Sunteți pe pagina 1din 19
FAR EASTERN UNIVERSITY INSTITUTE OF NURSING
FAR EASTERN UNIVERSITY
INSTITUTE OF NURSING

Effects of Tai Chi on the Cognitive Functions and Mood of Geriatric Patients with Mild Alzheimer’s Disease

Rosette Anne B. Abad, Carina Vielle D. Camacho, Fatima Arianne M. Concepcion, Maverick S. Corpuz, Ma. Aireen Virginia Vianikka R. De Leon, Aliza Ann E. Eclarinal

Aims and Objectives: The purpose of this study was to determine the effectiveness of Tai Chi as an intervention to the cognitive function and mood of geriatric patients with mild Alzheimer’s disease.

Design: Quasi-experimental design, specifically non-equivalent pretest-posttest control group design was selected for this approach. Quantitative data was gathered through Standardised Mini Mental State Examination (SMMSE) and Profile of Mood States (POMS). Twenty (n=20) respondents were in the study. Furthermore, they were divided into two groups, ten (n=10) in the control group and ten (n=10) in the experimental group. Mean, independent t-test, and dependent t-test were utilized to infer the findings.

Results: Levels of cognitive function of geriatric patients in pretest and posttest of both groups is moderate cognitive impairment. For the mood, pretests of control group showed a little total mood disturbance and a lot for experimental group. Posttest of both groups changed to moderately. Cognitive functions and mood in pretest and posttest for both groups showed no significant difference.

Conclusion: There is not enough evidence to show that Tai chi has an effect on cognitive function and mood of geriatric patients with mild Alzheimer’s disease.

INTRODUCTION

Alzheimer’s

dementia, is a neurodegenerative disease wherein there is memory loss, impaired communication, difficulty in carrying out motor skills, and inability to understand information from the five senses. Its symptoms usually develop slowly and get worse over time, but in some case, symptoms appear earlier and faster. Researchers at the

disease,

a

type

of

University of California, San Diego, found Alzheimer’s hit the “younger elderly” harder. Those in their 60s and 70s lost their mental sharpness quicker and brain mass faster than those in their 80s and 90s, according to the study of 723 older people (Adams, 2012). It is divided into 3 stages: mild Alzheimer’s disease, moderate Alzheimer’s disease, and severe Alzheimer’s disease. Mild Alzheimer’s disease is the first stage. A person may still function independently, but he or she may start to have memory lapses.

Common difficulties include: memory loss or recent events, difficulty with problem solving, complex tasks, and sound judgements, changes in personality, difficulty in organizing and expressing thoughts, and getting lost or misplacing belongings (Alzheimers disease, 2018).

Providing early treatment would lessen the advancement of the disease. Unfortunately, there is still no cure for Alzheimer’s disease, but there are ways that can decrease the progression of symptoms such as non-pharmacologic interventions. Non-pharmacologic interventions, such as physical exercise, have effect sizes similar to pharmacologic interventions in improving cognitive function (Brotons & Koger, 2000; Graf et al., 2001; Luijpen, Scherder, Van Someren, Swaab, & Sergeant, 2003). Exercise generally has been shown to improve cognitive functioning. It may slow the decline of cognitive function in elders with these conditions because it reduces pro- inflammatory cytokines in the periphery (Woods, Vieira, & Keylock, 2006). Convincing evidence indicates alteration of cytokine levels in the periphery also will affect the central nervous system (Wilson, Finch, & Cohen, 2002) because circulating pro-inflammatory cytokines can be transported into the central nervous system across the blood-brain barrier (Maier, 2003). A reduction in pro-inflammatory cytokines in the periphery caused by exercise may lead to decreased pro-inflammatory cytokines in the brain, and thus slow the decline of cognitive function in elders with pathological brain conditions caused by inflammation. Neurons continue to grow and change beyond the first years of development and well into

adulthood. Some of the changes were dramatic by neuron standards. One dendrite sprouted an impressive 90 microns (about .003 inches), more than doubling its length in less than two weeks (Nedivi et al., 2005). Even though exercise appears effective in maintaining cognitive function for elders, many community- dwelling elders with cognitive impairment do not exercise because they have multiple medical conditions and little physical strength (Bynum et al., 2004). They require exercise programs tailored to their frail physical conditions.

Tai Chi may be an excellent intervention for elders with cognitive impairment because it is a safe, gentle form of exercise that can be performed while standing or sitting. It is appropriate for different levels of mobility, and requires no special equipment or special clothing. Research shows that group exercises such as Tai Chi causes increase of blood vessel growth in the brain (angiogenesis) and is important to maintain the health of newly generated neurons. Using magnetic resonance imaging (MRI), a recent study found good correlations among exercise, neurogenesis in the dentate gyrus, cerebral blood volume, and cognition in humans (Pereira et al., 2007). Such findings suggest these observations could be made in elders who participate in Tai Chi exercise regularly. Because Tai Chi is not expensive, it is feasible in a wide variety of settings in the community, including senior centers, churches, adult day centers, and continuing care communities (Li et al., 2001; Tsai et al.,

2009).

On the other hand, in 2013 in a study conducted by Kaplan, Tai Chi can improve

clinical outcomes of mood disorders in older adults-as demonstrated in brain scans, biomarkers of cellular aging, and mental health rating scales (Kaplan 2013). Tai Chi training could increase noradrenaline excretion in urine, decrease salivary cortisol levels, and raise heart rate, leading to a less general mood disturbance with feelings of more vigor and less tension, anger, fatigue, confusion, state anxiety, and depression. A following study suggested that, whilst enhancing vigor, Tai Chi could reduce mental and emotional stress, reduce salivary cortisol levels, and improve mood states, although the author admitted that this could be due to the high expectancy level of people practicing Tai Chi (P. Jing, 1989).

With all the supporting studies for this paper that were mentioned, the researchers are ready to use Tai Chi as exercise to add knowledge whether Tai Chi has effects on cognitive function and mood of patients with mild Alzheimer’s Disease.

Prescriptive Theory

The researchers adapted the Prescriptive Theory by Ernestine Weidenbach which was based on three factors which were central purpose, prescription and realities. Ernestine Wiedenbach’s Prescriptive theory can be compared to the nursing process which includes assessment, planning, implementation and delivery of the nursing care. Wiedenbach defined Prescriptive theory as a theory in which the desired outcome was conceptualized and actions were planned to deliver to achieve a desired goal.

The prescriptive theory comprised central purpose, prescription and realities. Central purpose refers to the nurse’s philosophy of caring. As based on the study, the central purpose of the study was to enhance the cognitive functions and mood of Geriatric patients with mild Alzheimer’s disease. Prescription were actions that were implemented to achieve the desired outcome. The prescription of the study was the implementation of Tai Chi as an aerobic exercise to enhance cognitive functions and mood of geriatric patients with mild Alzheimer’s disease. Realities includes the factor that could affect how the prescription is implemented and how the nurse fulfills the desired outcomes. Realities in the study was the agent as the researchers, the recipient as the geriatric patients with mild Alzheimer’s disease and the goal which was the enhancement of cognitive functions and mood of geriatric patients with mild Alzheimer’s disease.

METHODOLOGY

Research Design

The researchers used a Quasi- experimental design, specifically non- equivalent pretest-posttest control group design. In the non-equivalent pretest-posttest control group design, respondents were assigned to either a control or experimental group. Both groups were pretested, and then the experimental group was exposed to the intervention while the control group was not. When the intervention was finished, both were post tested. Quasi experiments were called controlled trials without randomization in the medical literature. With

this design, the researchers examine change and the use of experimental design is the gold standard for testing interventions and it yields strong evidence about the effect of interventions (Polit & Beck, 2012). In this study, Tai chi was the independent variable. The effect on mood and the effect on cognitive function were the two dependent variables. The experimental group with 10 respondents performed Tai Chi, and the control group with 10 respondents didn’t performed Tai Chi.

Population and Sampling

The research study had involved twenty geriatric patients with Mild

Alzheimer's disease and had been

into two groups which included one experimental group (implementation of Tai Chi) and one controlled group (without implementation of Tai Chi). In simple experimental research with tight controls, successful research may be conducted with samples as small as 10 to 20 (Roscoe, 1975). Also because of the specific eligibility criteria, gathering samples more than 20 would be economically inefficient. The study population included geriatric patients who had met the inclusion criteria (geriatric patients diagnosed with Mild Alzheimer's disease, having the ability to participate in Tai Chi as an aerobic exercise, age 60-70 years old, having stable vital signs; temperature, blood pressure, pulse rate, pain scale and respiratory rate, and with a doctor's Clearance) and exclusion criteria (geriatric patients diagnosed with either respiratory disease and cardiovascular disease).

divided

respiratory disease and cardiovascular disease). divided The sampling technique was purposive sampling. The purposive

The sampling technique was purposive sampling. The purposive sampling technique, also called judgment sampling, is the deliberate choice of an informant due to the qualities the informant possesses. It is a nonrandom technique that does not need underlying theories or a set number of informants. Simply put, the researcher decides what needs to be known and sets out to find people who can and are willing to provide the information by virtue of knowledge or experience (Bernard 2002, Lewis & Sheppard 2006) The inclusion and exclusion criteria had been provided to the administrators of the facility. They had

chosen 20 research respondents that had the inclusion and exclusion criteria.

met

Instrumentation

Two instruments had been used in this study. The first was the Standardised Mini-Mental State Examination (SMMSE). It was first published in 1991 written by Dr. D. William Molloy. It was a 12-question which measured cognitive function: orientation, registration, attention and calculation, recall, and language. The second instrument that had been used in this study was the Profile of Mood States (POMS). It was developed by McNair et.al in 1971. It contained 65 self- report items using the 5-point Likert Scale. It had measured the six different dimensions of mood swings over a period of time: Tension or Anxiety, Anger or Hostility, Vigor or Activity, Fatigue or Inertia, Depression or Dejection, Confusion or Bewilderment (McNair et.al, 1971).

Data Analysis

Three types of data analysis were used to infer the findings; mean, independent t-test, and dependent t-test.

Data Collection and Procedure

The researchers got an approval of the nursing home to conduct the research study. They selected the respondents based on the inclusion criteria. Data was reviewed by the researchers. The research involved twenty geriatric patients with mild Alzheimer’s disease, the diagnosis was determined by their records and divided into two groups which included one experimental group (implementation of Tai Chi) and one control group (without implementation of Tai Chi). The study population included geriatric patients who met the inclusion criteria: (1) geriatric patients who were diagnosed with mild Alzheimer’s disease; (2) having the ability to participate in Tai Chi as an aerobic exercise; (3) geriatric age: 60-70 years old; (4) having stable vital signs (temperature, blood pressure, pulse rate, pain scale and respiratory rate); (5) having doctor’s clearance. Excluded in the study are: (1) geriatric patients diagnosed with cardiovascular diseases and (2) geriatric patients diagnosed with respiratory diseases.

The researchers explained the content and the objective of this study to the respondents, guardian of the respondents and the institution. They thoroughly elaborated the informed consent to the institution and respondents if they were willing to participate.

In this study, 10 respondents each for control group and experimental group. The

control group did not receive intervention and retained activities of daily living such as eating, taking a batch, watching TV, set activities for the day such outreach programs and napping. The experimental group were given eight sessions of Tai Chi therapy with a duration of 40 minutes. Their vital signs were assessed after each session of Tai Chi therapy. One pretest and one posttest was used in this study. Pretest was given on geriatric patients with mild Alzheimer’s disease of the experimental group and control group. The researchers assessed the level of cognitive function by Standardised Mini Mental State Examination and assessed the level of mood using Profile of Mood States. After the intervention, the experimental group and control group will undergo a posttest in which the researchers will assess the level of cognitive function using Standardised Mini Mental State Examination and assess the level of mood using Profile of Mood States. Blood pressure was also checked before and after every session of tai chi therapy of the control group and experimental group.

Tai Chi therapy was implemented to the experimental group. The control group did not receive Tai Chi therapy. The researchers provided the Standardised Mini Mental State Examination to measure the level of cognitive function and the Profile of Mood States to measure the level of mood. Results were analyze to determine the effects of Tai Chi therapy in cognitive function and mood among geriatric patients with mild Alzheimer’s disease.

RESULTS

Cognitive Functions

Score

Level

WMI

Interpretation of

Cognitive

Impairment (CI)

24

to

4

3.26-

No CI

30

4.00

19

to

3

2.51-

Mild

23

3.25

10

to

2

1.76-

Moderate

18

2.50

<9

1

1.00-

Severe

1.75

Table 1 shows the pretest scores in each domains of cognitive functions of the respondents in the control group. In orientation- time, they scored 1.7. In orientation-place, they scored 1.1. They garnered 1.8 in memory- immediate and 2.2 in language/attention. In the memory-short, they got a score of 1.1. In the language/memory-long, they garnered 0.6. In language/memory-short, they scored 0.6. In language/abstract thinking/verbal fluency, they scored 0.4. They amassed a score of 0.5 in

in

language/attention/comprehension. 0.1 was the

the

attention/comprehension/follow

commands/constructional. And 1.7 was the score

they

attention/comprehension/construction/follow commands. Overall, they scored 12.2 with a level of 1.90. Hence, it is interpreted as moderate cognitive impairment. All of the respondents were diagnosed with mild Alzheimer’s disease in which it causes a slow progressive decline in their memory and cognitive abilities. It was observed during pretest that respondents were displaying a wide array of behavior patterns indicative of memory loss, poor judgment leading to bad decisions, loss of spontaneity and sense of initiative, taking longer to complete normal daily tasks, repeating questions, etc…

in

score

language and

0.4

in

they

got

got

Table 2 displays the posttest scores in each domains of cognitive functions of the respondents in the control group. In orientation- time, they scored 1.4. In orientation-place, they

scored 1.6. They garnered 1.6 in memory- immediate and 2.2 in language/attention. In the memory-short, they got a score of 1.0. In the language/memory-long, they garnered 0.6. In language/memory-shot, they scored 0.6. In language/abstract thinking/verbal fluency, they scored 0.4. They amassed a score of 0.3 in both

in

language/attention/comprehension. 0.4 was the

score

the

attention/comprehension/follow

language

and

got

they

in

commands/constructional. And 1.5 was the score

in

attention/comprehension/construction/follow commands. Overall, they scored 11.9 with a level of 2.0. Thus, it was still interpreted as moderate cognitive impairment. Their overall score was

lower compared on the first day. On the last day, the researchers observed that the respondents were inactive. They were just sitting and didn’t do anything. The body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life (Booth et.al, 2012). Still, the respondents showed a wide array of behavior patterns indicative of memory loss, poor

of

spontaneity and sense of initiative, taking longer

to complete normal daily tasks, repeating questions, etc…

Table 3 indicates the pretest scores in

each domains of cognitive functions of the respondents in the experimental group. In orientation-time, they scored 1.3. In orientation- place, they scored 2.3. They garnered 1.8 in memory-immediate and 3.3 in language/attention. In the memory-short, they got a score of 0.9. In the language/memory-long, they garnered 0.9. In language/memory-short, they scored 0.7. In language/abstract thinking/verbal fluency, they scored 0.5. They accumulated a score of 0.9 in language and 0.4 in language/attention/comprehension. 0.3 was the

the

score they received in

attention/comprehension/follow commands/constructional. And 2.4 was the score

judgment leading to bad decisions, loss

they

got

in

attention/comprehension/construction/follow commands. All in all, the group amassed a total score of 15.7 with a level of 2.40. Hence, interpreted as moderate cognitive impairment. Same as the control group during pretest, all of the respondents were diagnosed with mild Alzheimer’s disease. As a result, it causes a slow decline in their cognitive functions. Also during pretest, the researchers noticed that the respondents for this group displayed behaviors indicative to alteration of their cognitive functions such as memory loss, poor judgment leading to bad decisions, loss of spontaneity and sense of initiative, taking longer to complete normal daily tasks, repeating questions, etc…

they

got

Table 4 shows the posttest scores in each domains of cognitive functions of the respondents in the experimental group. In orientation-time, they scored 1.5. In orientation- place, they scored 2.9. They garnered 2.1 in memory-immediate and 2.5 in language/attention. In the memory-short, they got a score of 0.9. In the language/memory-long, they garnered 0.8. In language/memory-short, they scored 0.9. In language/abstract thinking/verbal fluency, they scored 0.5. They amassed a score of 0.8 in language and 0.7 in language/attention/comprehension. 0.5 was the

score

the

attention/comprehension/follow

commands/constructional. And 1.7 was the score

in

they

attention/comprehension/construction/follow commands. In general, the group scored 15.8 still with a level of 2.40, interpreted as moderate cognitive impairment. There was 0.1 increase in their overall score. Although Tai Chi was provided to this group, there was still no improvement in their cognitive functions. Still, it was categorized as moderate cognitive impairment. During the course of the implementation, some of the respondents were not able to follow some of the directions of the tai chi instructor because they find it difficult to follow and they experience pain when they

they

got

got

in

execute a particular movement. Chronic illness, disability, joint pain, etc., are common health problems that can keep older adults from exercising (Matthews et.al, 2010). They may fear pain, further injury or sickness, or simply assume that they can’t physically do the work (Walther, J., 2015). When older adults render their bodies unfit and incompetent, developing a fear of injury is natural. Fear of falling, getting hurt, and general safety (Lees et. al, 2005) are among the most commonly reported barriers older adults express (Matthews et.al, 2010).

Mood

Score

Level

WMI

Interpretation of

Mood Status

90

to

4

3.50-

Extremely

100

4.00

60

to

3

2.51-

Quite a lot

89

3.50

30

to

2

1.51-

Moderately

59

2.50

6 to 29

1

0.51-

A little

1.50

0 to 5

0

0.00-

Not at all

0.50

*based on Dedekind cut

Table 5 shows the pretest results of the mood status of the respondents in the control group. The respondents scored 8.0 in Tension. 5.2 was the score they gathered in Anger. They amassed 5.3 in Fatigue. They scored 8.8 in Depression. In the Esteem-Related Affect, they garnered with a score of 9.9. In the Vigour, they scored 10.4. And lastly on the Confusion, they amassed a score of 7.6. Their total mood disturbance was 34.6 with a level of 1.80. Hence, it was interpreted as a little. During pretest, the researchers observed that during the interview, some were lively, some were tired, some were sad, and some were confused.

Table 6 shows the posttest results of the mood status of the respondents in the control

group. The respondents scored 4.9 in Tension.

1.4 was the score they gathered in Anger. They

amassed 3.1 in Fatigue. They scored 5.2 in Depression. In the Esteem-Related Affect, they garnered with a score of 8.2. In the Vigour, they scored 10.7. And lastly on the Confusion, they amassed a score of 3.8. Their total mood disturbance was 59.5 with a level of 2.40. Thus, it was interpreted as moderately. It can be seen on the table that most of the respondents got a low scores in Tension, Anger, Fatigue, Depression, Esteem-Related Affect and Confusion and they got high scores in Vigour. This is different than their pretest results. During posttest, the researchers learned that the respondents for this group took their respective medicines before the interview. After they took their respective medicines, most of the respondents felt relaxed during the course of the posttest interview. Some type of medicine such as mood stabilizers are medications designed to even out emotions that are highly variable. These drugs have also been prescribed at times to treat the behavioral and psychological symptoms of dementia (BPSD). These are also sometimes referred to as "challenging behaviors" in dementia (Heerema, 2018).

Table 7 shows the pretest results of the mood status of the respondents in the

experimental group. The respondents scored

5.0 in Tension. 3.1 was the score they gathered

in Anger. They amassed 5.6 in Fatigue. They scored 4.2 in Depression. In the Esteem- Related Affect, they garnered with a score of 14.9. In the Vigour, they scored 11.0. And lastly on the Confusion, they amassed a score of 6.5. Their total mood disturbance was 68.5 with a level of 2.90, interpreted as quite a lot.

Same as the control group, during pretest,

some respondents were lively. Some were tired, sad, and confused.

Table 8 shows the posttest results of the mood status of the respondents in the experimental group. The respondents scored 4.9 in Tension. 2.1 was the score they gathered in Anger. They amassed 3.1 in Fatigue. They scored 3.4 in Depression. In the Esteem- Related Affect, they garnered with a score of 10.8. In the Vigour, they scored 13.8. And lastly on the Confusion, they amassed a score of 3.5. Their total mood disturbance was 52.4 with a level of 2.20. Hence, it was interpreted as moderately. Their score in their total mood disturbance was lower than their pretest score. As observed by the researchers on gathering the posttests, the respondents’ mood status were observed to be more positive as compared to the time when pretest were gathered. Respondents were more alive, active and showed great appreciation after the intervention.

active and showed great appreciation after the intervention. Table 9 suggests that the control group mean

Table 9 suggests that the control group mean pretest test score as regards to their cognitive functioning was 1.90 while the control group mean posttest score was 2.0. The computed t value was -1.00 and the registered p value was .0.343 which is interpreted as not significant when contrasted against the level of significance which is .05 hence the null hypothesis of no significant difference was accepted. Cognitive change as a normal process of aging has been well documented in the specific literature. Some cognitive abilities,

such as vocabulary, are resilient to brain aging and may even improve with age. Other abilities, such as conceptual reasoning, memory and processing speed, decline gradually over time. (C.N.Harada, M.C. Natelson Love & K.Triebel, 2014)

time. (C.N.Harada, M.C. Natelson Love & K.Triebel, 2014) Table 10 indicates that the experimental group mean

Table 10 indicates that the experimental group mean pretest test score as regards to their cognitive functioning was 2.40 while the experimental group mean posttest score was 2.40. The computed t value was 0.00 and the registered p value was 0.343 which is interpreted as not significant when contrasted against the level of significance which is .05 hence the null hypothesis of no significant difference was accepted. The result of no significant between pretest and posttest of the experimental group’s level of cognitive functioning was related to the limited amount of time the Tai Chi exercise was implemented. Cognitive enhancement may best respond to treatments that were implemented for a longer period of time. The findings of a Tai Chi study by Lam and associates showed that a simplified form of Tai Chi developed specifically for the elderly improved cognitive functions as well as coordinated cognitive integration of attention, voluntary motor actions and postural control. Verbal and visual imagery required during Tai Chi practice may provide additional cognitive stimulation. Kasai and associate examined the effect of a 6-month Tai Chi intervention on cognition of elderly women with mild cognitive impairment and

found a significant improvement in memory performance (Y. Wu et.al, 2013).

improvement in memory performance (Y. Wu et.al, 2013). Table 11 demonstrates that the control group mean

Table 11 demonstrates that the control group mean pretest test score as regards to their mood status was 1.80 while the control group mean posttest score was 2.40. The computed t value was -1.50 and the registered p value was 0.168 which is interpreted as not significant when contrasted against the level of significance which is .05 hence the null hypothesis of no significant difference was accepted. A number of studies reported that neuropsychiatric symptoms (NPS) of dementia refer to a heterogeneous group of disturbances in perception, thought content, mood, personality, behavior, and basic functions (Finkel et al., 1996; Gauthier et al., 2010). NPS occur in 8090% of patients in the course of Alzheimer’s disease (AD) (Robert et al., 2005; Gauthier et al., 2010). Patients diagnosed with mild Alzheimer’s disease frequently present with depressed mood, anxiousness, irritability, and social withdrawal (Lyketsos et al., 2002).

irritability, and social withdrawal (Lyketsos et al., 2002). Table 12 suggests that the experimental group mean

Table 12 suggests that the experimental group mean pretest test score as regards to their mood status was 2.90 while the experimental

group mean posttest score was 2.20. The computed t value was 1.48 and the registered p value was 0.173 which is interpreted as not significant when contrasted against the level of significance which is .05 hence the null hypothesis of no significant difference was accepted. Based on table 4, there are changes in the mood of the respondents from quite a lot to moderately, however data shows no significant difference. There was a randomized controlled trial that found no significant impact of Tai Chi on mood. That trial randomized 22 community-dwelling participants (mean age 68 years) with lower extremity osteoarthritis to 12 weeks of twice-weekly, 1-hour-long Tai Chi sessions or to a control group. Tai Chi was found to improve pain, physical function, and other arthritis symptoms (measured using the Arthritis Self-Efficacy Scale) as well as satisfaction with general health status, but it did not result in a statistically significant difference in mood (Abbott and Lavrensky, 2013). Thus, accepting the null hypothesis.

and Lavrensky, 2013). Thus, accepting the null hypothesis. Table 13 elaborates the difference between post test

Table 13 elaborates the difference between post test scores of control and experimental group as to their cognitive functioning and it shows that the composite mean score of the group which did not receive manipulation bore a 2.0 rating or moderate impairment and the experimental group score was 2.40 and was also categorized as moderate. The computed t value was -.840 and

the registered p value was .844 which is interpreted as not significant when contrasted against the level of significance which is .05 hence the null hypothesis of no significant difference was accepted. The result of no significant difference was related to the inability of the respondents to follow and retain directions given to them while taking into consideration also their attention and span of focus to follow the rhythmic movements required to complete Tai Chi exercise program and their physical abilities. A number of studies reported exercise also benefited cognition in elders with cognitive impairment (CI). Even though exercise appears effective in maintaining cognitive function for elders, many community-dwelling elders with CI do not exercise because they have little physical strength and multiple medical conditions. Because Tai Chi is not expensive, it is feasible in a wide variety of settings in the community, including senior centers, churches, adult day centers, and continuing care communities.

adult day centers, and continuing care communities. Table 14 displays the difference between post test scores

Table 14 displays the difference between post test scores of control and experimental group as to their mood state and

it shows that the composite mean score of the

group which did not receive manipulation bore

a 2.40 rating or moderate impairment and the

experimental group score was 2.20 and was also categorized as moderate. The computed t value was -3.35 and the registered p value was

.741 which is interpreted as not significant when contrasted against the level of significance which is .05 hence the null hypothesis of no significant difference was accepted. As it stated in table 4, during the posttests, the respondents’ mood status were observed to be more positive as compared to the time when pretest were gathered. Respondents were more alive, active and showed great appreciation after the intervention. As a result, there are changes in the mood of the respondents from quite a lot to moderately, but data still shows no significant difference.

CONCLUSION

Levels

of

cognitive

function

of

geriatric patients in pretest and posttest of both

groups is moderate cognitive impairment. Pretests of control group showed a little total mood disturbance and a lot for experimental group. Posttest of both groups changed to moderately. Cognitive functions and mood in pretest and posttest for both groups showed no significant difference. Tai chi has no effect on the cognitive functions and mood of geriatric patients with mild Alzheimer’s disease.

RECOMMENDATIONS

From

the

resultant

findings

and

conclusions, we encourage:

a.) better implementation techniques wherein the geriatric patients will be able to internalize fully the Tai Chi exercise.

b.) implementation to a larger sample group and a longer period of time to fully exhibit the

effects of Tai Chi on cognitive function and mood of patients with mild Alzheimer’s disease.

c.) utilization of Tai Chi exercise to other chronic diseases such as arthritis, digestive disorders, and depression, and a different age group or population.

REFERENCES

Adams J. (2012, August 2). Alzheimer’s ‘more aggressive’ in the ‘young elderly’. Retrieved at https://www.telegraph.co.uk/news/health/new

s/9446837/Alzheimers-more-aggressive-in-

the-younger-elderly.html

Alzheimers

disease.

(2018,

December

8).

Retrieved

at

https://www.mayoclinic.org/diseases-

conditions/alzheimers-disease/symptoms-

causes/syc-20350447

Brotons M., Koger S.M. The impact of music

therapy

dementia. Journal

Therapy. 2000;37(3):183195.

Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 1143-211.

Bynum J.P. et.al. (2004, February). The relationship between a dementia diagnosis,

chronic illness, medicare expenditures, and

hospital use. Retrieved

https://www.ncbi.nlm.nih.gov/pubmed/14728

626

Finkel S. I., Costa e Silva J., Cohen G., Miller S., Sartorius N. (1996). Behavioral and psychological signs and symptoms of

on

language

functioning

of

in

Music

at

dementia: a consensus statement on current knowledge and implications for research and treatment. Int. Psychogeriatr. 8(Suppl. 3),

497500

Gauthier S., Cummings J., Ballard C., Brodaty H., Grossberg G., Robert P., Lyketsos C. (2010). Management of behavioral problems in Alzheimer’s disease. Int. Psychogeriatr. 22,

34637210.1017/S1041610210000888

Harada, C. N., Natelson Love, M. C., & Triebel, K. L. (2013). Normal cognitive aging. Clinics in geriatric medicine, 29(4),

737-52.

Heerema, E. (2018, September 22). Can Mood Stabilizers Help With Agitation in Dementia?.

Retrieved

at

https://www.verywellhealth.com/mood- 670?accountid=139285

stabilizers-role-in-dementia-98263

Lees,

Newman,

behavior among older adults: a focus-group

with cholinesterase inhibitors. Reviews in the Neurosciences. 2003;14(4):343368.

Lyketsos, C. et.al. (2005, Sep 25). Prevalence of Neuropsychiatric Symptoms in Dementia and Mild Cognitive Impairment. Retrieved at https://jamanetwork.com/journals/jama/fullart

icle/195320

Jin P. Changes in heart rate, noradrenaline, cortisol and mood during Tai Chi. Journal of Psychosomatic Research. 1989;33(2):197

206.

Kaplan, A. (2013). Mind-body interventions for mood disorders in older adults. Psychiatric Times, 30(9), 1-5,13. Retrieved from

https://search.proquest.com/docview/1442707

Maier R., Ulrich R. (2003) "Implementing process‐oriented knowledge management strategies", Journal of Knowledge Management, Vol. 7 Issue: 4, pp.62-

74, https://doi.org/10.1108/1367327031049

2958

Mathews, A.E., Laditka, S.B., Laditka, J.N.,

Wilcox, S., Corwin, S.J., Liu, R., Friedman, D.B., Hunter, R., Tseng, W., & Logsdon, R.G. (2010). Older adults’ perceived physical activity enablers and barriers: a multicultural perspective. Journal of Aging & Physical

Activity, 18,

119-

140. http://journals.humankinetics.com/AcuC

ustom/Sitename/Documents/DocumentItem/1

7918.pdf

Pereira A.C. et.al. (2007, Mar 27). An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus. Retrieved at

F.D.,

P.

Clark,

(2005).

P.G.,

Nigg,

to

C.R.,

&

Barriers

exercise

study. Journal

of

Aging

&

Physical

Activity, 13,

23-

13. http://journals.humankinetics.com/AcuCu

stom/Sitename/Documents/DocumentItem/45

12.pdf

Li F, Harmer P, McAuley E, Duncan TE, Duncan SC, Chaumeton N, Fisher KJ. An evaluation of the effects of tai chi exercise on physical function among older persons: A randomized controlled trial. Annals of Behavioral Medicine. 2001; 23(2):139146. [PubMed: 11394556] Luijpen M.W., Scherder E.J., Van Someren E.J., Swaab D.F., Sergeant J.A. Non- pharmacological interventions in cognitively impaired and demented patients--a comparison

https://www.ncbi.nlm.nih.gov/pubmed/17374

720

Robert P. H., Onyike C. U., Leentjens A. F. G., Dujardin K., Aalten P., Starkstein S., Verhey

F. R., Yessavage J., Clement J. P., Drapier D., Bayle F., Benoit M., Boyer P., Lorca P. M., Thibaut F., Gauthier S., Grossberg G., Vellas B., Byrne J. (2009). Proposed diagnostic criteria for apathy in Alzheimer’s disease and other neuropsychiatric disorders. Eur.

98

Psychiatry 24,

10410.1016/j.eurpsy.2008.09.001

Tsai P, Beck C, Chang JY, Hagen J, Anand S, Kuo Y, Beuscher L. The feasibility of implementing tai chi for nursing home residents with knee osteoarthritis and cognitive impairment. Activities Directors' Quarterly for Alzheimer's & Other Dementia Patients. 2009; 10(1):917.

Than, K. (2005, December 27). Adult Brain Cells Do Keep Growing. Retrieved at

https://www.livescience.com/505-adult-brain-

cells-growing.html

Walther, J. (2015, August 27). Are Older

Adults Indifferent, Scared, and Reluctant to

at

Exercise?. Retrieved

https://blog.nasm.org/uncategorized/are-

older-adults-indifferent-scared-and-reluctant-

to-exercise/

Wilson C.J., Finch C.E., Cohen H.J. (2002, December) Cytokines and cognition-the case for a head-to-toe inflammatory paradigm.

at

Retrieved

https://www.ncbi.nlm.nih.gov/pubmed/12473

Woods J.A., Viera K.J., Keylock K.T. (2006, August) Exercise, inflammation, and innate

at

immunity.

https://www.ncbi.nlm.nih.gov/pubmed/16877

Retrieved

125