"A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLED REGARDING
PROTECTIVE EFFECT OF BILINGUALISM ON
ALZHEIMERS DISEASE AMONG MONOLINGUAL
ADULTS BETWEEN THE AGES OF 35-50
YEARS AT SELECTED RURAL
COMMUNITIE AT
TUMKUR"
PROFORMA FOR REGISTRATION OF SUBJECT FOR THE
DISSERTATION
SUBMITTED BY
MISS MINU VARGHESE
MENTAL HEALTH PSYCHIATRIC NURSING
2011-2013
SRI SIDDARTHA COLLEGE OF NURSING
AGALAKOTE, B.H. ROAD
TUMKUR
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT
1 / NAME OF THE CANDIDATE & ADDRESS / MISS MINU VARGHESE
I YEAR M.Sc. NURSING
SRI SIDDARTHA COLLEGE
OF NURSING
AGALAKOTE,TUMKUR
2 /
NAME OF THE
INSTITUTION /
SRI SIDDARTHA COLLEGE
OF NURSING,
B.H ROAD,TUMKUR
3 /
COURSE OF THE
STUDY& SUBJECT /
MASTER OF SCIENCE IN
NURSING
MENTAL HEALTH PSYCHIATRIC
NURSING
4 /
DATE OF ADMISSION /
6th JULY 2011
5 /
TITLE OF THE TOPIC / "A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOW- LEDGE REGARDING PROTECTIVE EFFECT OF BILINGUALISM ON ALZHEIMERS DISEASE AMONG MONOLINGUAL ADULTS BETWEEN THE AGE GROUP OF 35-50 YEARS AT SELECTED RURAL COMMUNITIES IN TUMKUR”
FOR DISSERTATION
BRIEF RESUME OF THE INTENDED WORK
6. INTRODUCTION
“Language exerts hidden power, like a moon on the tides”
RitaMae Brown
Despite the past century’s fascination with measuring every facet of life ‘little is known about the middle years (age between35-50 years).After all, living in to middle age is a relatively recent phenomenon in human history. Although the pressing nature of age-related ill health precipitated a welcome and much needed boom in information about aging, there reunited a paucity of knowledge about the middle years1.
Alzheimer’s disease was first described by a German Psychiatrist and Neurologist, Dr Aloes -Alzheimer, in 1906, on a middle- aged patient suffering from Dementia. It was after the death of the patient, by autopsy, that Alzheimer was able to demonstrate abnormal changes in the brain. Alzheimer’s disease (AD) is also called the death of mind. The AD is cruel disease which not only destroys person’s mind but also robs him or her of memories. It is a progressive degenerative disease which attacks the tissues of the brain and results in impaired memory, thinking, behaviour and emotions. The process is gradual and is often associated with loss of the individual’s ability to care for him or herself2.
Bilingualism is an intriguing field Researchers across the world are racing towards a cure for Alzheimer’s disease. As prevalence rates climb, their focus has broadened from treatment to prevention strategies. Although there are no magic solutions, tantalizing new evidence suggests it may be possible to prevent or delay the onset of Alzheimer’s disease through a combination of healthful habits. Scientists with the Rot man Research Institute at the Bay crest Research Centre for Aging and the Brain have found the first evidence that another lifestyle factor, bilingualism, may help delay AD symptoms3.
Due to globalization and multiculturalism, the world has seen a rapid increase of bilingual or multilingual speakers. Throughout the world people have grasped the importance of acquiring a second or third foreign language, indicates that there are more bilingual people in the world than there are monolingual people4. Since the mid-twentieth century, bilingualism has been offering a broad spectrum of research possibilities. For instance, the positive influence of bilingualism on children and the correlation between bilingualism and cognitive decline have already been examined5. Over the last decades, Ellen Bialystok, a research professor of psychology at York University in Toronto, has proven to be a pioneer in this field of study. They examined the effect of lifelong bilingualism on the onset of symptoms of AD. Results showed that bilingualism has a protective effect in delaying the onset of AD by four years6.
The term of ‘bilingualism’, - and that of ‘multilingualism’, too - is used frequently. “bilingualism is the ability to use two or more languages sufficiently to carry
on a limited casual conversation”. They believe that the interpretation of bilingualism may differ from one individual to another .It indicates that there are at least twenty dimensions of language to determine whether a person is bilingual7. When the people have acquired a minimum level of competences, such as reading, writing and speaking, in a foreign language, they will be bilingual8.
Bilingualism is an intriguing field of study for many researchers. There are “two intrinsic values in studying bilingualism”. First, “studying bilingualism tells us something about the genetic potential of humans”. Second, “simply living in a community where two or more languages are spoken is a part of the human experience”9. Thus, the status of languages spoken within the community is an important factor in studying bilingualism. The possible benefits of bilingualism have raised many questions during the latter half of the twentieth century. Until the 1950s, researchers mainly focused on behavioural consequences of bilingualism. Later, the cognitive implications of bilingualism were considered. Peal and Lambert were the first to establish the positive effects of bilingualism10. Later on various studies have clearly indicated that bilingualism has positive effect on cognitive function.
The objective of this dissertation is to give an insight regarding these new areas of studies as well as encourage monolingual adult for learning a new language to fight with AD.
6.1 NEED FOR STUDY
Over the past 50 years careful research was able to show that Alzheimer’s disease occurs more commonly in the elderly than in those in middle age. It affects 5-10 % of those over 65 years of age and more than 20 % of those over 80 years. As the proportion of people over 65 years is gradually increasing more cases of AD will accumulate and it may turn in to a greater public health problem. In the USA and other western countries AD has become the 4th leading cause of death (after heart diseases, cancer and stroke) among adults around the age of 75. AD is becoming a problem in developing countries as well.
Even a 2-year delay in onset of Alzheimer’s disease (AD) would reduce the prevalence in the USA by 1.94 million after 50 years, and delays as short as 6 months could have substantial public health implications11. Many of the factors predisposing a person to AD are biological. So the search for methods to delay onset has focused largely on pharmacological and other biologically-based therapies12.There is growing evidence, however, that some environmental factors can maintain cognitive functioning in older adults and mitigate the effects of illnesses that produce AD.Notably,research on“cognitive reserve” has demonstrated that lifestyle factors, such as physical activity, stimulating leisure involvement, and social engagement play a role in post ponding the onset of AD and other dementias.
The report, released in September 2009 by Alzheimer's disease International, says more than 35 million people worldwide have Alzheimer's disease or other types of
dementia, according to the most in-depth attempt yet to assess the brain-destroying illness. The updated count is about 10 per cent higher than predicted just a few years ago, because earlier research underestimated Alzheimer's growing impact in developing countries. Barring a medical breakthrough, dementia will nearly double every 20 years. By 2050, it will affect 115.4 million people, the report suggests. Alzheimer's is the most common form of dementia and affects one in 20 Canadians over 65 — about 290,000 people. The number rises to one in four in those over 85. Close to 75 per cent of Canadians with Alzheimer's are women. According to researchers at the Johns Hopkins Bloomberg School of Public Health in Baltimore, by 2050 the number of cases around the world will quadruple to around 106 million people. '71,000 Canadians under the age of 65 are living with Alzheimer's disease or a related dementia. Approximately 50,000 are 59 or younger13.
The overall notion is that some factors allow a person to function within a normal cognitive range, despite the presence of brain pathology that would usually be associated with dementia. For example, Mortimer (1997) found that between 10 and 40% of autopsy cases -showing brain pathology exceeding the criteria for AD had shown no signs of cognitive impairment before death. Similarly a population-based study carried out by the UK Medical Research Council found that more than 30% of individuals with mild and severe AD pathology at autopsy had shown no previous signs of cognitive impairment14.
Importantly, most of the studies included in the review found significant effects of the protective variable in question after co-varying out age and other brain-reserve
measures. One surprising conclusion of the review was that “it is evident that mentally stimulating leisure activity is the most robust brain-reserve measure, since all these studies showed a significant protective effect even after controlling for age, education, occupation and other potential confounds” 13 .They found an overall decrease in incident dementia of 46% after a median follow-up interval of 7.1 years; these figures are based on a total of over 29,000 individuals from 22 studies. It is important to note the authors’ caution that higher levels of behavioural brain reserve may simply delay the onset of dementia, rather than reduce incidence in an absolute manner. In a comparison piece, the same authors conducted a review of studies of longitudinal cognitive change and factors ameliorating cognitive decline in the elderly14. This second review was based on a new sample of 18 studies involving more than 47,000 individuals; the main finding was that higher levels of behavioural brain reserve were related to decreased rates of cognitive decline.
A longitudinal study was conducted on 2004, also found strong evidence for the role of social, mental, and physical activities in protecting against all types of dementia. Similarly, they concluded that “more education and a more cognitively complex occupation predict higher cognitive ability in old age than would be expected for a person’s childhood ability and accumulated brain burden”15.
According to the 1981 Census, out of a total population of 685.2 million, in the world, 44 million people were aged 60 years and over. In the 1991 census the number of elderly was about 55.3 million, that is, 6% of the total population of 844.3 million. The
number of people over 60 years is expected to touch the 60 million mark by the end of this century. Although there is no exact figure of AD patients in India, recent surveys in south India report that the rate of Dementia of the people over 60 years varied from 2.7% to3.4%, a figure almost identical to the western countries16.
From these reviews, it seems clear that the prevalence rate of AD is rising gradually as well as the complex mental activity across the lifespan can acts to at least delay the incidence of Alzheimer’s. So it is essential to find out the types of mental activity yield this protective function as well as the mechanism linking mental activity to its neuroprotective function. The recent report contributes some solution for this by demonstrating a further type of mental activity that may be associated with a delay in the appearance of the symptoms of dementia and Alzheimer’s. The activity in question is the constant use of two languages over many years; Bilingualism has been shown to enhance attention and cognitive control in both children17 and older adults18.
In these studies, lifelong bilinguals who use both languages in their daily lives showed an advantage in a variety of tasks involving attention control. The suggested interpretation is that the use of two languages requires a mechanism to control attention to the relevant language and ignore or inhibit interference from the competing language. This experience provides continual practice in attention control and results in its earlier development in children, improved functioning in adults, and slower decline in older age.
Therefore, bilingualism might contribute to cognitive reserve and protect older adults from decline in the context of dementia and AD. This hypothesis was examined.
A Canadian study regarding Bilingualism and Dementia reports that speaking two languages can help delay the onset of Alzheimer’s symptoms by as much as 5 years18. This could be good news in India, where many people know multiple languages and can therefore choose to actively speak more than 1 language and acquire the claimed protection.
Research on the correlation between bilingualism and Alzheimer’s has only started recently. Most studies mainly focus on the effects of neurological, social and environmental factors on the onset of AD. Their investigation indicated that some environmental factors may postpone the onset of symptoms and illnesses that produce dementia. For instance, sustained mental activity, and hence higher brain reserve, can protect against dementia and cognitive decline in elderly individuals19.
A Canadian study regarding effects of bilingualism on the memory of elderly people - found that bilingualism enhanced attention and cognitive reserve in older adults. The eye movement study showed few differences between monolingual and bilingual subjects. Nonetheless, older bilingual subjects scored significantly higher during a key press response test. The behavioural study, therefore, indicated advantages in older bilingual subjects20. In a consecutive study, they investigated how dementia was influenced by bilingualism. They examined the effect of lifelong bilingualism on the onset of dementia in
old age. The study was conducted among 184 Canadian patients diagnosed with dementia and their caregivers. 51% of all patients were bilingual. To be considered as bilingual, patients had to have spent a majority of their lives using two languages. Results of this study showed that on average bilingualism delays the onset of dementia by an average of 4.1 years concluded that there is no difference between the results for men and those for women21.
Even though a comparison of the level of education showed that bilinguals had often had less education, educated monolinguals showed few advantages over uneducated bilinguals. Apart from the level of education, the primary occupation of the patients was compared. Results indicated that bilinguals with the same occupational status as monolinguals developed the first symptoms of dementia at a later age. Some knowledge of another language is not sufficient to be considered as being bilingual. Furthermore, they mention that this study may be seen as subjective since most data relies on reports of the patient, family members or caretakers. They nevertheless conclude that the research has indicated that bilingualism can be considered as a possible factor to protect against dementia and AD and cognitive decline in elderly individuals.