Alzheimer's disease is the most common type of dementia and the most high-risk factor for its appearance is (old) age. It is a degenerative illness that affects cells of the cerebral cortex and its surrounding structures. It is progressive, incurable, accompanied with somatic complications and results in death. A yearly report from the Alzheimer's Association shows that one out of three elderly persons will die from this disease or some other form of dementia. Typical clinical symptoms include memory disorders and behavioral changes. Alzheimer's disease attacks cells in the cerebral cortex, it is characterized by a quick progression and cannot be reversed to its original state. In other words, it permanently damages one's neurons. The formation of the so-called "senile plaque" and "neurofilament aggregations" is caused by neural damage in the hippocampus.
Because of such a histopathological assessment, dementia of the Alzheimer's type is also called "hippocampal dementia". It is manifested with a memory disorder and spatial disorientation. After this, other physical disorders which include motor, speech, hearing and other disorders follow. It is a long and difficult illness and, currently being incurable, is very exhausting for the patient and his/her family. Other symptoms include forgetfulness, loss in time and space, inability to live on your own which leads to total dependency on others and their constant care. Since dementia is a slowly progressing illness, symptoms can become visible only after approx. 10 years or ever 20 years before they start to develop more seriously and rapidly.
Alzheimer's disease denotes the biggest challenge for the patient's family who may not be sufficiently versed in the illness and its progression. The disease requires a lot of sacrifice, dedication and love for the person affected by dementia. It requires a lot of work, motivation, knowledge and patience in order to gain a good and successful communication with the person suffering from Alzheimer's disease. An early diagnosis will have a great impact because the family often doesn't recognize the symptoms or assigns such behavior to "senile dementia". According to the number of people suffering from Alzheimer's disease, they take up to 60% of all patients suffering from some type of dementia. It is very important to point out that ageing increases the risk of dementia's appearance, but it doesn't necessarily mean that one will suffer from it. It would be very harmful to wrongfully interpret symptoms of dementia as a normal process of ageing. This refers us to the growing need to educate various experts who work with elderly persons as well as society in general. Also, an early, active and correct diagnosis of the illness is paramount.
The key role in the early discovery of cognitive disabilities, Alzheimer's disease and other dementia have general practitioners because the first symptoms are usually noticed by the patient's family, his/her guardians or the patient himself. The patient and his/her family are gradually being isolated because the patient's behavior will become socially unacceptable. A reassignment of roles will probably happen within the family as well as an emotional and material exhaustion. There are retirement homes and social and health institutions which will unwillingly house these kinds of patients because their symptoms have become more complicated or they have showed a behavioral disorder. Many foster families, certain retirement homes and social welfare institutions are not professionals for this kind of care, whereas family care and keeping the patient within the family can, with time, become insufficient. Family members are most often left on their own. By placing their loved ones into retirement homes, care over the patient is taken over by their nurses.
Human population around the world is becoming more and more older, hence a larger number of people suffering from Alzheimer's disease is appearing. A new study shows that around 15 million Americans will have this type of disease by 2050 which is double the amount of patients (7 million) that have it now. "Today there are around 47 million people living in the US who have some sort of evidence about pre-clinical symptoms of Alzheimer's disease. This means that they have an accumulation of protein fragments called beta-amiloids or a neurological brain degeneration, but still do not manifest any symptoms related to the illness." said Dr. Ron Brookmeyer, a professor of Biostatistics from UCLA Fielding School of Public Health and a leading author of the study. The situation is a bit better in Europe and Australia, while the number of patients is most favorable in Asia.
It is important to point out how nutrition has a very important role in the prevention of diseases related to dementia. Also, adequate physical activity helps secure brain health which, in turn, affects the health of the entire human organism. Studies that have been run across the world prove that well-balanced and professionally-chosen martial arts exercises positively affect Alzheimer's disease. Namely, at the end of the 20th century in China, many different studies have been published about the positive effects of practicing Tai Chi on persons suffering from Alzheimer's disease. Similar studies, after which professional articles have been published, have been written at the beginning of the 21st century in Japan, Europe, America and Australia. Although many scientific papers have been written about the effects of martial arts on the human organism, literature is pretty scarce when it comes to Alzheimer's disease.
Studies that were presented at the The Alzheimer's Association International Conference in Washington showed how scientists have proven that exercise has a significant effect on Alzheimer's disease in comparison to medication because it lowers the amount of protein responsible for the formulation of the disease. Also, published studies point to the fact that daily training of Tai Chi can positively affect the prevention and preservation of the health of people who are suffering from Alzheimer's disease, especially on their memory. Scientists from the University of Texas have reported that certain physical exercise (this also includes a controlled exercise of certain martial arts several times a week) can slow down the hippocampus' degeneration (the part of the brain in charge of memory) in those patients who already have clusters of the toxic beta amiloid protein in their brain. Thanks to its known cardiovascular benefits, a medically-approved martial arts exercize programme is worth to be part of any kind of health plan.
Additionally, it has been specially proven that exercising Tai Chi positively affects maintaining balance while walking among those people whose balance has been degraded thanks to Alzheimer's disease. Although the major part of the study deals exclusively with exercising Tai Chi, a correctly dosed and professionally guided practice of this and some other martial arts can positively affect patients. This, of course, greatly depends on the person, as well as his/her stage and progress of the illness. It is very important to take into consideration realistic criteria for creating a training program with not too difficult exercises that the patient is able to successfully perform. Activities should be comfortable, stimulating, but shouldn't include big decision-making or too many challenges. For example, in the first and somewhat second stage of the illness, certain dosed pushing and pulling exercises that include a person in order to maintain balance are extremely useful. Thanks to these exercises, the patient is gently thrown out of balance and can try to establish it on his/her own. This mainly corresponds to certain exercises in wrestling, judo, aikido, ju-jitsu, but also some movements in boxing which are very beneficial and recommended. The body's ability to maintain balance and strength and, therefore, prevent frequent falls is crucial when it comes to dementia.
When creating an exercise program or while choosing exercises for a patient suffering from Alzheimer's disease, we should take into consideration some recommended training that includes an exercise band which is often used to perform strength training in wrestling, judo, ju-jitsu, boxing and other martial arts. This type of strength training is very beneficial for patient and is even recommended by doctors. An exercise band which is available and affordable in sports shops is an excellent tool and is easy to adapt to the physical abilities of each person. With the help of the band, it is simple to perform certain strength exercises and strengthen postural muscles.
In the first and, partially, in the second phase of the disease it might be very beneficial to practice some basic steps in Brazilian capoeira in order to maintain balance during walking. By practicing this basic step, a person alternates between a left and right broader and more stable stance which is how he/she can maintain his/her balance more easily. It is also beneficial to practice the basic step with an emphasis on a dance step and with music because this makes it more fun and enjoyable. Namely, learning and memorizing new steps activates neural paths in the brain while keeping it strong, active and healthy.
For the same reason, certain martial arts where the exercises are performed with sticks are also recommended because the patient can coordinate his/her moves more easily, which is of great benefit. Here, the recommended skills are kali, escrima, arnis etc. This type of practice adds to a better blood flow throughout the brain and it also stimulates growth and survival of brain cells. Certain martial arts where a person spins around a stick or performs some easier movements with a stick are also recommended. If needed, the person can also lean onto the stick for a better balance. Apart from karate, tae kwon do, aikido and ko budo, some kung fu styles also use a stick. The French skill called la canne as well as certain English, Basque or Indian martial arts that use a stick should also be mentioned.
In order to keep a balanced posture as well as practicing to memorize certain moves in a sequence, apart from the already-mentioned Tai Chi skill, it is also recommended to practice some easier katas (forms) in karate, tae kwon do or kung fu. By slowly performing some easier katas or at least some of its parts, the patient will gain a better control over his/her apraxia as well as with disorientation. As dementia progresses, the physical ability to walk and do some regular daily chores such as dressing oneself and getting ready in the morning, decreases. This is why it is important to choose those martial arts exercises that will strengthen the patient's postural muscles, i.e. those muscles that contract in order to keep one's balance and overall posture. However, if strengthening them, one also needs to make sure he/she is stretching them properly so here is where practicing Tai Chi, karate, aikido, tae kwon do, kung fu and some other martial arts falls into place. When choosing an exercize, martial arts masters should focus on the patient's weaker spots, such as developing upper leg strength or hip mobility. By gently performing leg kicks, the patient is developing balance on one leg which is a very useful exercize when it comes to this type of illness. This type of exercise is very present in the above-mentioned martial arts skills such as Tai Chi, karate (performing katas), tae kwon do, capoeira, or kung fu.
Additionally, if performing katas with an emphasis on a breathing technique, this can help a patient who has difficulty breathing, but also to facilitate pronouncing certain words that result in speaking difficulties. It is recommended to perform katas along with music because it can improve the patient's engagement, his/her social and emotional skills and abilities, decrease problematic behavior and act as a stimulant to regain some linguistic skills when dealing with dementia. Also, this kind of exercise helps persons suffering from dementia thanks to a greater flow of oxygen into the brain. It is recommended that the patient counts the various kicks and punches in boxing, karate or tae kwon do. It isn't important if the kicks are given to a boxing bag or if performed idly, with an arm or a leg. Many studies show that practicing certain martial arts adds to a rise in cognitive skills among those people who are suffering from a mild or medium type of Alzheimer's disease.
Professionally picked martial arts exercises can help establish the brain activities of the affected person, not just by stabilizing the bloodflow, but also in encouraging the creation of neurotransmitters that protect the brain and slow down the process of ageing. Along with these martial arts exercises, the patients should be frequently taken out for walks. It is good to consolidate a combination of light walking and chosen martial arts exercises that can be done in nature (in a yard or in the nearest park). A positive effect of such exercise was also proven by a study conducted by Dr. Nicola Lautenschlager from the University of Melbourne (A study about the effects of exercise and walking among patients suffering from Alzheimer's disease). He has proven that this type of training lowers the blood pressure as well as the risk of cardiovascular diseases in patients suffering from the disease.
Performing medically-recommended and adequately adapted martial arts exercises can, among other activities that require mobility, help in maintaining a higher level of functioning for a longer period of time. This is why it is recommended for patients to practice performing boxing punches with lighter weights in their hands. Sometimes the gloves themselves can bear enough weight for the patient. Depending on the person, some find themselves in the first and some in the second phase of the disease. Light bag punching that lasts for several minutes can be used as a good aerobic training for the patient. He or she can perform certain exercizes, e.g. boxing punches or hand blocks used in karate (tae kwon do) while sitting on a chair if the person is too weak to stand on his/her own. In the third and most difficult phase of the disease, the patient can lightly perform the punches or various hand blocks by even laying in bed. Some other light martial arts exercises can also be done this way, e.g. light leg kicks.
In the second phase of the disease, patients can become more irritable and can sometimes be uncontrollably or inexplicably aggressive. This is usually so among male patients. Aggressive behavior can be best avoided by actively listening, with an efficient verbal response as well as by removing the cause for the problem. Among such patients, in come situations, exercise and light boxing bag punching can help with lowering their irritability level and uncontrolled aggressiveness. Punching the bag will reduce their anger as well as the patients wish to harm other unknown persons, i.e. "strangers". It will also reduce the possibility of self-harm that is caused by an aggressive outburst.
Also, well-picked and dosed martial arts exercises help the patients with their sleeping and resting night cycles. A lack of exercise can prevent the ability to sleep well, especially if a person often sleeps during the day and is unsettled and awake during nighttime. This is why it is recommended for the patients to train a certain martial art, at least three times a week for 40 minutes. It is also good to listen to some relaxing music or melody that the patient likes while training because it helps them if they are upset or confused. The music, along with the well-chosen and professionally led martial arts exercises, will improve the patient's mood and will benefit his or her life when suffering from the disease.
Practicing martial arts is widely considered to be beneficial in the context of physical wellness and cognitive health because it boosts one's mood, reduces anxiety and enhances one's resistance to stress. Scientists haven't found all the reasons and connections, but they agree that socialization and the practice of appropriate martial arts exercises that stimulate the patient's mental activities also foster the connection between the neurons in the brain. By practicing closely-picked martial arts exercises (e.g. Tai Chi, aikido, karate, kung fu, tae kwon do, capoeira), this activity will reduce general symptoms of depression and improve the cognitive functions of elderly patients. For this reason, it is recommended to practice during morning hours because this is when patients are least upset and their cognitive functions are at their highest level.
The caregiver (in this case, the martial arts professional) needs to be aware of certain important details such as: the patient should be able to practice in a yard or the nearest park and, at the same time, put away any unnecessary things. The patient should be able to take on other outdoor activities along with martial arts. When walking, he/she should be given a cane or a walker. Whenever possible, one should avoid steps or other possible obstacles. The living environment should be adjusted to the patient's needs and one should take away all objects that might be in the way (chairs, lamps), take off all unnecessary pictures and mirrors from the walls (the patients aren't able to recognize themselves). The comfort of the space should be a priority as well as giving the patient enough light because they are often afraid of the dark. The bathroom should also be adapted and one should help the patient when using the toilet. It is important to make sure that the patient doesn't lock himself/herself, that he/she doesn't leave the water or the stove on. Food and drinks should be prepared and given in the patients' hands because they won't take them on their own from the table. Several smaller and diverse meals should be adjusted to their needs. When they forget or lose something, don't be angry with them and don't yell. One should definitely help them get dressed or changed. If they are walking with you around the apartment (around the dojo or fitness), it means that they are afraid or scared of some noise or sound. The caregiver should be thoughtful, kind and patient. It is especially important that the front door or the apartment door is locked and the key is stored (it is also good to put a poster on the door so that the patient doesn't think this is the exit).
It is paramount that the caregivers who are taking care of patients suffering from dementia are calm, composed, well-educated and rational persons as well as people of a stable and strong character. Caregivers (usually family members) can be under a significant amount of stress caused by concern for the patient, their frustration, exhaustion, anger or bitterness because this type of care takes a lot of toll on their personal life. In order for the caregiver to remain calm and composed even in the most difficult moments, martial arts training can actually be of great help. By practicing tai chi, karate, tae kwon do, boxing, wrestling, kung fu, aikido, judo, ju jitsu or even MMA, the caregiver will free himself/herself from a lot of accumulated frustration and will regain his/her stability. By practicing martial arts, he/she will reestablish their inner strength and return to their necessary calmness and stability which is crucial when working with patients.
Stability and focus of the caregiver are especially important when the patient doesn't want to eat or drink anymore, when they are starting to lose weight and degenerate or become paralysed and their bodies are starting to die out. The medication that is currently available for Alzheimer's disease as well as adequate nutrition and exercize can slow down its progression, but there is still no chance to cure it. This is why it is very important for the caregiver to think rationally and accept the process of dying and to understand that, while it is extremely difficult, that it is inevitable. Taking on martial arts, knowing how to properly make use of meditation as well as certain religious beliefs can be of great help. The patient's stay in his/her home is the best option recommended by doctors. However, this type of care won't be sufficient until the very end because of the disease's progress. When taking the patient to an adequate medical facility, one should consider the time which is necessary for the person in order to adapt to his/her new surrounding so this transition isn't too stressful and in order not to aggravate his/her condition and behavior.
The caregivers (members of the family, physiotherapists, martial arts professionals, medical staff) as well as the patient's surroundings need to adapt to the disease and their consequences and, therefore, must maintain the patient's dignity.
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