Brain Diseases and Disorders

9

Memory impairment is the primary clinical indication of AD in its early

stages. As the disease progresses, dysfunctions related to other cognitive ar-

eas such as attention and executive functions, thought and behavior, language,

apraxia and visuospatial functions also manifest themselves [40]. Owing to the

disease’s progressive nature, patients experience worsening motor abilities, de-

creased social functioning, and increased memory loss as the stages advance.

Patients in the latter stages need assistance with everyday tasks [41]. In most

patients with AD, cognitive decline coexists with noticeable behavioral ab-

normalities and psychiatric symptoms. Depression, anxiety, apathy, phobia of

being alone, aimless wanderings, agitation, aggression, hallucinations, delu-

sions, and sleep disorders are among these behavioral changes and psychiatric

symptoms. Extrapyramidal symptoms such as bradykinesia and rigidity are

observed in the majority of patients, while myoclonus and seizures occur in a

few of them [37].

Pharmacological treatments are applied to slow down the disease and re-

duce the symptoms [42]. Tacrine is a centrally and peripherally acting re-

versible cholinesterase inhibitor with a duration of action of 4–6 hours, but its

effect is nonspecific. It inhibits acetylcholinesterase, yet high doses are mod-

erately effective in AD. Further, its hepatotoxicity and gastrointestinal side

effects limit its use. Therefore, liver function tests should be performed weekly

for the first 16 weeks of treatment. In cases where enzymes are elevated, the

drug should be discontinued. However, it positively affects behavioral prob-

lems in AD patients [42]. Another drug called methyl folate, is an organophos-

phorus with partial selectivity to inhibit choline esterase and it passes easily

into the brain. It improves behavioral issues and has less negative effects in ad-

dition to cognitive difficulties [43]. Rivastigmine is also an acetylcholinesterase

inhibitor and it binds to the esoteric site of the target enzyme and dissociates

very slowly causing false reversible inhibition. As it rapidly travels into the

CNS, rivastigmine inhibits acetylcholinesterase in cortical and hippocampal

areas more than in other areas of the brain. The consequence of this activity

leads to specific treatment of memory disorders without causing respiratory

and extrapyramidal system side effects [44].

In recent years, there has been a growing interest in general workouts

designed for those suffering from dementia or cognitive impairments since ex-

ercise promotes the creation of new neurons and provides neuroplasticity [45].

An exercise regimen can help patients in a variety of ways, regardless of their

stage. The Finnish Alzheimer’s Disease Exercise (FINALEX) study suggests

that exercise regimens carried out twice a week for a year, under the guidance

of a physiotherapist, improve patients’ physical functioning in cases of mild

dementia and reduce their risk of falls in cases of advanced dementia [46].

1.6.2

Parkinson’s Disease (PD)

Parkinson’s disease (PD) occurs as a progressive and degenerative disorder

with the deficiency of dopaminergic neurons in the nigro-striatal system [47].