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By definition, executive function entails capacity to perform tasks familiar tasks for example book balancing or being able to plan projects. A new study has found that Alzheimer’s disease start developing when one’s memory begins declining. This disease is common among the old people and it is associated with memory loss. The symptoms of this disease include memory loss, communication and reasoning problem and also mood changes. This disease has an effect on the brain. The first description of the disease was given by a neurologist from Germany by the name Alois Alzheimer (Baudic, 2006). The disease starts slowly and develops until it fully develops. At the course of its development, there is death of brain cells caused by development of plaques of protein in the brain structure. The disease is rated the commonest dementia form among elderly. The disease interferes with individual’s capacity to undertake daily activities. As the disease progresses, there is complete loss of memory, develops problems in reading, writing as well as speaking. In US alone, about 5.3 million people are suffering from the disease.
This disease occurs from the age of 60 years. Following the decline in memory, the executive functioning of the brain then follows suite. The early signs of the disease include loss of concentration, impairment of decision making; inability to multitasking as well as inability to pay gives attention to several tasks (Baudic, 2006). When the executive function declines, there is deterioration of situation as there is increased impairment of day to day activities. When this continues to occur, the mild impairment of cognition progresses to Alzheimer. The decline in memory affects the medial robe and these progresses to lowered ability to function properly. This is a clear indication that there is buildup of extra tangles as well as plaques within the brain as the executive function deteriorates. The plaque as well as tangle development is as a result of accumulation of proteins abnormally in the cells as well as presence of abnormal material presence outside the brain cells. This result to slow deteriorating death of neurons as well as shrinkage of part of the brain affected.
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Up to date, it is unknown why the impairment of mild cognition has an effect on memory and then finds its way to executive function during the progression of the disease into Alzheimer’s. Future studies will play a great role in determining whether a specific drug can be used in stopping or making the disease slow down. It is important for the relatives of the patient to inform the doctor in case they notice a change from decline of memory to executive function problems (Baudic, 2006). The physician can then act by issuing medication that can possibly slow the deterioration of the patient. The purpose of this paper is to review the work done on executive functioning of the brain. This paper also aims at reviewing previous work done on executive function of Alzheimer’s. Apart from that, the paper provides a room for further research on executive functioning in Alzheimer’s disease.
Review of the research
Sophie Baudic, Gianfranco Dalla Barba, Philippe Remy, Latchezar Traykov, and Marie Claude Thibaudet et al (2006) investigated about Executive deficit in early Alzheimer’s disease and their relationships with episodic memory. The research question was the relationship between executive deficit in Alzheimer’s and episodic memory (Baudic et al, 2006). The study also aimed at investigating baseline neuropsychological as well as clinical variables that predicts progress to AD dementia from MCI. The participants were patients of Alzheimer’s disease. They all underwent an evaluation on neuropsychology (Baudic et al, 2006). The time duration was six months. On doing follow-up for two years, about 54 of the original number of 109 patients developed dementia. 50 of these 54 developed AD dementia. Combination of California verbal learning test long delayed total recall (CVLT-LDTR) and that of MMSE was the best model to be predicted (Baudic et al, 2006). Participants who scored over 26/30 when using MMSE and 4/16 when using CVLT-LDTR developed a negative value of that could be predicted at a period of two years. The participants who scored figures lower that that were observed to be having a value that was positive (Baudic et al, 2006).
Stella Karantzoulis, James AND Gervin (2011) investigated on Dimentia and executive function as well as attention. they found that amnesia is rated as the commonest dementia form among elderlies. The disease interferes with individual’s capacity to undertake daily activities. As the disease progresses, there is complete loss of memory, develops problems in reading, writing as well as speaking. The population was patients suffering from Alzheimer’s disease (Karantzoulis, James & Gervin, 2011). All these patients were found to have poor memory. The study also found out that executive function of the brain is highly influenced by the disease. As the disease deteriorates, the executive function also deteriorates. Some of the participants who were males drawn from various hospitals were seen to be forgetting their family member.
Future research proposal
The research question for this study is how executive functioning of the brain is affected in Alzheimer’s disease. It hypothesizes that Alzheimer’s disease among the old people makes the executive functioning of the brain to deteriorate (Karantzoulis, James & Gervin, 2011).. The participants of this study are older people above 6o years who are suffering from Alzheimer’s disease. The sample size for this study is 200 elderly people who are suffering from Alzheimer’s disease. All those participating will be recruited from clinics as well as homes for the elderly. The demographic criteria used for selecting the participants will include age, sex and Alzheimer’s disease among others.
All those participating will be required to have a minimum age of 60 years. They will also be required to be suffering from Alzheimer’s disease. Only the control group will be exempted. The male participants will be 43% while the female participants will be 57%. The sample was a mixture of both white and blacks. The sample was randomly selected. The exclusive criteria were all elderly people who had no signs of Alzheimer’s disease. Each participant will be issued with consent form. They will be explained about the purpose of the study and reassure them that the information given will be for the purpose of the study only. There will be assessment of cognitive function. This will be done using modified min-mental status Examination.
This method is essential in measuring cognitive functions which include attention, language, orientation, as well as a memory which is short-term. The scores for this test will be from zero up to 100. Verbal learning as well as memory will be measured using the Buschke selective Reminding Test. There will be presentation of two words which the examiner will read aloud. The participants will be asked to remember the exact words the examiner had used. This process will be repeated for five times. Test on attention will be done using different shapes. The participants will be asked to differentiate these shapes.
As Alzheimer’s is associated with memory loss, it is expected that all the participants will have forgotten where they had been taught (Baudic et al, 2006). . Continuous memory loss results into deterioration of executive functioning of executive functioning in Alzheimer’s. as a result of this, those with highest level of deterioration are expected to even forget their family members. The independent variables for this study will be Alzheimer’s disease and age. The dependent variables will be executive functioning and memory loss. I expected to find the show how Alzheimer’s affects he executive functioning of the brain. It is expected that individuals who are at the advanced stage of the disease are likely to have a deterioration of the executive functioning. My hypothesis was supported. The research show that has proofed that the deterioration of executive functioning of the brain is as a result of Alzheimer’s disease.
There was a difference in the approach between the current study and generation of earlier ADI/Lancet being estimated and then summarized in the tables. There was a systematic review of worlds literature on prevalence of the dementia with the PubMed or the Medline in 2009 and using search terms prevalence, dementia or the epidemiology mesh. We also sorted out and included the population which based on the studies of prevalence of the dementia with the people who are aged above sixty years old and due to the statistical and the diagnostic manual of the mental disorders 4th edition or international classification of the diseases in the 10th edition criteria or even same clinical criteria, this shows that the field work began January 1980 (Baudic, 2006). Sampling was related to the exclusion criteria, the ascertainment of the procedures in case, and the outcome of the descriptions or definitions.
- Prevalence studies from follow up phase and rather the inception of the phase in the population cohort.
- The studies that sampled out of the date population register that was prepared 2 years prior the survey.
- The studies of the nursing residential or home care populations, attendees of primary care or the unrepresentative of the service populations.
- The studies whereby the ascertainment of the dementia only depended upon the help seeking and the receipt of the dementia care services.
- Also, the studies whereby dementia is diagnosed purely on basis of the cognitive impairment, such was according to the cut point on MMSE.
- There was inclusion of two phase studies whereby the screening methods or guidelines were inadequate and the two phase methodology was also applied properly.
- The Alzheimer disease prevalence studies or the dementia were restricted to the young and onset dementia.
All the eligible study was systematically coded thus the study quality design. The overall score quality is derived by the summing scores of the following elements;
Sample size: five hundred, 0.5 point; five hundred to 1499, 1 point; one thousand to two thousand nine hundred and ninety nine, 1.5 points; three thousand, 2 points
Study design: The two phase of the study has no sampling of the screen negatives and zero points, 2 phase study with the sampling of screen and negatives but not weighting back, one point; also one phase study or the two phase study that have appropriate sampling and the weighting, two points.
Response proportion: sixty percent, 1 point; sixty–eighty percent, 2 points; eighty five percent, 3 points.
Diagnostic assessment: One of the points, each of the multidomain cognitive battery testing, the assessment of formal disability, and the informative with clinical interviews.
The search which was done is what led to the abstracts which were used for 2017 publications. After the abstracts were read, that is when the 1764 publications were excluded. There were proved to be clearly ineligible. This therefore, left 253 for further review. Where possible, copies of each published version were obtained of each study. These were then carefully assessed against inclusion and exclusion criteria. Apart from that, a further 98 publications were excluded at this stage. This left 155 publications which described 157 studies that were provisionally eligible. Out of all the publications in twenty of them, it was not possible to confirm eligibility with the information which was found available. In other words it was unable to use the data in the form in which it was provided. Finally, 135 among the publications which vividly described the 147 studies, there were fully eligible to be included in the review summarized.
Apart from that, a good to reasonable coverage was identified for 11 of the 21 GBD regions.61 studies were done in Western Europe and 34 studies in East Asia accounted for the majority of the world’s studies. The region which was also best represented was Asia Pacific High Income which had 22 studies. It was closely followed by North America which had 13 studies, and Latin America also had 11 studies. Other regions which were found to have reasonable coverage were South Asia which had 7 studies, South East Asia which had 5 studies, and Australasia which had 4 studies. On the hand a very sparse coverage was also achieved in five regions: that was as follows the Caribbean had only 4 studies, Central Europe which also had 4 studies; North Africa or rather Middle East only had 2 studies which is very sparse; Eastern Europe only had 1 study; and Western had 2 studies and finally Southern had only1 study Sub-Saharan Africa. In other points, eligible studies were identified for the remaining three GBD world regions which are the Central the Eastern Sub-Saharan Africa and even the Central Asia.
The annual numbers of prevalence studies are shown according to the median year in which data were keenly collected. This therefore indicates a large and sustained increase in studies conducted in LMIC as shown since the mid-1990s. On the other hand, studies in high-income countries which peaked in the early 1990s and declined sharply thereafter. From this 27% of high-income country studies focusing mainly on Europe and North America there were conducted in the 1980s, 63% in the 1990s, and just 10% in the 2000s.
Quality of included
There are various principals that were shown:
The main or rather major quality issue mainly concerns the use of articulate surveys with two or more phases. Therefore the given multiphase survey designs are very popular in dementia research. The dementia uses 70% of dementia prevalence studies in this design. This is majorly due to the perceived efficiencies in interviewer time and the cost. Unfortunately, since most investigators using a multiphase design did not sample screen negatives, and those who did often did not weight back appropriately. Therefore for 79% of multiphase studies such that49% of all studies the design was not correctly applied or rather analyzed appropriately as needed or required to.
A sample of 500 participants could in the same estimate a true prevalence of 6% with a precision of about ±2.1%.There is an increase in precision to ±1.2% for a given sample size of 1500.The same increase will be to ±0.8% for a sample size of 3000. There was just over a half of the studies which had sample sizes of 1500. Apart from that, nearly a third of Western European studies had sample sizes less than 500. East Asia which included China and Chinese Taipei mainly contributed a relatively and precisely high proportion of large studies. In general, sample sizes tended to be larger in LMIC studies.
The participation in studies of dementia prevalence was generally adequate to good; only six studies which represented 4% reported less than 60% of eligible participants responding. Whereas more than half reported less than or equal to 80% responding. However, 15% of studies provided no information on the proportion responding.
Mean scores for the quality index which varied significantly between these regions. The overall study quality was therefore high for the Latin American region and that is particularly poor for Asia Pacific High Income which is mainly attributable to the Japanese studies and South East Asia studies
Scope of definitive diagnostic assessment:
Dementia diagnosis requires cognitive impairment and decline from a previous level of functioning thus in memory and other domains of intellectual function, and consequent social or occupational impairment. Other causes, which including functional psychosis, depression, and delirium, should be excluded
Participation in studies of dementia prevalence was generally adequate to good that is only six studies which was only 4% reported less than 60% of eligible participants responding. Whereas, more than half reported less than or equal 80% responding
It is easier to on depend on scant research and on the evidence collected from the most preferred data directly than export opinion; this is because most people can now study what they prefer. After having done the research systematically, from the people’s survey, we identified adequate studies that we were able to study quantitative menta-analyses regionally in 11 out of 21 places like WHO GBD. In addition, we supplemented the consent approximates we had done before, from the well done data that had been conducted, that any country, as well as any other nearby region could apply. We realized increased dementia prevalence exponentially according to the age, and mostly realized at older ages especially in women as compared to men. Gender issue can to some extent be explained by the majority women in old ages and partially by different consistence. We find that consistency with dementia especially AD, appeared to take long in females unlike men. Even though years survived may be similar or even more.
The main shortcomings realized after carrying out these investigations are: a. the minor proof provided from many regions globally.(b) the low quality of the most studies incorporated in the evaluation , and (c)the heterogeneity of the incidences estimated among studies in regions. Hence the issues are now to be more detailed. We foresee that the increased number of persons with dementia should be looked at carefully in future. Firstly the conclusions were made on demographic statistics that may not be precise in most parts globally, like for the aged grouping. Secondly, the assumption was made that the particular age occurrences would still be the same all throughout in all regions. But the increase and reduction may occur as a result of the changes in the experiences due to danger. However therapies and improved social as well as frequent health check reduce death also increase prevalence. For instance we have the therapies that holdup up the starting of a disease to a degree that significant likely hood to reducing the particular age insistence.
In this research, Alzheimer’s disease has been shown to interfere with the executive functioning of the brain. The disease has been shown to interfere with individual’s capacity to undertake daily activities. As the disease progresses, there is complete loss of memory, develops problems in reading, writing as well as speaking (Karantzoulis, James & Gervin, 2011). Following the decline in memory, the executive functioning of the brain then follows suite. The early signs of the disease include loss of concentration, impairment of decision making; inability to multitasking as well as inability to pay gives attention to several tasks. The disease is responsible for memory destruction as well as mental functions. It is the commonest form of dementia.
The condition has been linked to causing intellectual as well as social skills loss. Owing to development of this disease, there is degeneration of brain cells (WebMD, 2013). Symptoms can be temporally improved through medication as well as medication strategies. Deterioration of the disease interferes with executive functioning of the brain. This is mainly because of brain cells’ death (WebMD, 2013). The erosion of memory by the disease leads to reduction of task performance ability. The disease has three stages namely mild, moderate stage and severe stage. Mild Alzheimer results to the affected becoming mood less. The person also suffers from poor judgment as well as from organizational difficulties (WebMD, 2013).