Effects of motor practice on cognitive disorders in older adults
European Review of Aging and Physical Activity volume 6, pages 67–74 (2009)
The demographics of our societies have changed drastically during the past few decades. The general population is aging rapidly as human life spans continue to expand and more adults are set to mature during the next quarter century. This aging process has numerous implications for the way we live and will have particularly important impacts on health and healthcare. In particular, substantial evidence suggests that cognitive–motor function deteriorates considerably as the result of inactive life style, biological aging, and cognitive impairments. The number of individuals with Alzheimer's disease (AD), an aging-related cognitive disorder, is expected to increase significantly during the next 40 years. The development of mild cognitive impairment (MCI) or AD can exaggerate the functional declines observed in cognitive or motor performance. The functional declines affect an array of social, cognitive, mental, physical, and motor activities in our daily lives. However, recent studies suggest that cognitive, physical, motor practice, or skill learning can improve motor speed, smoothness, and accuracy in both MCI and AD patients and their age-matched healthy peers. From theoretical and practical perspectives, this paper addresses several critical aspects of motor deficits and the kinematical characteristics of motor skill development in MCI and AD populations. Empirical data will be presented relative to the sensory–motor functions of MCI and AD, the motor skill acquisition, exercise rehabilitation in older adults with memory loss, as well as the implications for therapies. Finally, this review concludes with thoughts and suggestions for future research in these areas.
According to the latest census data, adults aged 85 and above are the fastest-growing segment of the United States population. In 2007, about 5.1 million Americans suffered from Alzheimer's disease (AD) or a related dementia . As a result of the increasing proportion of senior citizens in the US population, around a quarter of a million more people will develop AD in the US every year . It has been estimated that the number of people with AD will nearly triple by 2050, between 13.2 and 16 million . The consequences of AD are severe, as this disease damages brain cells, causes motor and cognitive problems, and reduces functional abilities of daily living. As the fourth leading cause of death in the US at present, AD is a major health issue for senior citizens and places additional pressure on healthcare providers. As a result, there is a growing global effort to find an effective means of preventing and treating AD.
Mild cognitive impairment (MCI) is usually considered a transitional or intermediate step between normal aging and AD. Although there are many different causes of MCI, including AD, cerebrovascular disease, metabolic problems, and other degenerative disorders (e.g., Lewy body dementia, Parkinson's disease, frontotemporal dementia), individuals with this disorder are at an increased risk of developing dementia . In fact, estimates suggest that between 10% and 15% of individuals with MCI will convert to dementia, particularly AD, every year. Furthermore, the prevalence of MCI is twice as high as that of dementia . Given these alarming statistics and the fact that MCI can have negative effects on the quality of life of both individuals with the disorder and their caregivers , researchers are becoming increasingly interested in the accurate diagnosis, treatment, and potential rehabilitation of MCI [38, 43]. Early detection and treatment of MCI may reduce the risk of conversion to AD or other forms of dementia .
Given the absence of valid biomarkers, the diagnosis of AD and MCI is based primarily on clinical findings from neurological, neuroimaging, and neuropsychological examinations . MCI patients typically report a subjective memory loss and score at least 1.5 standard deviations below the mean of their age-matched healthy peers on objective tests of episodic memory . However, the same individuals usually perform within the normal range on other tests of cognitive functioning and show no major deficits on measures of functional abilities . MCI subjects do not appear to experience problems with finger tapping, but those with mild AD are impaired on this simple movement task . Researchers have recently discovered that MCI is a very heterogeneous disorder and that the motor control and movement performance of MCI patients can differ considerably . Diagnoses of MCI based on the traditional neuropsychological or psychomotor tests are, therefore, not always accurate .
When MCI is associated with an isolated loss of episodic memory, it is generally referred to as amnestic MCI (a-MCI). Research suggests that this subtype of MCI is usually associated with an increased risk of incident AD [26, 29]. This has spurred research interest in the early detection of a-MCI subtype and MCI in general and the development of potential therapeutic agents to slow down the decline and delay the onset of clinically diagnosed AD [3, 5, 21, 38]. One important area of behavioral research that has so far received little attention is the assessment of movement kinematics of motor performance or control as a means of providing useful information that will enable clinicians to better identify MCI. This is a line of research that might also result in a better understanding of the effects of behavioral assessments in diagnosis and treatments for functional capacities for cognitively impaired individuals .
This article reviews relevant studies reporting sensory–motor performance of individuals with MCI or AD and the effects of physical activities on late-life cognitive and motor functions (e.g., attention, memory, perception, decision-making, movement responses, or performance). The contents are divided into four major sections. The first summarizes evidence regarding motor disorders and intact functions of normal cognitive aging, MCI, and AD. The second section discusses the effects of practice or motor training on sensory–motor function for MCI and AD. The third section introduces selected studies that show the benefit of physical practice on neural changes. The concluding section discusses new developments in the clinical rehabilitation in older adults with memory complaints and also draws attention to their practical implications and suggests future directions for research.
Sensory–motor disorders associated with aging
Sensory–motor dysfunctions are often associated with cognitive aging, MCI, or AD. The findings of numerous studies indicate that cognitive–motor functioning declines considerably as the result of cognitive aging or impairments. For example, healthy seniors aged 65 years or older demonstrate longer reaction times (RTs), greater variations in RTs, slower movement speeds (longer movement times [MT]), and less smooth movements than children and young adults (Fig. 1; [42, 45, 46]). Age-related sensory–motor deficits or neural “noise” in the central nervous system are assumed to account for the observed movement deterioration associated with normal aging [30, 39].
During the past two decades, a number of theories have been proposed to explain the processes of cognitive aging in perceptual–motor performance (e.g., the speed, accuracy, quality, or efficiency of responses). The explanations include deficits in sensory functioning, cognitive resources, processing speed, inhibition, and recollection (see a detailed review by Dennis and Cabeza ). Specifically, these approaches hypothesize that the poor cognitive and motor performances of older adults are due to significant deteriorations in numerous behavioral domains. More specifically, inadequate sensory inputs from visual and auditory systems, reduced levels of perceptual or attentional sources for on-going cognitive activities, decreased speeds of information processing or longer preparation times (RT), inability to suppress irrelevant stimuli for goal-directed sensory or motor control (inhibitory control), or memory loss of past events or experience (episodic memory) can individually or collectively affect late-life cognitive and motor performances . As a result, older individuals may adopt compensatory mechanisms to overcome some of the cognitive and motor deficits .
Clearly, the functional deterioration seen in the movement performance of healthy older adults can be exacerbated by the development of MCI or AD. The onset of this deterioration differs considerably in individual cases and can be accelerated in people with neurodegenerative disorders such as AD [8, 16, 27, 28]. In particular, individuals with AD exhibit a significant behavioral decline or disturbance in their motor and cognitive performance [16, 20, 27, 30]. A recent study of handwriting in AD and MCI patients indicates that a compromised motor performance is the behavioral manifestation of cognitive impairments . This study describes reduced levels of sensory–motor performance in fine movement control and motor coordination of AD and MCI, as reflected in several patterns of handwriting movements. Kinematic analysis showed that AD and MCI patients are slower, jerkier, less coordinated, and less consistent in selected handwriting tasks than their healthy peers (Fig. 2; ).
From a theoretical or a clinical view, the changes seen in MT and smoothness of handwriting performance in MCI and AD patients may be used in conjunction with more traditional tests to further improve the early identification of impaired individuals. The results and assumptions may lead to further studies of the links between deficits in motor performance, dysfunctions of the brain (the basal ganglia or hippocampus), and potential peripheral disorders (e.g., tremor). Behavioral studies of AD or MCI can also, to a certain extent, facilitate our understanding of the relationship between the executive level (information processing, memory, or decision-making) and the effector level (movement planning, integration, or implementation). Motor tests enable specific changes in the functioning of older adults to be tracked accurately, as they are not influenced by the variables of language, education, or cultural background. These confounding factors often result in problems in the administration and interpretation of cognitive tests [43, 44].
The effects of practice on motor control and skill learning
In recent years, the topic of motor skill learning in seniors has aroused considerable interests among researchers in the fields of neurology, psychology, motor behavior, and gerontology. Several studies have been designed to test the hypothesis that motor learning or physical practice can enhance the capabilities of motor control and performance in healthy or normal controls and patients with a diagnosis of AD and MCI, resulting in better motor performance [41, 43]. While an individual's cognitive and motor functions may decline with advancing age or cognitive impairments, recent studies indicate that both healthy adults and MCI and AD patients can improve their motor performance in movement speed, smoothness, and accuracy as a function of cognitive–motor practice (e.g., memory and physical training; [41, 43]). From a clinical perspective, this review addresses critical features of motor deficits and the kinematical characteristics of motor skill development in MCI and AD populations. The practical implications will also be discussed.
Although the finding that older adults can acquire new motor or cognitive skills as a result of motor practice [31, 41] is scarcely surprising, the fact that individuals with mild-to-moderate AD and MCI can also become skillful in some motor or cognitive tasks as a result of training [14, 15, 20] is very encouraging. Yet, the declines in cognitive functioning (e.g., attention, inhibitory control, memory, or execution) may contribute to the difficulties observed in acquiring new skills in older people or individuals who suffer from AD . From a theoretical point of view, further investigation into the brain function and its role in controlling motor responses should provide a clearer picture of the brain and body relationship. From a clinical standpoint, studying motor skill learning or acquisition in this particular population is important because the findings will facilitate the development of exercise programs that enhance motor–cognitive performance for both healthy seniors and individuals with clinical disorders. At the issue is the determination of the underlying mechanisms responsible for skill improvement in AD or MCI. For instance, how does internal processing (motor planning or programming) or memory affect motor execution or performance in MCI and AD patients?
It is also important to understand why or how practice improves motor skills and to identify the parameters that will change as a function of learning or motor practice . The model proposed by Meyer et al.  seems to provide a framework for addressing these questions. This model specifically suggests that for a rapid goal-oriented motor task, the primary submovement (PS) of the movement is under internal or central control (by a motor program). The secondary submovement (SS), however, is under peripheral control (by using visual feedback) to hit the target. This framework has advantages over others in terms of identifying or quantifying movement parameters that are related to the effects of practice . Yan and Dick  used this model to examine the role of central and peripheral contributions to motor control and to shed light on some of the factors implicated in skill acquisition in MCI and AD patients.
More specifically, Yan and Dick  investigated the possibility that practice could result in an increased level of central control (as reflected by an increased PS and faster movement) and a reduced proportion of on-line corrective movements (as indexed by a shorter SS and more consistent movements). Mild AD patients, MCI patients, and a group of age-, sex-, and education-matched seniors either received or did not receive practice on a rapid aiming arm movement on a digitizer. Three dependent variables of movement were assessed (MT, percentage of PS, and motor jerk; Fig. 3). The researchers found that, despite the fact that the mild AD and MCI patients demonstrated considerable motor or cognitive deficits in baseline tests (e.g., inability to plan or execute motor responses shown), all participants benefitted equally from practice in terms of movement speed and smoothness, as well as the proportion of the movement under central control. Theoretically, this line of study offers insights into the mechanisms of motor control in AD or MCI patients. Equally important, studying the effects of practice on motor and cognitive function may lay the foundations for the development of future behavioral treatments for AD patients.
The findings of a number of studies performed at the University of California Irvine, Alzheimer's Disease Research Center also supported the contention that motor practice or learning can facilitate or strengthen motor and cognitive performance for AD and MCI patients. Although the laboratory-based evidence needs to be validated in a clinical setting, many of these investigations have important practical implications. For instance, using a rotary pursuit task (a fine motor task), mild AD patients significantly improved their movement accuracy as the results of extensive motor practice. Most importantly, these impaired participants retained the benefits of practice for up to 1 month following the end of behavioral intervention . Another study indicated that mild-to-moderately impaired AD patients improved their motor performance of a beanbag tossing task (a gross motor task) after practice . The findings of these studies, which demonstrated different patterns of motor skill control and learning, call for further investigation. For example, the optimal training regimen for this population in terms of the intensity, duration, or frequency of motor practice remains unclear. If AD or MCI patients only retain the learned motor skills for a short period of time after practice, it is important to discover optimal ways of maintaining the skill levels by providing them with some post-practice “booster” activities. More clinical studies are also needed to determine how physical or motor training is best integrated with the traditional therapies for AD or MCI patients.
Effects of training or practice on brain function
Geriatric research suggests that both aging and cognitive impairments (e.g., MCI and AD) can reduce the cognitive vitality of the elderly . In consequence, we often observe significant aging-related reductions in the speed of information processing, attention span, long-term or short-term memory, and motor performance among this population group [7, 18]. It should be noted that the age of onset and the severity of declines in cognitive and motor performance of the elderly are subject to considerable individual variations . To a certain extent, the onsets of cognitive–motor deteriorations can be delayed and the speed of progression can be reduced by actively or habitually engaging in skill learning, social interaction, cognitive and mental rehabilitation, or physical exercises .
In recent years, a growing body of studies on animals and humans has provided direct or indirect evidence for the benefits of mental and physical activities in stimulating and promoting active brain responses critical for healthy or normal cognitive and motor functioning. Training or practice is assumed to result in enhanced capacities of both motor performance and brain functions. It appears that healthy life styles, frequent or habitual exercises, and enriched environments, by providing physical activities and decision-making opportunities, facilitate the development of these two important neural processes, and under these conditions, the changes occurring in the brain can be long-lasting (e.g., [11, 40]).
More specifically, during our lifetimes, neurons undergo on-going or continuous changes, a process called “neural plasticity.” “Synaptogenesis” refers to the neural processes of increased synaptic connections between the neighboring brain cells. “Neurogenesis” is the occurrence of the birth of new neurons. It has been reported that habitual physical exercise or motor learning facilitates the preservation of cognitive function through a number of processes or mechanisms. In this context, “exercise everyday keeps Alzheimer's away” is a simple yet accurate expression of the benefits of physical activities for the elderly . Exercises, physical practice, skill learning, or stimulating mental activities are assumed to prompt the creation of new connections among brain cells and the formation of neurons (e.g., [10, 43]). This slows down the progress of aging processes and cognitive deteriorations would slow down and helps to preserve the quality of life for the elderly .
Some investigators have attempted to use computer-based technologies for memory training or rehabilitation in elderly populations (e.g., ). For instance, Rasmusson et al.  indicated that senior participants significantly improve their cognitive functions as the results of group memory training, auditory memory training, and computer-based memory training. Moore et al.  extended these findings to the cognitively impaired and showed that memory rehabilitation programs could facilitate the memory performance of mild to moderate AD patients in tasks of daily living. They recommended that this type of training should be integrated with other therapies for an optimal result. Based on a review of the literature and behavioral characteristics of the elderly persons, Mayhorn et al.  integrated a number of strategies and developed a systematic approach for effective computer training with the elderly. These activities successfully facilitated learning and also improved cognitive overall functioning [4, 13, 34].
This review article provides evidence about movement disorders and the effects of motor practice on sensory–motor function for healthy seniors and MCI and AD patients. The empirical data discussed in the preceding sections clearly demonstrate the contributions of motor skill learning and performance, exercise and physical activities to the physical and cognitive functions of elderly populations. A growing body of evidence indicates that a suitable exercise program may help to slow the progressive cognitive and motor deterioration seen in individuals with AD or MCI. Thus, behavioral interventions or treatments are assumed to be appropriate for the elderly, both those who are healthy and those who suffer from mild cognitive impairments or memory losses associated with the aging processes. In other words, a number of practical and clinical implications can be drawn from the empirical findings from several recent studies (e.g., [2, 32, 36]).
First, clearly cognitive and motor dysfunctions are often associated with normal aging, MCI, or AD. Although behavioral evidence shows that the MCI and AD patients react and move slower, are more variant, and show more hesitations (e.g., jerks) in their movements than their age-, sex-, and education-matched peers or younger adults, the neuropsychological and neurophysiological mechanisms that account for these sensory–motor characteristics are not completely clear and call for further investigation. For instance, examining the executive component of working memory can provide new information about motor disorders among seniors. Fresh insights into the cognitive or motor processes underlying this deterioration will facilitate the planning and design of effective behavioral intervention for this population.
Second, it is apparent that motor learning or physical practice can enhance the capabilities of cognitive and motor control in both healthy seniors and those with AD and MCI and consequently results in better motor performance. How to effectively assess motor skill learning and understand aging-related characteristics in various types of motor behavior, however, is less clear. Traditional measures of cognitive and motor skill have yet to address the behavioral heterogeneities seen in aging populations (including MIC and AD patients). The assessments should be simple and practical, make use where possible of movements found in normal daily activities, and measure the efficiency of these movements (e.g., speed, smoothness, accuracy, inhibitory control, and economy of effort). A better understanding of the critical features of movement deficits and the associated kinematical characteristics of motor performance in MCI and AD populations is important to practitioners.
Third, although the findings of a number of preliminary research studies investigating the effects of practice on motor learning and control in MCI and AD have been encouraging (e.g., [43, 44]), relatively little is known about optimal strategies or approaches. For instance, sleep appears to be critical for motor memory consolidation and skill learning in general. However, more research is needed to determine exactly how sleep influences motor skill learning of seniors or people with cognitive impairments. Recently, the author of this chapter has explored the impacts of daytime naps and overnight sleep on motor skill learning of seniors with memory loss or cognitive dysfunctions (timing accuracy). It is anticipated that, in future therapeutic programs for individuals who suffer from MCI or AD, the control of sleep (e.g., timing and duration) will be incorporated into the routine of treatments.
Finally, as computer technology becomes increasingly commonplace, we would expect that various computer-assisted techniques will be utilized in memory training or rehabilitation of the elderly. However, some daily physical or mental activities or a combination of both physical and mental activities may still be the most effective ways of enhancing seniors' motor and cognitive functions and accomplish an optimal outcome.
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This work was supported partially by the China Link Program and the Direct Grant of the Chinese University of Hong Kong.
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Yan, J.H., Zhou, C.L. Effects of motor practice on cognitive disorders in older adults. Eur Rev Aging Phys Act 6, 67–74 (2009). https://doi.org/10.1007/s11556-009-0049-6
Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti. Idadi ya watu wanaobaki katika umri wa miaka inaongezeka kwa kasi, na idadi ya watu wazima wanaokua katika miaka 25 ijayo. Uzee una athari nyingi kwa maisha yetu na kwa afya na huduma za afya. Hasa, ushahidi mkubwa unaonyesha kwamba utendaji wa utambuzi wa motor unazorota sana kama matokeo ya mtindo wa maisha usio na shughuli nyingi, kuzeeka kwa kibiolojia, na kasoro za utambuzi. Idadi ya watu wenye ugonjwa wa Alzheimer, ugonjwa unaosababishwa na uzee, inatarajiwa kuongezeka kwa kiasi kikubwa katika miaka 40 ijayo. Uharibifu wa utambuzi wa upole (MCI) au AD inaweza kuongeza kupungua kwa utendaji ulioonekana katika utendaji wa utambuzi au wa motor. Kupungua kwa utendaji huathiri shughuli nyingi za kijamii, za utambuzi, za kiakili, za kimwili, na za mwendo katika maisha yetu ya kila siku. Hata hivyo, utafiti wa hivi karibuni unaonyesha kwamba mazoezi ya utambuzi, mwili, utendaji wa magari, au ujuzi wa kujifunza, yanaweza kuboresha kasi ya magari, usawa, na usahihi katika wagonjwa wa MCI na AD na wenzao wenye afya wa umri sawa. Kutoka kwa mtazamo wa kinadharia na vitendo, karatasi hii inashughulikia mambo kadhaa muhimu ya upungufu wa magari na sifa za kinematics za maendeleo ya ujuzi wa magari katika idadi ya watu wa MCI na AD. Data ya empirical itawasilishwa kuhusiana na kazi za sensorimotor za MCI na AD, upatikanaji wa ujuzi wa motor, mazoezi ya ukarabati kwa watu wazima wazee na hasara ya kumbukumbu, pamoja na athari kwa matibabu. Hatimaye, ukaguzi huu unamalizika na mawazo na mapendekezo kwa ajili ya utafiti wa baadaye katika maeneo haya. Kulingana na takwimu za hivi karibuni za sensa, watu wazima wenye umri wa miaka 85 na zaidi ndio kikundi cha watu wanaokua kwa kasi zaidi nchini Marekani. Katika mwaka wa 2007, takriban Wamarekani milioni 5.1 walikuwa na ugonjwa wa Alzheimer au ugonjwa unaohusiana na ugonjwa huo. Kwa sababu ya kuongezeka kwa idadi ya wazee katika idadi ya watu wa Marekani, karibu robo ya milioni zaidi ya watu wataendelea kuugua ugonjwa wa Alzheimer kila mwaka. Inakadiriwa kuwa idadi ya watu wenye ugonjwa huo itazidi mara tatu kufikia mwaka 2050 na kufikia milioni 13.2 hadi 16. Matokeo ya ugonjwa wa Alzheimer ni mabaya sana, kwani ugonjwa huu huathiri seli za ubongo, husababisha matatizo ya utendaji wa mwili na akili, na hupunguza uwezo wa kufanya kazi za kila siku. Kama sababu ya nne ya vifo nchini Marekani, ugonjwa wa Alzheimer ni tatizo kubwa la afya kwa wazee na huweka shinikizo zaidi kwa watoa huduma za afya. Kwa sababu hiyo, kuna jitihada zinazozidi kuongezeka ulimwenguni pote za kutafuta njia yenye matokeo ya kuzuia na kutibu ugonjwa huo. Uharibifu wa utambuzi wa upole (MCI) ni hatua ya mpito kati ya uzee wa kawaida na AD. Ingawa kuna sababu nyingi za MCI, ikiwa ni pamoja na AD, ugonjwa wa mishipa ya ubongo, matatizo ya kimetaboliki, na matatizo mengine ya degenerative (kwa mfano, Lewy body dementia, ugonjwa wa Parkinson, frontotemporal dementia), watu walio na ugonjwa huu wana hatari kubwa ya kuendeleza dementia. Kwa kweli, makadirio yanaonyesha kwamba kati ya 10% na 15% ya watu wenye MCI watageuka kuwa dementia, haswa AD, kila mwaka. Kwa kuongezea, kuenea kwa MCI ni mara mbili ya juu kuliko ile ya dementia. Kwa kuzingatia takwimu hizi za kutisha na ukweli kwamba MCI inaweza kuwa na athari mbaya kwa ubora wa maisha wa watu wote walio na ugonjwa na watunzaji wao, watafiti wanavutiwa zaidi na utambuzi sahihi, matibabu, na ukarabati wa uwezekano wa MCI. Ugunduzi wa mapema na matibabu ya MCI inaweza kupunguza hatari ya kubadilisha kwa AD au aina nyingine za dementia. Kwa sababu ya kutokuwepo kwa viashiria vya kibiolojia, utambuzi wa AD na MCI unategemea hasa matokeo ya kliniki kutoka kwa uchunguzi wa neva, neuroimaging, na neuropsychological. Kwa kawaida, wagonjwa wa MCI wanaripoti kupoteza kumbukumbu ya kibinafsi na kupata angalau 1.5 kupotoka kwa kawaida chini ya wastani wa wenzao wenye afya wa umri wao kwenye vipimo vya lengo vya kumbukumbu ya episodic. Hata hivyo, watu hao kawaida kufanya ndani ya kiwango cha kawaida juu ya vipimo vingine vya utendaji wa utambuzi na kuonyesha hakuna upungufu mkubwa juu ya vipimo vya uwezo wa kazi. Watu wenye MCI hawaonekani kuwa na matatizo ya kupiga kwa vidole, lakini wale walio na AD ya upole wanaathiriwa katika kazi hii rahisi ya harakati. Watafiti wamegundua hivi karibuni kwamba MCI ni ugonjwa tofauti sana na kwamba udhibiti wa magari na utendaji wa harakati za wagonjwa wa MCI zinaweza kutofautiana sana. Kwa hiyo, utambuzi wa MCI unaotegemea vipimo vya jadi vya neuropsychological au psychomotor si sahihi sikuzote. MCI inahusishwa na hasara ya kumbukumbu ya vipindi, kwa ujumla inajulikana kama MCI ya amnesic (a-MCI). Utafiti unaonyesha kwamba aina hii ya MCI kwa kawaida inahusishwa na hatari iliyoongezeka ya AD ya tukio [26, 29]. Hii imesababisha maslahi ya utafiti katika kugundua mapema ya aina ya a-MCI na MCI kwa ujumla na maendeleo ya wakala wa matibabu wa uwezekano wa kupunguza kupungua na kuchelewesha mwanzo wa ugonjwa wa Alzheimer' s. Sehemu muhimu ya utafiti wa tabia ambayo hadi sasa imepokea umakini mdogo ni tathmini ya kinematics ya harakati ya utendaji wa motor au udhibiti kama njia ya kutoa habari muhimu ambayo itawawezesha madaktari kutambua vizuri MCI. Hii ni mstari wa utafiti ambao unaweza pia kusababisha uelewa bora wa athari za tathmini za tabia katika utambuzi na matibabu kwa uwezo wa kazi kwa watu wenye ulemavu wa utambuzi. Makala hii inazungumzia masomo yanayohusiana na ripoti ya utendaji wa hisia za watu wenye MCI au AD na athari za shughuli za kimwili juu ya kazi za utambuzi na motor za maisha ya marehemu (kwa mfano, umakini, kumbukumbu, utambuzi, maamuzi, majibu ya harakati, au utendaji). Maudhui hayo yamegawanywa katika sehemu nne kuu. Kwanza ina muhtasari wa ushahidi kuhusu matatizo ya magari na kazi intact ya kuzeeka kawaida utambuzi, MCI, na AD. Sehemu ya pili inazungumzia athari za mazoezi au mafunzo ya motor juu ya kazi ya sensorymotor kwa MCI na AD. Sehemu ya tatu inaonyesha masomo yaliyochaguliwa yanayoonyesha manufaa ya mazoezi ya kimwili juu ya mabadiliko ya neva. Sehemu ya mwisho inazungumzia maendeleo mapya katika ukarabati wa kliniki kwa watu wazima wazee na malalamiko ya kumbukumbu na pia inatoa tahadhari kwa athari zao za vitendo na kupendekeza mwelekeo wa baadaye wa utafiti. Sensory-motor matatizo yanayohusiana na kuzeeka Sensory-motor dysfunctions ni mara nyingi kuhusishwa na kuzeeka utambuzi, MCI, au AD. Matokeo ya masomo mengi yanaonyesha kwamba utendaji wa utambuzi wa utambuzi hupungua sana kama matokeo ya kuzeeka kwa utambuzi au kasoro. Kwa mfano, wazee wenye afya wenye umri wa miaka 65 au zaidi huonyesha nyakati za majibu ndefu (RTs), tofauti kubwa katika RTs, kasi ya harakati ya polepole (wakati wa harakati ndefu [MT]), na harakati zisizo laini kuliko watoto na vijana. 1; [42, 45, 46]). Umri kuhusiana sensory-motor upungufu au neva "ngurumo" katika mfumo wa neva kuu ni kudhaniwa kuwa akaunti kwa ajili ya kuzorota mwendo aliona kuhusishwa na kuzeeka kawaida [30, 39]. Katika miongo miwili iliyopita, nadharia kadhaa zimependekezwa kuelezea michakato ya kuzeeka kwa utambuzi katika utendaji wa utambuzi wa motor (kwa mfano, kasi, usahihi, ubora, au ufanisi wa majibu). Ufafanuzi ni pamoja na upungufu katika utendaji wa hisia, rasilimali za utambuzi, kasi ya usindikaji, kuzuia, na kukumbuka (tazama ukaguzi wa kina na Dennis na Cabeza). Kwa mfano, utafiti unaonyesha kwamba utendaji duni wa utambuzi na utendaji wa magari wa watu wazima ni kwa sababu ya uharibifu mkubwa katika maeneo mengi ya tabia. Kwa mfano, usumbufu wa hisia kutoka kwa mifumo ya kuona na kusikia, viwango vya chini vya vyanzo vya utambuzi au tahadhari kwa shughuli za utambuzi zinazoendelea, kupunguza kasi ya usindikaji wa habari au nyakati za maandalizi (RT), kutokuwa na uwezo wa kukandamiza vichocheo visivyofaa kwa udhibiti wa hisia au motor (udhibiti wa kuzuia), au kupoteza kumbukumbu ya matukio ya zamani au uzoefu (kumbukumbu ya kipindi) inaweza kuathiri utendaji wa utambuzi na motor. Matokeo yake, watu wazima wanaweza kupitisha taratibu za fidia ili kushinda baadhi ya upungufu wa utambuzi na mwendo. Kwa wazi, uharibifu wa kazi unaoonekana katika utendaji wa harakati za watu wazima wenye afya unaweza kuongezeka na maendeleo ya MCI au AD. Kuanza kwa uharibifu huu hutofautiana sana katika kesi za mtu binafsi na inaweza kuharakishwa kwa watu wenye matatizo ya neurodegenerative kama vile AD [8, 16, 27, 28]. Watu walio na AD wanaonyesha kupungua kwa tabia au usumbufu mkubwa katika utendaji wao wa motor na utambuzi (16, 20, 27, 30). Utafiti wa hivi karibuni wa maandishi ya mikono katika wagonjwa wa AD na MCI unaonyesha kuwa utendaji wa magari ulioharibiwa ni maonyesho ya tabia ya kasoro za utambuzi. Utafiti huu unaelezea viwango vya kupunguzwa kwa utendaji wa sensorimotor katika udhibiti wa harakati nzuri na uratibu wa motor wa AD na MCI, kama inavyoonyeshwa katika mifumo kadhaa ya harakati za uandishi wa mkono. Uchunguzi wa kinematics ulionyesha kuwa wagonjwa wa AD na MCI ni polepole, jerkier, chini ya kuratibu, na chini ya mfululizo katika kazi zilizochaguliwa za maandishi ya mkono kuliko wenzao wenye afya (Fig. 2) 2) Kutoka kwa mtazamo wa kinadharia au kliniki, mabadiliko yaliyoonekana katika MT na usawa wa utendaji wa uandishi wa mkono katika wagonjwa wa MCI na AD yanaweza kutumika pamoja na vipimo vya jadi zaidi ili kuboresha utambulisho wa mapema wa watu walioathirika. Matokeo na dhana zinaweza kusababisha masomo zaidi ya uhusiano kati ya upungufu katika utendaji wa motor, dysfunctions ya ubongo (ganglia ya msingi au hippocampus), na matatizo ya uwezekano wa peripheral (kwa mfano, tetemeko). Uchunguzi wa tabia ya AD au MCI pia unaweza, kwa kiwango fulani, kuwezesha uelewa wetu wa uhusiano kati ya ngazi ya mtendaji (usindikaji wa habari, kumbukumbu, au maamuzi) na ngazi ya effector (upangaji wa harakati, ushirikiano, au utekelezaji). Uchunguzi wa utendaji wa mwili wa watu wazima huonyesha kwamba watu wazima wanafanya kazi kwa njia ambayo haitegemei lugha, elimu, au utamaduni. Sababu hizi za kuchanganya mara nyingi husababisha matatizo katika utoaji na tafsiri ya vipimo vya utambuzi [43, 44]. Katika miaka ya hivi karibuni, mada ya kujifunza ujuzi wa magari katika wazee imesababisha maslahi makubwa miongoni mwa watafiti katika nyanja za neva, saikolojia, tabia ya magari, na gerontology. Utafiti wa utafiti unaonyesha kwamba mafunzo ya magari yanaweza kuboresha uwezo wa udhibiti wa magari na utendaji katika watu wenye afya au kawaida na wagonjwa wenye ugonjwa wa ADHD na MCI, na kusababisha utendaji bora wa magari. Ingawa kazi za utambuzi na za motor zinaweza kupungua na umri wa kukua au kasoro za utambuzi, masomo ya hivi karibuni yanaonyesha kwamba watu wazima wenye afya na wagonjwa wa MCI na AD wanaweza kuboresha utendaji wao wa motor katika kasi ya harakati, laini, na usahihi kama kazi ya mazoezi ya utambuzi na motor (kwa mfano, kumbukumbu na mazoezi ya mwili). Kwa mtazamo wa kliniki, ukaguzi huu unashughulikia sifa muhimu za upungufu wa gari na sifa za kinematiki za maendeleo ya ujuzi wa gari katika idadi ya watu wa MCI na AD. Matokeo ya vitendo yatazungumziwa pia. Ingawa matokeo ya kwamba watu wazima wanaweza kupata ujuzi mpya wa motor au utambuzi kama matokeo ya mazoezi ya motor, ukweli kwamba watu wenye AD na MCI ya upole hadi wastani wanaweza pia kuwa na ujuzi katika baadhi ya kazi za motor au utambuzi kama matokeo ya mafunzo ni ya kutia moyo sana. Hata hivyo, kupungua kwa utendaji wa utambuzi (kwa mfano, uangalifu, udhibiti wa kuzuia, kumbukumbu, au utekelezaji) kunaweza kuchangia ugumu wa kupata ujuzi mpya kwa watu wazima au watu wanaosumbuliwa na AD. Kwa mtazamo wa nadharia, uchunguzi zaidi juu ya kazi ya ubongo na jukumu lake katika kudhibiti majibu ya motor inapaswa kutoa picha wazi ya uhusiano wa ubongo na mwili. Kutoka kwa mtazamo wa kliniki, kujifunza kujifunza au upatikanaji wa ujuzi wa motor katika idadi hii maalum ni muhimu kwa sababu matokeo yatasaidia maendeleo ya programu za mazoezi ambayo huongeza utendaji wa motor-cognitive kwa wazee wenye afya na watu wenye matatizo ya kliniki. Kwa sababu hii, ni muhimu kuamua ni nini kinachohusika na maendeleo ya ujuzi katika AD na MCI. Kwa mfano, jinsi gani usindikaji wa ndani (upangaji wa motor au programu) au kumbukumbu huathiri utekelezaji wa motor au utendaji katika wagonjwa wa MCI na AD? Ni muhimu pia kuelewa kwa nini au jinsi mazoezi kuboresha ujuzi wa motor na kutambua vigezo kwamba itabidi kubadilika kama kazi ya kujifunza au mazoezi ya motor. Mfano uliopendekezwa na Meyer et al. Inaonekana kutoa mfumo wa kushughulikia maswali haya. Mfano huu unaonyesha kwamba kwa kazi ya haraka ya lengo la motor, submovement ya msingi (PS) ya harakati iko chini ya udhibiti wa ndani au wa kati (na programu ya motor). Submovement sekondari (SS), hata hivyo, ni chini ya udhibiti wa pembeni (kwa kutumia maoni ya kuona) kugonga lengo. Mfumo huu una faida juu ya wengine katika suala la kutambua au quantifying mwendo vigezo kwamba ni kuhusiana na athari za mazoezi. Yan na Dick walitumia mfano huu kuchunguza jukumu la michango ya kati na ya pande zote kwa udhibiti wa gari na kutoa mwangaza juu ya baadhi ya sababu zinazohusika katika upatikanaji wa ujuzi katika wagonjwa wa MCI na AD. Yan na Dick walichunguza uwezekano wa mazoezi kuwa na kiwango cha juu cha udhibiti wa kati (kama inavyoonyeshwa na PS iliyoongezeka na harakati ya haraka) na uwiano mdogo wa harakati za kurekebisha mkondoni (kama inavyoonyeshwa na SS fupi na harakati za mfululizo zaidi). Wagonjwa wa AD wa hali ya chini, wagonjwa wa MCI, na kikundi cha wazee wenye umri, jinsia, na elimu iliyofanana walipokea au hawakupokea mazoezi ya harakati ya haraka ya mkono wa lengo kwenye digitizer. Vipimo vya tatu vya kutegemea vya harakati zilipimwa (MT, asilimia ya PS, na jerk ya motor; Mchoro. 3) Watafiti walipata kwamba, licha ya ukweli kwamba wagonjwa wa AD na MCI walionyesha upungufu mkubwa wa motor au utambuzi katika vipimo vya msingi (kwa mfano, kutokuwa na uwezo wa kupanga au kutekeleza majibu ya motor), washiriki wote walifaidika sawa na mazoezi katika suala la kasi ya harakati na laini, pamoja na uwiano wa harakati chini ya udhibiti wa kati. Kwa nadharia, mstari huu wa utafiti hutoa ufahamu wa taratibu za udhibiti wa gari katika wagonjwa wa AD au MCI. Kwa hivyo, utafiti wa athari za mazoezi juu ya utendaji wa motor na utambuzi unaweza kuweka msingi wa maendeleo ya matibabu ya tabia ya baadaye kwa wagonjwa wa AD. Matokeo ya utafiti uliofanywa katika Chuo Kikuu cha California Irvine, Kituo cha Utafiti wa Ugonjwa wa Alzheimer, pia ilisaidia hoja kwamba mazoezi ya magari au kujifunza inaweza kuwezesha au kuimarisha utendaji wa magari na utambuzi kwa wagonjwa wa AD na MCI. Ingawa uthibitisho wa maabara unahitaji kuthibitishwa katika mazingira ya kliniki, uchunguzi mwingi una athari muhimu za vitendo. Kwa mfano, kwa kutumia kazi ya kufuatilia mzunguko (kazi nzuri ya motor), wagonjwa wa AD wa hali ya chini waliongeza kwa kiasi kikubwa usahihi wa harakati zao kama matokeo ya mazoezi ya kina ya motor. Kwa upande mwingine, washiriki walioharibika waliendelea kupata faida za mazoezi kwa hadi mwezi mmoja baada ya kumaliza uingiliaji wa tabia. Utafiti mwingine ulionyesha kuwa wagonjwa wa AD wenye ulemavu wa kiasi hadi wa wastani waliongeza utendaji wao wa magari ya kazi ya kutupa mfuko wa maharagwe (kazi ya magari makubwa) baada ya mazoezi. Matokeo ya masomo haya, ambayo yalionyesha mifumo tofauti ya udhibiti wa ujuzi wa magari na kujifunza, yanahitaji uchunguzi zaidi. Kwa mfano, utaratibu bora wa mazoezi kwa ajili ya idadi hii ya watu katika suala la nguvu, muda, au mzunguko wa mazoezi ya motor bado haijulikani. Ikiwa wagonjwa wa AD au MCI wanadumisha tu ujuzi wa magari waliopatikana kwa muda mfupi baada ya mazoezi, ni muhimu kugundua njia bora za kudumisha viwango vya ujuzi kwa kuwapa shughuli za "kuongeza" baada ya mazoezi. Utafiti zaidi wa kliniki unahitajika pia kuamua jinsi mafunzo ya mwili au ya motor yanavyounganishwa vizuri na matibabu ya jadi kwa wagonjwa wa AD au MCI. Matokeo ya mafunzo au mazoezi juu ya kazi ya ubongo Utafiti wa geriatric unaonyesha kwamba uzee na kasoro za utambuzi (kwa mfano, MCI na AD) zinaweza kupunguza nguvu ya utambuzi wa wazee. Kwa sababu hiyo, mara nyingi tunatazama kupungua kwa kasi ya usindikaji wa habari, muda wa umakini, kumbukumbu ya muda mrefu au ya muda mfupi, na utendaji wa magari katika kikundi hiki cha watu [7, 18]. Ni muhimu kutambua kwamba umri wa mwanzo na ukali wa kupungua kwa utendaji wa utambuzi na motor kwa wazee ni chini ya tofauti kubwa za mtu binafsi. Kwa kiwango fulani, mwanzo wa kuzorota kwa utambuzi wa utambuzi unaweza kucheleweshwa na kasi ya maendeleo inaweza kupunguzwa kwa kushiriki kikamilifu au kwa kawaida katika kujifunza ujuzi, mwingiliano wa kijamii, ukarabati wa utambuzi na akili, au mazoezi ya mwili. Katika miaka ya hivi karibuni, idadi inayoongezeka ya masomo juu ya wanyama na wanadamu imetoa ushahidi wa moja kwa moja au wa moja kwa moja kwa faida za shughuli za akili na za kimwili katika kuchochea na kukuza majibu ya ubongo ya kazi muhimu kwa afya au kazi ya kawaida ya utambuzi na motor. Mafunzo au mazoezi yanadhaniwa kusababisha uwezo ulioimarishwa wa utendaji wa magari na kazi za ubongo. Inaonekana kuwa mtindo wa maisha wenye afya, mazoezi ya mara kwa mara au ya kawaida, na mazingira yaliyotajirishwa, kwa kutoa shughuli za mwili na fursa za kufanya maamuzi, kuwezesha maendeleo ya taratibu hizi mbili muhimu za neva, na chini ya hali hizi, mabadiliko yanayotokea katika ubongo yanaweza kuwa ya muda mrefu. Katika maisha yetu, neuroni hupitia mabadiliko ya kuendelea au ya kuendelea, mchakato unaoitwa "neural plasticity" - synaptogenesis inahusu mchakato wa neva wa kuongezeka kwa uhusiano wa synaptic kati ya seli za ubongo jirani. <unk>Neurogenesis<unk> ni tukio la kuzaliwa kwa neuroni mpya. Utafiti unaonyesha kwamba mazoezi ya kawaida ya mwili au kujifunza motor huwezesha kuhifadhi kazi ya utambuzi kupitia taratibu kadhaa. Katika muktadha huu, "kufanya mazoezi kila siku huondoa ugonjwa wa Alzheimer" ni usemi rahisi lakini sahihi wa faida za shughuli za mwili kwa wazee. Mazoezi, mazoezi ya mwili, kujifunza ujuzi, au kuchochea shughuli za akili ni kudhaniwa kuchochea uundaji wa uhusiano mpya kati ya seli za ubongo na malezi ya neurons (kwa mfano, [10, 43]. Hii hupunguza kasi ya mchakato wa kuzeeka na kupunguza kuzorota kwa utambuzi na kusaidia kuhifadhi ubora wa maisha kwa wazee. Watafiti wengine wamejaribu kutumia teknolojia za msingi wa kompyuta kwa mafunzo ya kumbukumbu au ukarabati katika idadi ya wazee (kwa mfano, ). Kwa mfano, Rasmusson et al. "Wanafunzi wa umri wa miaka miwili na zaidi walipata ""kuongeza kwa kiasi kikubwa utendaji wao wa utambuzi"" kutokana na mafunzo ya kumbukumbu ya kikundi, mafunzo ya kumbukumbu ya kusikia, na mafunzo ya kumbukumbu ya kompyuta." Moore et al. Utafiti huo ulionyesha kuwa programu za kurekebisha kumbukumbu zinaweza kuwezesha utendaji wa kumbukumbu ya wagonjwa wa AD wa kiwango cha chini hadi cha wastani katika kazi za maisha ya kila siku. Walipendekeza kwamba aina hii ya mazoezi yapaswe kuunganishwa na tiba nyinginezo ili kupata matokeo mazuri. Kulingana na ukaguzi wa fasihi na tabia sifa ya watu wazee, Mayhorn et al. Mfumo huu umejumuisha mikakati kadhaa na umebuni mbinu ya utaratibu kwa ajili ya mafunzo ya kompyuta yenye ufanisi kwa wazee. Utafiti huo ulisaidia kuimarisha uwezo wa kujifunza na kuboresha utendaji wa jumla wa utambuzi. Makala hii ya mapitio hutoa ushahidi kuhusu matatizo ya harakati na athari za mazoezi ya motor juu ya kazi ya sensorimotor kwa wazee wenye afya na wagonjwa wa MCI na AD. Takwimu za empirical zilizozungumziwa katika sehemu zilizotangulia zinaonyesha wazi mchango wa kujifunza ujuzi wa motor na utendaji, mazoezi na shughuli za kimwili kwa kazi za kimwili na za utambuzi za watu wazee. "Uhakika unaongezeka unaonyesha kwamba mpango wa mazoezi unaofaa unaweza kusaidia kupunguza ""kuzorota kwa utambuzi na mwendo"" unaoonekana kwa watu walio na ugonjwa wa Alzheimer's au MCI." Kwa hivyo, uingiliaji wa tabia au matibabu hufikiriwa kuwa sahihi kwa wazee, wale ambao ni afya na wale ambao wanateseka na kasoro ndogo za utambuzi au upotezaji wa kumbukumbu zinazohusiana na mchakato wa kuzeeka. Kwa maneno mengine, idadi ya athari za vitendo na kliniki zinaweza kuchukuliwa kutoka kwa matokeo ya uzoefu kutoka kwa masomo kadhaa ya hivi karibuni (kwa mfano, [2, 32, 36]. Kwa mfano, matatizo ya utambuzi na utendaji wa magari mara nyingi huhusianishwa na uzee wa kawaida, MCI, au AD. Ingawa ushahidi wa tabia unaonyesha kuwa wagonjwa wa MCI na AD wanaitikia na kusonga polepole, ni tofauti zaidi, na huonyesha kusita zaidi (kwa mfano, jerks) katika harakati zao kuliko wenzao wa umri, jinsia, na elimu au watu wazima wadogo, mifumo ya neuropsychological na neurophysiological ambayo inahesabu sifa hizi za sensorimotor sio wazi kabisa na inahitaji uchunguzi zaidi. Kwa mfano, kuchunguza sehemu ya utendaji ya kumbukumbu ya kazi kunaweza kutoa habari mpya kuhusu matatizo ya utendaji wa magari miongoni mwa wazee. Uelewa mpya wa taratibu za utambuzi au za magari zinazoongoza uharibifu huu utawezesha mipango na muundo wa uingiliaji wa tabia yenye ufanisi kwa idadi hii ya watu. Kwa upande mwingine, ni wazi kwamba kujifunza motor au mazoezi ya kimwili inaweza kuongeza uwezo wa utambuzi na udhibiti wa motor katika wazee wenye afya na wale walio na AD na MCI na kwa hivyo kusababisha utendaji bora wa motor. Hata hivyo, jinsi ya kutathmini kwa ufanisi kujifunza ujuzi wa magari na kuelewa sifa zinazohusiana na kuzeeka katika aina mbalimbali za tabia ya magari haijulikani wazi. Vipimo vya kawaida vya ujuzi wa utambuzi na motor bado hazijashughulikia heterogeneities ya tabia inayoonekana katika idadi ya watu wenye kuzeeka (ikiwa ni pamoja na wagonjwa wa MIC na AD). Tathmini hizo zinapaswa kuwa rahisi na za vitendo, kutumia, ikiwezekana, harakati zinazopatikana katika shughuli za kawaida za kila siku, na kupima ufanisi wa harakati hizi (kwa mfano, kasi, laini, usahihi, udhibiti wa kuzuia, na uchumi wa juhudi). Uelewa bora wa sifa muhimu za upungufu wa harakati na sifa zinazohusiana za kinematics za utendaji wa motor katika idadi ya watu wa MCI na AD ni muhimu kwa watendaji. Kwa upande mwingine, ingawa matokeo ya utafiti wa awali wa utafiti wa athari za mazoezi juu ya kujifunza na udhibiti wa motor katika MCI na AD yamekuwa ya kutia moyo (kwa mfano, [43, 44]), ni kidogo sana inayojulikana kuhusu mikakati bora au mbinu. Kwa mfano, usingizi unaonekana kuwa muhimu kwa kuimarisha kumbukumbu ya magari na kujifunza ustadi kwa ujumla. Hata hivyo, utafiti zaidi unahitajika ili kuamua hasa jinsi usingizi unavyoathiri kujifunza ujuzi wa magari kwa wazee au watu wenye ulemavu wa utambuzi. Hivi karibuni, mwandishi wa sura hii amechunguza athari za usingizi wa mchana na usingizi wa usiku juu ya kujifunza ujuzi wa magari ya wazee wenye hasara ya kumbukumbu au dysfunctions ya utambuzi (usahihi wa wakati). Inatarajiwa kwamba katika mipango ya matibabu ya baadaye kwa watu wanaosumbuliwa na MCI au AD, udhibiti wa usingizi (kwa mfano, wakati na muda) utaingizwa katika utaratibu wa matibabu. Mwishowe, kwa kuwa teknolojia ya kompyuta inazidi kuwa ya kawaida, tunatarajia kwamba mbinu mbalimbali za kompyuta zitatumiwa katika mafunzo ya kumbukumbu au ukarabati wa wazee. Hata hivyo, baadhi ya shughuli za kila siku za kimwili au akili au mchanganyiko wa shughuli zote mbili za kimwili na akili bado inaweza kuwa njia bora zaidi ya kuboresha utendaji wa magari na utambuzi wa wazee na kufikia matokeo bora. "Albert Moss, MD, Tenzing R, Jones K, MD, M.D. (2001) ""Utabiri wa kabla ya kliniki wa AD kwa kutumia vipimo vya neuropsychological.""" J. Int Neuropsychology, S. 7631, 639: Barnes, R. D. Whitmer, J. K. Yaffe, 2007: Shughuli za kimwili na dementia: uhitaji wa majaribio ya kuzuia. "Kama ilivyoelezwa katika kitabu cha ""Exercise Science Rev 35:24-29"" na ""Bennett, Wilson, R.S.J. Schneider, Evans, Beckett, L.A., Aggarwal, N.T., Barnes, L.L., Fox, J.H., Bach, J.,"" ""Uchunguzi wa asili wa kasoro kali ya utambuzi kwa wazee.""" Neurology 59: 208-205 Bond, W. V. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F. F "Bowen J. Teri L. Kukul W. McCormick W. McCurry S. Larson E. (1997) ""Uzuri wa ugonjwa wa akili kwa wagonjwa wenye kupoteza kumbukumbu kwa muda mfupi.""" "Lancet, 349: 763, 765, Brookmeyer, R. Johnson, E. Ziegler-Graham, K. Arrighi, H. M. (2007) ""Utabiri wa mzigo wa ulimwengu wa ugonjwa wa Alzheimer.""" Alzheimer's na Dementia: Uchunguzi wa shughuli za maisha ya kila siku katika dementia: maendeleo ya Bristol shughuli za maisha ya kila siku. 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