Psychological and physical benefits of traditional dance programs in elderly with dementia: theoretical approaches and research results

Transcription

1 Psychological and physical benefits of traditional dance programs in elderly with dementia: theoretical approaches and research results Stella Douka, Vasiliki Zilidou, Olympia Lilou, Magdalini Tsolaki 9o Panhellenic Interdisciplinary Conference,

2 Dementia 2 (taken from Latin, originally meaning "madness", from de- "without" + ment, the root of mens "mind"). A serious loss of global cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging. It may be static, the result of a unique global brain injury, or progressive, resulting in long-term decline due to damage or disease in the body.

3 Greece Prevalence of dementia The number of people with dementia in Greece in 2012 as being 201,766. This represents 1.77% of the total population. The number of people with dementia is higher than the EU average of 1.55%. 3 By 2050, people aged <60 will account for 22% of the world s population.

4 Mild Cognitive Impairment (MCI) 4 Intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. It can involve problems with memory, language, thinking and judgment. Increase the risk of later progressing to dementia, caused by AD or other neurological conditions. Some people with MCI never get worse, and a few eventually get better.

5 Alzheimer Disease 5 Alzheimer's disease is a neurological disorder in which the death of brain cells causes memory loss and cognitive decline. A neurodegenerative type of dementia, the disease starts mild and gets progressively worse.

6 Risk Factors for Dementia 6 Age Female Gender Low education Genetics Vascular risk factors Head Trauma Depression

7 Treatment? 7 Until today there is no effective treatment for AD (Tsolaki et al., 2011). Used medication, which delay progression, especially in the early stages of the disease. The last 15 years using non- pharmacological interventions to slow the disease, but also improve the quality of life of patients and their carers. If we can change the mood of people can also improve cognitive and functional abilities.

8 Physical Activity 8 The lack of mobility is a major reason that the elderly have problems in functionality. Physical activity stimulates the physiological functions of the body and can contribute to the stabilization of a good level cognitive functions making the elderly more functional. Exercise improves physical health, behavior, cognitive status, communication and functionality in the elderly with cognitive impairment. Also exercise improve the perceived quality of life! Heyn, P., Abreu, B. C., Ottenbacher, K. J. (2004)

9 Benefits of aerobic exercise 9 Researches have shown: Physical exercise, especially aerobic, increases blood flow and brain metabolism and reduces oxidative stress in the brain. Neuropsychobiology 2009, 59: Regular exercise causing angiogenesis and increased blood flow in the cerebellum, the motor cortex and hippocampus. Neuroscience 2003, 117:

10 Benefits of aerobic exercise 10 The hippocampus of the brain in elderly decreases in 1-3% per year, but the systematic participation in aerobic exercises increased the size of the hippocampus to 2%.

11 Risks of falls - Sociability 11 The strength training exercises designed to maintain mobility and ability to perform daily activities safely, while the balance and flexibility promote safe mobility, improve of walking and prevention of falls. Dement Geriatr Cogn Disord 2010, 29: Exercise improves behavior, reduces depression, improves the quality of sleep, keeps interesting and sociable, reduces fear, boosts self, prevents disorders of balance and falls and generally maintaining the functional capacity of person and improves quality of life. BMJ 2004, 328:680, Am J Alzheimers, Dis Other Demen 2007, 22:

12 Music 12 The rhythmic music improves the coordination of walking and movement control of people with neuromuscular and skeletal disorders and leads to an increase in stability and mobility. Cooper, L. & Thomas, H. (2002)

13 So, what does dance offer? 13 Physical activity Balance Dance Rhythm Sociability

14 Methodology 14 Participants : 41 people, 7 men & 34 women Diagnosis: Healthy: 8 persons (2M & 6W) MCI: 29 persons (4M & 25W) Dementia: 3 persons (1M & 2W) Schizophrenia: 1 person (1W)

15 Methodology 15 Participants M SD Min Max Age Education in years For all statistical analyses, a level of significance at 0.05 was chosen. The selected dances were specific, moderate intensity, with gradually increasing intensity, indicative of age and physical abilities of the people..

16 Intervention: Methodology a) Open Care Center of Municipality of Thessaloniki b) Greek Association of Alzheimer's Disease and Related Disorders 16 Frequency: twice a week Training time: 60 Duration: 32 weeks

17 Neuropsychological Tests 17 Neuropsychological tests were held to the participants before and after the intervention. The tests have been selected on the basis of the psychometric properties (validity, reliability) and the existence of norms for the Greek population. Kosmidis, 2008; Lezak, 2004; Tsolaki & Kounti, 2010

18 Neuropsychological Tests different tests were used, which examine all cognitive functions (memory, reason, judgment, abstract thinking, complex skills, attention, concentration, orientation, visuospatial perception). The tests that were selected are nominally the following: MMSE, CDR, FUCAS, FRSSD, IADL, TEA, TMT, ROCF, RAVLT, RBMT, VFT, NPI, GDS, QOL-AD, BAI.

19 Somatometric Tests For the physical condition and functional ability, they evaluated before and after the intervention, by tests were related with : 19 aerobic endurance, strength of the lower limbs and dynamic balance, strength of upper limbs, flexibility low back and hamstrings, speed, agility and balance during movement, jumping ability, balance on one leg, body mass index (BMI) body fat percentage

20 p<0,05 Statistical Analysis Paired Differences Paired Differences 95% Confidence Interval of the Difference Pair Mean Std. Deviation Std. Error Mean Lower Upper t df Sig. (2-tailed) 1 Pre-MMSE - Post-MMSE 0,348 1,849 0,386-0,452 1,147 0, ,377 2 Pre-FUCAS - Post-FUCAS -2 3,367 0,718-3,493-0,507-2, ,011 3 Pre-s1MAP - Post-s1MAP -3,316 8,635 1,981-7,478 0,846-1, ,111 4 Pre-s4viac - Post-s4viac 1,556 6,732 1,587-1,792 4,903 0, ,341 5 Pre-s4viti - Post-s4viti -1,2144 3,4441 0,861-3,0496 0,6209-1, ,179 6 Pre-s6tels - Post-6tels 1, , , , , , ,005 7 Pre-FRSSD - Post-FRSDD -0,636 2,838 0,856-2,543 1,27-0, ,474 8 Pre-NPI - Post-NPI 0,083 1,929 0,557-1,142 1,309 0, ,884 9 Pre-rav1 - Post-rav1-1,13 2,581 0,538-2,247-0,014-2,1 22 0, Pre-rav2 - Post-rav2 0,87 3,209 0,669-0,518 2,257 1, , Pre-rav3 - Post-rav3-0,391 2,017 0,421-1,263 0,481-0, , Pre final rav - Post final rav -2,609 9,389 1,958-6,669 1,452-1, , Pre-verbal - Post-verbal -1,5 3,661 0,781-3,123 0,123-1, , Pre-verfls - Post-verfls -1,818 2,239 0,477-2,811-0,825-3, , Pre-verfla - Post-verfla -1,318 3,969 0,846-3,078 0,441-1, , Pre-verfmo - Post-verfmo -1, , ,6356-2, , , , Pre-rbmt1 - Post-rbmt1 1,087 3,157 0,658-0,278 2,452 1, , Pre-rbmt2 - Post-rbmt2 0,978 3,679 0,767-0,613 2,569 1, , Pre-rey - Post-rey -0,9087 6,5934 1,3748-3,7599 1,9425-0, , Pre-reydel - Post-reydel -0,3636 4,1495 0,8847-2,2034 1,4762-0, , Pre-GDS - Post-GDS 1 2,415 0,67-0,46 2,46 1, , Pre-BDI - Post-BDI 3,4 13,343 4,22-6,145 12,945 0, , Pre-BAI - Post-BAI 24,5 21,92 15,5-172, ,446 1, , Pre-PSS - Post-PSS 0,609 11,276 2,351-4,268 5,485 0, ,798

21 Results FUCAS test, estimates generally the daily functioning of patients with dementia and mild cognitive disorder. Dance shown to maintain the functionality of patients which would be worsen significantly if they didn't do this intervention (p=0,011). TEA (6tels) test, examines the visual selective attention, which is the ability to control the space properly and maintain the attention on a particular thing for some time. Dance shown that helped participants to increase attention and concentration as to stimulate more the piece of the visual perception (p=0,005). RAV1 test, examines the immediate memory and whether the patient is able to use learning strategies. The test allows a comparison between skill learning and retention (p=0,047). Verbal test (verfls), examines the speed with which the mind can work, to whether slowly moves based on age and to whether the patient is able to maintain verbal fluency (p=0,001). Verbal test (verfmo), examines the difference being that takes averages of words that emerged from the trials of the letters "s", "a" and "x". The dance introduced positive results on the verbal fluency of participants, helped them to operate and think faster (p=0,045).

22 p<0,05 Statistical Analysis 22 Paired Differences 95% Confidence Interval of the Difference Mean Std. Deviation Std. Error Mean t df Sig. (2-tailed) Lower Upper Pair 1 Weight_Pre -Weight_Post,537 2,215,346 -,162 1,236 1,551 40,129 Pair 2 Height_Pre -Height_Post,024,418,065 -,107,156,374 40,710 Pair 3 ΒΜΙ_Pre - ΒΜΙ_Post,19634,85486, ,07349, ,471 40,149 Pair 4 Chair_Stand_Pre - Chair_Stand_Post -2,610 2,558,400-3,417-1,802-6,53 40,000 Pair 5 Pair 6 Chair_Sit_And_Reach_Pre - Chair_Sit_And_Reach_Post Foot_Up_And_Go_Pre - Foot_Up_And_Go_Post -4,561 5,325,832-6,242-2,880-5,49 40,000,95829,89807,14025, , ,833 40,000 Pair 7 Back_Scratch_Pre - Back_Scratch_Post -,683 5,841,912-2,527 1,161 -,749 40,458 Pair 8 Arm_Curl_Pre- Arm_Curl_Post -1,415 5,153,805-3,041,212-1,76 40,086 Pair 9 Pair 10 Two_Min_Step_Pre - Two_Min_Step_Post Balance_One_Leg_Pre - Balance_One_Leg_Post -8,415 18,431 2,878-14,232-2,597-2,92 40,006-5, , , , , ,61 40,115 Pair 11 Hand Grip_Pre - Hand Grip_Post -1,289 4,876,791-2,892,313-1,63 37,112 Pair 12 Jumping_Pre - Jumping_Post -,711 2,804,443-1,608,186-1,60 39,117 Pair 13 Body fat_pre - Body fat_post -2, ,75797, , , ,97 37,005

23 Results 23 Chair Stand test, evaluates the functional capacity of individuals through the strength of the lower limbs and the dynamic balance which are important for activities such as someone get up from a chair, or get out by bus or car. The strength in the legs affects directly the ease with which elderly perform daily activities. (p = 0,000). Chair Sit And Reach test, evaluates the flexibility of low back and hamstrings, which is important for good body posture, for normal gait patterns and various mobility functions, such as getting in and out of a bath or car (p = 0,000). Foot Up And Go test, evaluates the speed, agility and balance during movement. It is important to tasks requiring quick shunting, such as getting a bus on time or to answer the phone. Having better balance, the elderly feel more confident to live an active life and in combination with the speed directly affected self confidence in everyday activities (p = 0,000). 2 Minute Step test, evaluates the aerobic capacity. The resistance is considered important for activities such as shopping, walking a certain distance, and also for travel (p = 0,006). To measure the percentage of fat,used the method that measures the width of the fold of skin at various points of the body, by dermatoptychometro in combination with equation Siri (p = 0,005).

24 Conclusions 24 Dance as a form of exercise, except that offers the increase in physical strength, helps maintain proper body posture, tones the muscles and improves fitness. Combined with the music, helps in express their feelings in combating stress and improves mental health. By repeating steps, the movement of the hands and the combined operation, dance helps to improve the cognitive processes.

25 Conclusions 25 Dance contributes the improvement of psychology of elderly. Dancing other than a form of physical exercise, which seems to be particularly important for protection against dementia and also to slow the progression of the disease, is also a means of socializing participants. Socialization in turn contributes to maintaining of a positive psychology, which may be a protective shield for dementia, and to protect patients with Mild Cognitive Impairment (MCI) from possible depression, which aggravates the situation of a patient with cognitive problems.

26 Conclusions 26 Nowadays, where non-pharmacological interventions for the treatment of dementia play a very important role on the world stage, our research confirms - the previously conducted studies - who report the importance of dance.

27 Conclusions 27 The Greek traditional dance can be an important tool to combat health problems and at the same time an ally of health and quality of life of older people.

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30 30 THANK YOU FOR YOUR ATTENTION