1.

EXERCISE AND MOTOR REHABILITATION FOR ALZHEIMER’S

DISEASE OR OTHER FORMS OF DEMENTIA

I. Read the text paying attention to the italicised words:

A
lzheimer's disease (AD) and dementia are chronic diseases with
progressive deterioration of cognition, function, and behavior
leading to severe disability and death. The prevalence of AD and
dementia is constantly increasing because of the progressive aging of the population.
No disease-modifying treatment has been demonstrated to be effective in AD. Some
symptomatic drugs may improve cognitive and behavioral outcomes, but their
clinical impact remains modest and controversial.1.

1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300511/
2
https://bhamnow.com/2017/04/18/uab-alzheimers-research/
Background & Etiology3

T
o do their work, brain cells operate like tiny factories. They receive
supplies, generate energy, construct equipment and get rid of waste. Cells
also process and store information and communicate with other cells.
Keeping everything running requires coordination as well as large amounts of fuel
and oxygen.
As damage spreads, cells lose their ability to do their jobs and, eventually die,
causing irreversible changes in the brain.
Two abnormal structures called plaques and tangles are prime suspects in damaging
and killing nerve cells.
Plaques are deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-
loyd) that build up in the spaces between nerve cells.
Tangles are twisted fibers of another protein called tau (rhymes with “wow”) that

build up inside cells.

The formation of amyloid plaques and neurofibrillary tangles are thought to
contribute to the degradation of the nerve cells in the brain and the subsequent
symptoms of Alzheimer's disease. 

3
Adapted from https://www.alz.org/alzheimers-dementia/what-is-alzheimers
 Amyloid plaques and neurofibrillary tangles in Alzheimer’s disease4

Scientists do not know exactly what role plaques and tangles play in
Alzheimer's disease. Most experts believe they somehow play a critical role in
blocking communication among nerve cells and disrupting processes that cells need
to survive.
Though autopsy studies show that most people develop some plaques and
tangles as they age, those with Alzheimer’s tend to develop far more and in a
predictable pattern, beginning in the areas important for memory before spreading to
other regions (see picture below).

Signs and symptoms6

T
here are some classic symptoms and subtler early signs that might
indicate a person may have Alzheimer’s or another form of dementia such
as Lewy body or vascular dementia (related to stroke). The following

4
https://www.google.ro/search?
q=PLAQUES+AND+TANGLES+IN+ALZHEIMER&source=lnms&tbm=isch&sa=X&ved=2ahUK
EwizuLhpKToAhUs2aYKHSicBZoQ_AUoAXoECA4QAw&biw=1381&bih=674#imgrc=GrTsX8z
UybPyjM&imgdii=XwPfvwCVFiSXDM
5
https://www.medicine-99.com/invision/index.php?/topic/146-the-role-of-plaques-and-tangles/
6
Adapted from https://health.usnews.com/conditions/brain-disease/alzheimers
general signs or symptoms are associated with Alzheimer’s disease and would
require an appointment with the doctor:
 Disruptive forgetfulness or memory loss.
 Challenges related to changes in one’s ability to plan or problem-solve.
 Difficulty performing familiar tasks.
 Confusion with time or place – e.g. losing track of dates or forgetting how
you got somewhere.
 Difficulty understanding visual images and spatial relations, like reading or
judging distance.
 Problems with language – speaking or writing – such as difficulty engaging
in conversation.
 Misplacing items, can’t retrace steps.
 A decline in judgment or poor judgment, such as in money matters.
 Withdrawal – pulling back from work or hobbies or avoiding being social.
 Changes in mood – becoming depressed – or personality, becoming
confused or anxious.
 Hallucinations may appear in the later stages of Alzheimer's, in which the
patient sort of sees "shadowy figures in the corner," which are frightening to
the patient.

T he general symptoms can be loosely grouped into four categories sometimes

called "the 4 A's of Alzheimer's Disease"7.
Amnesia
Amnesia typically begins with the short-term to memory loss and progresses to a
decline in long-term.
There are different types of amnesia, including the following:

7
Adapted from The 4 A's of Alzheimer's Disease by Esther Heerema, MSW, available at
https://www.verywellhealth.com/the-4-as-of-alzheimers-disease-98591
  Retrograde amnesia is memory loss that is limited to the period before a
head injury occurred or before a disease such as Alzheimer's developed.
Retrograde amnesia hinders the ability to retrieve the memories that were
already stored in the brain.
 Anterograde amnesia is memory loss that is present for events that occur or
information that is presented after a brain injury or a disease develops. The
ability to make new memories is impaired in anterograde amnesia.
Aphasia
Aphasia is a term used to describe impaired communication. Aphasia may be further
divided into:
 Expressive aphasia is someone’s incapacity to find the right words or utter
them incorrectly.
 Receptive aphasia is the impaired ability to understand, receive and interpret
language.
Aphasia is commonly thought of as the impairment of speech and language, but
it also can include the ability to read and write.
Alzheimer's disease affects both expressive and receptive aphasia. In the early stages
of Alzheimer's, there might be some mild difficulty with finding the right word. As
Alzheimer's progresses into the later stages, speech may become nonsensical and
impossible to understand and it may be difficult to determine how much of what you
say is being comprehended.
Apraxia
Apraxia is a deficit in voluntary motor skills. While Alzheimer's is known primarily
for affecting cognitive functioning, it also affects the body's physical ability to
function. As Alzheimer's progresses, the ability to perform certain activities of daily
living such as bathing and getting dressed might decline. Activities such as walking
and eating become more difficult in the late stages of Alzheimer's disease.
Due to these changes, people living with Alzheimer's also are at a high risk of
falling, and when they do fall, they are at a higher risk of fracturing their hip.
Remaining as active as possible, for as long as possible, may help delay some of the
physical changes in apraxia that develop in Alzheimer's.
Agnosia
Agnosia is the impairment of the ability to receive or correctly understand
information from the senses. It may be:
 auditory - the sense of hearing is intact but the ability to interpret what the
sound means is impaired;
 olfactory - the sense of smell is altered; although the ability to distinguish
between or recognize odorants may be normal the identification of smells
may be partial or specific;
 visual – the sense of vision is less accurate in recognizing or interpreting
visual shapes;
 gustatory – the sense of taste is impared; although the ability to distinguish
between or recognize tastants may be normal the identification of smells
may be partial or specific;
 tactile - inability to recognize familiar objects by touch.
People with Alzheimer's disease have difficulties in understanding the feeling of a
full bladder or they also might not be able to recognize loved ones as the disease
progresses.

Physical Therapy Inverventions8

8
Adapted from Physical Therapy Benefits for Alzeimer’s Disease by Laura Inverarity, DO, available
at www.verywellhealth.com/alzhemers-disease-and-exercise-2696672
 M
any studies have shown that exercise is beneficial for people with
Alzheimer's disease. Along with cardiovascular fitness, increased
endurance, and improved strength, people with Alzheimer’s
disease get added benefits from exercising such as maintenance of motor skills,
decreased falls, and reduced rate of disease associated with mental decline.
Improved behavior, improved memory, and better communication skills are a few
other benefits associated with routine exercise programs in Alzheimer's disease.
Physical therapy plays an important role in exercises for patients with
Alzheimer's disease by tailoring routines to meet the individual needs of each
patient.
Often as we age, our balance skills deteriorate. For this reason, it is important to do
exercises to improve and maintain balance throughout our lives. Balance exercises
can be performed daily and in your own home.
Maintaining optimum strength can help keep muscles strong and keep functional
mobility at its optimum. PTs can help people decide which strengthening exercises
are right for them.
Stretching in the morning is a great way to "waken" up the muscles, and get them
ready for the day. Stretching loosens up the body while increasing blood flow.
Incorporating morning stretches into your daily routine is a positive way to begin
each day.
Endurance exercises include any activities that increase your heart rate and
respiratory rate. Choose from these fun activities to increase your endurance:
Dancing, Yoga, Gardening, House Work, Bowling, Biking, Tai Chi.

WORDS TO REMEMBER

Provide meanings to the following lexical units considering their morphological

category:
prevalence __________________________________________________________
plaque ____________________________________________________________
tangle ____________________________________________________________
twist ____________________________________________________________
subsequent __________________________________________________________
spread ____________________________________________________________
forgetfulness ________________________________________________________
misplace __________________________________________________________
retrieve ____________________________________________________________
nonsensical _________________________________________________________

II. Scan the text and answer the following questions:

1. What is the Alzheimer’s disease?
2. Explain what plaques and tangles are.
3. What did research reveal about the causes of this degenerative brain disease?
4. What are the symptoms that would require an appointment to the doctor ?
5. What are the 4 A's of Alzheimer's Disease? Talk about each of them.
6. What are the added benefits from routine exercise programs?
7. What main needs of the AD patients are there targeted by routine activities ?

TEAM WORK
1. Write the words that have connection with the 4 A's of Alzheimer's Disease
under the each of the headings in the table below:
write sense of hearing brain injury bathing
 visual shapes retrieve walking to store information
tastants nonsensical language odorants retrograde touch.
motor skills getting dressed eating speech read
memory utter words
:
Amnesia Aphasia Agnosia Apraxia

2. Consider the following words used in daily language. Provide the scientific
equivalent related to AD terminology:
low odour discriminationn

loss of memory

incorrect utterance of words

low vision activity

impaired understanding of language

incapacity to interpret sounds

altered taste

impaired motor skills

touch disorder

FOCUS ON
Substitute the underlined words for their synonyms/ antonyms (words or phrases):
1. Keeping everything running requires coordination of the brain activity.
.........................................................
2. The formation of amyloid plaques and neurofibrillary tangles contribute to
subsequent symptoms of Alzheimer's disease. .......................................................
3. Pulling back from work or hobbies or avoiding being social is a sign of
Alzheimer's disease. ................................................
4. Retrograde amnesia hinders the ability to retrieve the memories stored in the
brain. .........................................................................................
5. In the early stages of Alzheimer's, there might be some mild difficulty with
finding the right word. ..................................................
6. People with Alzheimer’s disease get added benefits from exercising such as
endurance and maintenance of motor skills.
...........................................................................................

GRAMMAR ACTION
ACTIVITY 1. Change the present simple into past simple using the adverbials of
time given:
1.He looks for a job as he needs money. (two months ago)
………………………………………………………………………………………
2. I have no work experience at all. (last summer)
………………………………………………………………………………………
3.You get on well with people and lead them well. (when you lived in Rome)
……………………………………………………………………………………
4.She is a young mother with experience in advertising. (in 1997)
………………………………………………………………………………………
5.The position of Finance Manager requires a lot of responsibilities. (immediately
after hiring)
………………………………………………………………………………………
6.Our company offers fast-moving environment for young people. (last season)
………………………………………………………………………………………
7.Excellent remuneration package stimulates competition. (three years ago)
……………………………………………………………………………………
8.Job recruitment agency gives useful information to unemployed people. (the day
before yesterday)
………………………………………………………………………………………

ACTIVITY 2: Choose the appropriate conjunction and fill in the gaps below:
1. Could I try a pair of shoes ………… a pair of sandals?
a. or b. or else c. either …………or
2. Please, go and pay the telephone bill ……… they’ll cut it off.
a. or b. or else c. either …………or
3. You can …………… run in the park ………… stay on the bench.
a. or b. or else c. either …………or
4. You should try again ………… give up.
a. or b. or else c. either …………or
5. I must ……………fix my watch ……… buy a new one.
a. or b. or else c. either …………or
6. Hurry up ………… you’ll miss the train.
a. or b. or else c. either …………or

KEY LANGUAGE
Fill in the blanks with the suitable words given below:

frailty(a) weightlifting(b) chair stand(c) enhance(d) timed(e) outcome(f)

interventions(g) significant(h) cohort(i) decreased(j)

A number of prospective (1) ............ studies suggested that a regular physical activity may (2)
............ cognitive function and reduce the risk of AD and other dementias and delay their
onset or progression. moderate intensity midlife physical activity was significantly associated
with a (3) .................. risk of incident dementia. as it may improve physical health, reduce
(4) ............, lower the risk of depression, improve cognitive function in the short and long
term
The exercise (5) ............. explored in dementia include a variety of training methods (e.g.,
aerobic exercise, resistance training or (6) ............, balance, and flexibility training), and the
physical/motor (7) .......... measures were quite different across studies (e.g., (8) ........... tests,
timed up and go, (9) .......... walking tests). Comparative studies to explore the most effective
exercise intervention, the amount of exercise, the most sensitive and (10) .......... outcome, and
the role of physical activity in different patients' groups are needed9.

Solutions: 1-i, 2-d, 3-j, 4-a, 5-g, 6-b, 7-f, 8-c, 9-e, 10-h

9
Chiara Zucchella et alli ,*The Multidisciplinary Approach to Alzheimer's Disease and Dementia. A Narrative
Review of Non-Pharmacological Treatment in Front Neurol. 2018;9:1058. Published online 2018 Dec
13. doi: 10.3389/fneur.2018.01058
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300511/