of exercise on elders with Alzheimer’s dementia (AD),
and none concerning late-stage AD. This study provides an initial investigation of the possible cognitive
effects of a specialized exercise program for patients with late-stage AD. In a pretest/posttest design,
patients participated in 20-minute movement groups. Results indicated a statistically significant decrease
in patients’ aphasia and/or agnosia following the program. This study is the first to indicate that
movement has the ability to immediately affect the memory recall of patients with late-stage AD. These
techniques may be used by caregivers seeking increased lucidity during interactions.
Key words: Alzheimer’s disease, dance therapy, dementia, exercise, memory
B
Y
S
HOSHANA
D
AYANIM
, P
H
D
Alzheimer’s Care Today 2009; 10(2):93–98
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Alzheimer’s Care Today | April–June 2009
94
cognitive benefits, which may be of great use to care tak-
ers seeking to communicate with patients.This study pro-
vides an initial investigation of the possible acute
cognitive effects of a specialized exercise program on in-
dividuals with late-stage dementia.
LITERATURE REVIEW
Exercise’s effects on the cognitive abilities of
Alzheimer’s dementia
Research investigating the impact of exercise on the cog-
nitive abilities of patients with Alzheimer’s dementia (AD)
falls into 2 groups.The first type of study uses a pre- and
posttest method of the same group participating in a phys-
ical activity.The second type of study is an experimental or
quasi-experimental design in which an experimental
group participates in an exercise program and is compared
with a control group, which receives either a nonmove-
ment-oriented program or no program.
Studies tracking the impact of exercise interventions
for patients with AD found increases in cognitive abili-
ties. For example, in an exercise-training program for pa-
tients with early AD (n15) meeting 3 times weekly for
3 months, Palleschi and colleagues
5
found a significant
increase in cognitive performance. Rolland and col-
leagues
6
also found that a group (n23) of patients
with moderate to severe AD significantly improved on
cognitive tests after participating in an endurance exer-
cise program of walking and bicycling. However, the ab-
sence of a control group in these studies weakens their
positive findings.
Other studies compared participation in exercise
groups with social groups. Friedman and Tappen
7
found
that a 30-minute walking group meeting 3 times a week
significantly improved the verbal and nonverbal communi-
cation skills of patients with moderate to severe dementia
over the course of 10 weeks,whereas a social group meet-
ing with the same frequency showed no improvement. In
another experimental study, Scherder and colleagues
8
compared 3 randomly assigned groups of adults (n43)
with pre-Alzheimer’s cognitive impairment.Both the treat-
ment groups—a walking group and a group including only
hand and face exercises—had significantly improved
scores on tasks measuring executive functioning and ver-
bal fluency, whereas the control group, which included
only social visits, did not improve.
By contrast, Sobel
9
compared social recreation stimula-
tion using bingo with daily physical activity among pa-
tients with early-stage Alzheimer’s attending adult day care
centers (n50). Physical activity included 20 minutes of
walking or arm and leg extensions. He examined short-
term memory, word retrieval, and word recognition and
found that the cognitive stimulation from bingo signifi-
cantly increased retrieval and word recognition, but the
physical activity did not.
Several studies have compared the use of a specialized
movement therapy program with a recreational or social
program. Powel
10
compared the effects of a 1-hour,
12-week movement therapy program versus a recreational
therapy program on institutionalized dementia patients
(n30).He found a significant improvement in the move-
ment group, when compared with the recreational group,
on memory and IQ scales but not on scales measuring
social or behavioral changes.
Diesfeldt and Diesfeldt-Groenendijk
11
evaluated the ef-
fects of participation in movement therapy on psychogeri-
atric nursing home residents with organic brain syndrome
(n40), a diagnosis used to describe AD and other de-
mentias when this study was conducted. The authors
stated that these patients were able to give consent, had
difficulty performing daily tasks,were disoriented,and had
memory disorders. Using a repeated test design with a 1-
month interval, they tested the experimental group and
control group before and after the movement therapy ses-
sions.The movement therapy participants showed signifi-
cant increases in a free recall test when compared with the
control group and qualitatively exhibited greater retrieval
activity than the control group.
Ample research exists on the health
benefits for exercise among the elderly,
including overall good physical health,
emotional health, and cognitive health.
Conversely, little research exists on the
potential benefits of exercise or physical
activity on elders experiencing cognitive
impairment due to dementia despite the
known benefits to unimpaired elders.
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Specialized Movement Verbal Ability Alzheimer Dementia
The current study was designed similarly to the Dies-
feldt and Diesfeldt-Groenendijk
11
study with a control
group and a repeated test design. Two important differ-
ences,however,were the current study’s inclusion of a test
prior to and following each movement therapy group and
the participation of a population that included patients
who were more demented than those Diesfeldt and
Diesfeld-Groenendijk describe.
Theories on exercise’s positive effects on cognition
Although a clear reason has not been established for why
exercise appears to affect cognition and behavior, theo-
ries have been suggested. Craik et al
12
relate increase in
age with a decline in mental and physical energy as well
as decreased capacity for attention.These may be a func-
tion of a decline in the processing abilities of the central
nervous system. One existing theory is that physical exer-
cise, which increases the amount of endorphin and sero-
tonin levels in the brain, may in turn increase the
functioning of the central nervous system and enhance
cognitive performance.
13
Another theory is postulated by Eggermont et al
14
in
their conclusion of their review on the biological links to
dementia.They theorize that exercise could restore cere-
bral hypoperfusion, the decrease of the perfusion of the
blood into the brain, resulting in renewed circulation
through the cortical capillaries, which, in turn, could revi-
talize brain functioning.
This study hypothesizes that a specified 20-minute
movement program would positively affect aphasia and/or
agnosia of a patient with late-stage dementia, as seen
through increased abilities to name common objects and
colors.
METHODS
Participants
Participants (N22, females 16, males 6) were re-
cruited on the basis of the recommendation of the medical
staff on the locked dementia unit in a hospital home where
patients resided for between 8 months and 4 years.Partici-
pants were between 61 and 93 years (average age of 79)
with a diagnosis of stage 6 or 7 senile dementia/
Alzheimer’s type. Participants included approximately
equal numbers of African American, white, Hispanic, and
Asian American adults. All participants were mobile and
able to walk with or without using assisted devices to pre-
vent falls. Some patients rarely spoke or made sounds,
whereas others spoke in a nonsensical order. Patients
were either incontinent or in need of assistance with toi-
leting. Patients were prone to wandering or sitting in one
place all day. Patients were not consistently able to say
their names and no longer recognized familiar faces.
Participants were taking a variety of medications to treat
dementia, depression, and other ailments typical among
elderly patients with AD.
Procedure
Patients with signed consent forms from caregivers, who
were mobile with a diagnosis of dementia and were resid-
ing on a locked unit, were selected to participate in this
study. Participants were administered a pretest while sit-
ting in the common room in the unit where they ate their
meals and participated in most recreation activities. This
test was administered between 1 and 3 times based on
availability of the patient. The test was readministered
20 minutes later to evaluate whether the passing of time
alone changed the patients’ answers. The initial adminis-
tration included asking the patient the color of an object
and the identity of an object.The second administration re-
peated the same questions but included different colors or
objects. For example,in the first round a patient may have
been asked to identify the color blue and then a banana,
and in the second administration the color brown and
then an apple.The inclusion of only 2 questions was nec-
essary to avoid any passage of time factors, as the patients’
ability to focus was extremely limited, especially prior to
group participation.
Participants also participated in seated movement ther-
apy groups.The number of groups varied between 1 and
10, depending on the patients’ availability on the day and
time of the group. Patient availability was not reliable as
The specialized movement therapy program
has the ability to provide immediate acute
effects on memory recall of patients with
late-stage AD. After 20 minutes of move-
ment therapy, participants appeared more
organized in their speech abilities.
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Alzheimer’s Care Today | April–June 2009
96
their proneness to wandering or to “bad days” was unpre-
dictable and it was against hospital policy for groups to be
mandatory.Prior to the start of the group and at the end of
the group a recreation therapist,certified nursing assistant,
or nurse who was not in the room for the group asked
each participant the same questions as mentioned previ-
ously. The group included activities designed to provide
the patient with body orientation and spatial awareness
with the intention of increased mental organization. An
outline of the 20- to 30-minute session is broken down in
Table 1.The group was designed on the basis of standard
movement therapy work with patients with dementia.The
session included the same format for every administration.
Analysis
Analysis was carried out using the Statistical Package for
the Social Sciences version 11.0. Correlational analyses
were conducted to rule out the possibility that the vari-
ance in the number of times each member received the
test or attended a group could affect his or her ability to
identify objects or colors. A repeated measures ttest was
calculated to measure the impact of the movement inter-
vention versus no intervention.
RESULTS
Table 2 compares raw scores from the pre- and posttests by
number of trials. Correlational analysis indicated that the
number of sessions did not significantly relate to the partici-
pants’ ability to identify objects or colors. Ttests indicated
that there was a statistically significant increase in partici-
pants’ ability to identify objects correctly when comparing
scores from the time lapse testing (M0.09, SD 0.19) to
scores from the movement intervention testing, M0.25,
Moving With Dementia Movement
Therapy Group
Preparation: Sit in a circle in groups of no more than
6 patients plus leader
a
Purpose: To explore kinosphere (personal space),
orient, and organize
Stretching—reaching up and out with arms
Work through body—warm up/move each part
of the body head to toe using self-touch as
much as possible. When possible, ask each
member of the group to select a movement for
a specified body part
Purpose: To ground and organize using weight and
space
Toss/hit 1 or 2 balloons
This uses weight and space to expand patients’
kinosphere
Play catch with a ball or balloon filled with beads
This uses weight and space for organizing; it
works on eye contact, decision making (each
patient chooses to throw to someone), and
control
Use large ball on floor for rolling and kicking
This uses weight and space for grounding and
organizing
Use co-oper band, a stretchy band onto which
each participant in the circle holds
This is for grounding by use of weight and
interaction
Purpose to refocus to self
Repeat balloon toss
Repeat self touch
a
These methods need not be in a group setting but may also be
used in one-on-one interactions.
TABLE 1.
Comparison of Trials With and Without Group Participation (Task: Ability to Name Colors
and Objects)
% named object correctly % named color correctly
Mean number of trials Pretest Posttest Pretest Posttest
No group 1.89 tests 56 46 44 34
Group 3.47 groups 33 60 28 65
TABLE 2.
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Specialized Movement Verbal Ability Alzheimer Dementia
SD 0.38, t(14) 3.47, P.005,
2
0.46.There was
also a statistically significant increase in participants’abilities
to identify colors correctly when comparing scores from the
time lapse testing (M0.08, SD 0.30) to scores from the
movement intervention testing, M0.35, SD 0.36,
t(14) 3.78, P.005,
2
0.51.The
2
statistic for both
items indicated a large effect size, suggesting a considerable
difference in the scores.
15
The control pretests were gener-
ally higher than those participating in movement groups.
This may be a result of the inclusion of several patients who
were slightly more verbal and refused to attend groups.
DISCUSSION
The results for this study indicate that the specialized move-
ment therapy program has the ability to provide immediate
acute effects on memory recall of patients with late-stage
AD. After 20 minutes of movement therapy,participants ap-
peared more organized in their speech abilities. This is con-
sistent with Diesfeldt and Diesfeldt-Groenendijk’s
11
research focused on midlevel functioning AD patients.
Perhaps the difference in results between the current
study and Diesfeldt’s
11
versus Sobel’s,
9
which did not regis-
ter an increase in word recognition and retrieval after par-
ticipation in physical activities,is in the severity of patients
with AD.The participants in the current study were in the
last stages of AD, whereas Sobel’s participants were in the
early stages of AD; this study’s participants could not have
completed the cognitive tests administered to Sobel’s par-
ticipants.The type of program may also be a factor in the
differences. Sobel’s exercise program included walking or
leg and arm exercises, whereas movement therapy utilizes
purposeful movement intended to help organize a patient
mentally through the use of movement rather than exercise
physically.
This is an important finding as it suggests that some forms
of physical activity—in this case movement therapy—can
help mentally organize patients with AD as severe as those
in the late stage of dementia in which they often have
limited to no speech.
This program is simple and may be utilized for patients
with AD by a caregiver or family member seeking a
method of increased communication with their loved one.
Although the duration of the cognitive effects was not ex-
amined, a moment of clarity between a patient with AD
and a family member would certainly be an improvement
and much welcomed change for the family member.
One limitation of this study, as with the exercise studies
referenced earlier, is the small number of participants due
to the limited number of residents on this particular de-
mentia unit. Future research should include a larger num-
ber of participants from various residents in hope to gain
additional subgroup comparisons. For example, the small
sample size prevented the examination of possible medic-
inal effects. Future research should also investigate the du-
ration of the increased object and color recall following
the movement session. Furthermore, future research
should include a more comprehensive cognitive assess-
ment before and after movement sessions.
Shoshana Dayanim, PhD,Assistant Professor, Department
of Psychology, Argosy University, Chicago, Illinois, and
Research Associate, Emory University, Atlanta, Georgia.
This research was funded by a grant from the Thomas and
Jeanne Elmezzi Foundation at Hebrew Hospital Home, Bronx,
New York. Parts of this research were presented at the Annual
International American Dance Therapy Conference in October
2000.
Address correspondence to: Shoshana Dayanim, PhD, Argosy
University, 1400 Penn Ave, Pittsburgh, PA 15222 (sdayanim@
argosy.edu).
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