Our problem in creating this idea was that Alzheimer's disease causes progressive memory loss and cognitive decline, significantly affecting a person's ability to function independently. Currently, there is no cure for AD, and treatments have a limited effect in slowing cognitive loss. Cognitive exercises are often recommended as a possible way to reduce the effects of Alzheimer's. There is inconsistent evidence on whether cognitive exercises can improve memory. This uncertainty creates a need for research to better understand the effectiveness of cognitive exercises.

Our data was collected through secondary research. We would search terms such as  “physical/ cognitive activity on Alzheimer patients,” and we mainly used PubMed and Google Scholar. We selected relevant studies and reviewed their citations to find reliable sources. As we intended to look for sources, we would reach a stage where we would look over the source/study, being aware of the key terms “physical exercise” and “cognitive exercise”. Through this, the research that aligned with our purpose for our project was selected. This process was repeated several times to gather accurate information

Dementia is the general term to describe a significant decline in cognitive activities. Alzheimer's is a neurodegenerative condition with insidious onset and progressive impairment of cognitive and behavioral functions. AD is the most common form of dementia in aging adults. Symptoms include the loss of memory, comprehension, attention, language, reasoning, and judgment. There is no cure for AD, although there are some treatments that may manage the symptoms. In recent years, there have been significant advances in the development of AD. The symptoms of AD vary depending on the stage of the disease at which a person is diagnosed. AD is classified into different stages based on the level of cognitive impairment and the availability and severity of disability an individual has experienced. These stages include the preclinical and presymptomatic stage, mild cognitive impairment, and disability experienced by individuals. The dementia stage is further divided into mild, moderate, and severe stages 

What part of your brain gets affected over time (3 Major Stages) 

Mild/Early-On: 

Hippocampus - A specialized grey matter tissue located deep within your medial temporal lobe, which is used to form new memories, intake, and learn new information. Turns short-term memories into long-lasting memories that remain in your brain for a prolonged time 

Entorhinal Cortex- The part of the brain that acts as the interface between the hippocampus and the neocortex (highly involved with sensory perception, reasoning, consciousness, and language)

Moderate/Middle-On: 

Cerebral Cortex: The outermost layer of your brain, which consists of 14-16 billion nerve cells that send information to certain parts of your brain. The cortex is divided into 4 lobes: temporal, frontal, parietal, and occipital. Its wrinkled appearance allows large chunks of information to be processed 

Temporal Lobes-  Processes sensory information, particularly crucial for hearing, recognizing language, and forming memories 

It contains the primary auditory cortex, which receives auditory sounds from our ears and transmits these and problem solving. Contains the primary motor cortex, which is responsible for the body's voluntary movement system 

Severe/End-on:

Occipital Lobes- Also known as the primary visual cortex, since it receives optic information from the eyes. This information is further passed onto secondary visual functions that can process and understand the depth, relation, identity, location, and distance of the object/image presented 

Cerebellum- Located at the back of the brain in the skull. This part is mainly responsible for controlling and ensuring voluntary movements are smooth, well-timed, and precise. Though it may be small, it holds 80% of the brain's neurons since it interacts with every part of the brain, coordinating your muscle movement 

Brainstem-  It connects the brain to our spinal cord, and it unconsciously regulates involuntary functions like breathing and our heart rate. It sends messages to our other body parts so that vital functions perform automatically, like hearing, swallowing, balance, taste, blood pressure, and consciousness. We retain certain reflexes that protect vital organs. For example, the gag reflex protects our airways, which allows easy breathing   

7 Clinical Stages of Alzheimer's 

Stage 1: No Dementia Seen

• The person will not experience cognitive or subjective decline, nor will their behaviors and mood be affected 

Stage 2: Subjective Memory Loss

• Forgetting where you placed objects, forgetting familiar words and names, and basic forgetfulness 

Stage 3: Mild Cognitive Impairment

• Repeat phrases, and the ability to perform executive tasks becomes compromised. 
• Difficult for them to master new skills or to host and organize an event   

Stage 4: Moderate Cognitive Decline 

• Hinders their ability to do complex tasks independently (paying the bills, checks) without assistance. 
• Recent major events may not be remembered, though they can recall simple facts (weather, address) 
• Seems less emotionally connected and responsive, which makes Alzheimer's noticeable at this stage 

Stage 5: Moderately Severe Cognitive Decline 

• That person can no longer live independently and requires assistance for basic tasks (provided food, choosing weather-appropriate clothing)
• Those who are not properly supervised will experience behavioral problems (anger, suspiciousness, or confusion)
• Have trouble recalling aspects of their current life and things they experienced in the past (education)
• This stage lasts for 1.5 years 

Stage 6: Severe Cognitive Decline 

• 6a) Assistance for basic tasks like clothing
• 6b) Full assistance for clothing, showering, brushing their teeth, and basic hygiene
• 6c) Aiding in toileting, they may forget to flush the toilet, or they throw tissues in the wrong area  
• 6d) Urinary incontinence (loss of bladder control) occurs 
• 6e) Fecal incontinence (unable to control bowel movements leading to accidental leakage). The ability to walk may be compromised, but with proper care, it can be delayed 
• To manage incontinence, proper bedding, clothing, and absorbent undergarments may become necessary 
• A person will display little to no knowledge of topics regarding their current life. May not recognize loved ones or their names
• Their energy is not being utilized for productive activities, which leads to fidgeting, unnecessary pacing, and placement  

Stage 7: Very Severe Cognitive Decline 

• 7a) Speech has become severely limited, and fewer words are understood 

-1 year duration 

• 7b) Speech has become extremely circumscribed, limited to one ineligible word being stated 

- 1.5-year duration 

• 7c) The ability to perform properly has been lost, requiring full assistance 

- 1 year duration 

• 7d) Need support while sitting up

- 1 year duration 

• 7e) Lose the ability to smile and make facial movements 

- 1.5-year duration

• 7f) Lose the ability to hold their head up independently. They may obtain pneumonia, infected ulcerations, or other conditions during stage 7

Stage 7 AD:

• Certain physical and neurological changes become evident. Physical changes are expressed in the form of contractures (an irreversible deformities that prevent a range of motion in joints

MENTAL EXERCISES 

Cognitive stimulation refers to activities that actively engage thinking, memory, attention, and problem-solving skills. Examples include puzzles, reading, conversation, memory games, learning new skills, and creative activities. Research indicates that cognitive-only interventions can help maintain short-term memory, attention span, and executive functioning, particularly in individuals with early to moderate dementia.  

Mental engagement encourages continued use of neural pathways that might otherwise weaken due to disuse. Some studies suggest that cognitively stimulating activities may increase cognitive reserve, allowing the brain to compensate for damage caused by AD pathology. Cognitive stimulation helps individuals remain mentally engaged and socially connected. Cognitive activities are also associated with improved emotional well-being. People who regularly participate and help with mentally stimulating tasks often experience reduced apathy and improved mood, which further supports overall quality of life. This made us realize that the greatest benefits occur when physical and cognitive activities are combined. Multimodal interventions—such as exercise paired with memory tasks, dance routines requiring coordination and recall, or interactive group activities—produce stronger improvements in cognitive performance than single-method approaches.

These combined interventions simultaneously activate multiple brain systems, including motor, memory, and executive networks. Studies comparing physical-only, cognitive-only, and combined programs consistently show that the combined group demonstrates better outcomes in memory performance and functional independence.

Reminiscence therapy 

Reminiscence therapy encourages people with AD to recall and talk about past events/memories. This helps stimulate cognitive function and improve memory retrieval. Thinking about familiar topics can provide comfort and closeness.

Memory games 

Activities that challenge memory, such as word games, crossword puzzles, and memory matching games, can help improve cognitive function and stimulate memory recall. These types of games can be adapted to the person's level of ability and can provide an enjoyable way to exercise the brain. It may prolong the duration of the patient's current stage. Word puzzles: Games like crosswords, word searches, and anagrams. 2019 research suggests crosswords may help delay the onset of memory loss in early dementia, specifically by building the neural pathways in your brain that help you retain knowledge. High-Density Neuroplasticity thrives when the brain is learning, adapting, and self-correcting, which forms newer and stronger connections between neurons to solve the puzzle  Jigsaw puzzles: Engaging in these puzzles long-term may have a pal well-being. People who regularly participate and help with mentally stimulating tasks often experience reduced apathy and improved mood, which further supports overall quality of life. This made us realize that the greatest benefits occur when physical and cognitive activities are combined. Multimodal interventions—such as exercise paired with memory tasks, dance routines requiring coordination and recall, or interactive group activities—produce stronger improvements in cognitive performance than single-method approaches.

These combined interventions simultaneously activate multiple brain systems, including motor, memory, and executive networks. Studies comparing physical-only, cognitive-only, and combined programs consistently show that the combined group demonstrates better outcomes in memory performance and functional independence.

Reminiscence therapy 

Reminiscence therapy encourages people with AD to recall and talk about past events/memories. This helps stimulate cognitive function and improve memory retrieval. Thinking about familiar topics can provide comfort and closeness.

Memory games 

Activities that challenge memory, such as word games, crossword puzzles, and memory matching games, can help improve cognitive function and stimulate memory recall. These types of games can be adapted to the person's level of ability and can provide an enjoyable way to exercise the brain. It may prolong the duration of the patient's current stage. Word puzzles: Games like crosswords, word searches, and anagrams. 2019 research suggests crosswords may help delay the onset of memory loss in early dementia, specifically by building the neural pathways in your brain that help you retain knowledge. High-Density Neuroplasticity thrives when the brain is learning, adapting, and self-correcting, which forms newer and stronger connections between neurons to solve the puzzle  Jigsaw puzzles: Engaging in these puzzles long-term may have a pal well-being. People who regularly participate and help with mentally stimulating tasks often experience reduced apathy and improved mood, which further supports overall quality of life. This made us realize that the greatest benefits occur when physical and cognitive activities are combined. Multimodal interventions—such as exercise paired with memory tasks, dance routines requiring coordination and recall, or interactive group activities—produce stronger improvements in cognitive performance than single-method approaches.

These combined interventions simultaneously activate multiple brain systems, including motor, memory, and executive networks. Studies comparing physical-only, cognitive-only, and combined programs consistently show that the combined group demonstrates better outcomes in memory performance and functional independence.

Reminiscence therapy 

Reminiscence therapy encourages people with AD to recall and talk about past events/memories. This helps stimulate cognitive function and improve memory retrieval. Thinking about familiar topics can provide comfort and closeness.

Memory games 

Activities that challenge memory, such as word games, crossword puzzles, and memory matching games, can help improve cognitive function and stimulate memory recall. These types of games can be adapted to the person's level of ability and can provide an enjoyable way to exercise the brain. It may prolong the duration of the patient's current stage. Word puzzles: Games like crosswords, word searches, and anagrams. 2019 research suggests crosswords may help delay the onset of memory loss in early dementia, specifically by building the neural pathways in your brain that help you retain knowledge. High-Density Neuroplasticity thrives when the brain is learning, adapting, and self-correcting, which forms newer and stronger connections between neurons to solve the puzzle  Jigsaw puzzles: Engaging in these puzzles long-term may have a positive effect on cognition, which may help slow the impact of aging or dementia on the brain. Their brain is compelled to make a connection between pieces by understanding their shape and image.  Dice games: Many dice games supply extra fun and are competitive. A 2020 study of the Chinese game Mahjong found that playing it for 12 weeks may benefit older adults with mild cognitive impairment. Neurotransmitters like dopamine (drives motivation and pleasure), serotonin (improves mood), oxytocin (stronger bonds), and endorphins (relieves stress & pain) will start up.  Board games: Board games like Monopoly or Chess use a premade board and pieces, often with additional elements like cards and dice. A 2019 case showed that playing these games may help reduce cognitive decline in older individuals from age 70 to 79, as they are using logic and focus to keep their minds active. Mental workouts like remembering rules, tracking progress, and strategizing build cognitive reserves (the brain’s resilience) Video games: Video games come in many forms, from computer to handheld and mobile. Generally, research shows that brain training games can improve cognitive function in older adults. Examples include TETRIS, Candy Crush Saga, Wii Sports, and mobile versions of word puzzles, cards, and board games.

What other activities can help people with dementia?

Reading: AD patients should read to expand their knowledge, improve their focus, and vocabulary. They don't have to read books alone, but they can view poetry, magazines, newspapers, comics, and other printed or online content. Entertainment: Watching television shows or listening to radio shows are great examples of how modern entertainment can help keep the brain engaged by processing current events. The viewer is unconsciously using their brain’s previous knowledge to comprehend the content they are perceiving. They utilize the ability to connect information to draw a conclusion Arts: Art comes in many forms, such as painting, drawing, and playing musical instruments. Any form of art expression is beneficial for people with dementia as it increases their creativity and forces their brain to produce original solutions and ideas. Their hand mobility will be improved  Learning: Comprehending new things, whether through a class, YouTube videos, podcasts, or other mediums, is a great way to reinforce cognitive skills in older age. It gives patients a fresh enjoyment that actively engages them in expanding their knowledge.

Researchers have focused on non-pharmacological interventions, such as physical activity and cognitive stimulation. Clinical trials demonstrate that structured exercise programs can help preserve activities of daily living (ADL) Such as walking, dressing, and self-care. Even when cognitive decline continues, physically active individuals often maintain functional abilities longer than those who are inactive. Physical exercise improves cerebral blood flow, allowing more oxygen and nutrients to reach brain cells. Exercises also stimulate the release of growth factors such as brain-derived neurotrophic factor (BDNF), which support neuron survival and synaptic plasticity (the brain's ability to strengthen or weaken neuron connections over time). These processes are important for learning and may help slow the structural brain changes. Some studies also suggest that physical activity reduces neuroinflammation (the brain's immune response driven by activated immune cells like microglia and astrocytes) and oxidative stress (an imbalance of reactive oxygen species). In addition to cognitive benefits, exercise has been shown to reduce behavioral and psychological symptoms of dementia, including agitation, restlessness, depression, and anxiety. These improvements are especially important in clinical and institutional settings, where behavioral symptoms often increase caregiver stress and the need for medication

Physical Activity Research

Recent studies have made us realize that exercise may reduce Alzheimer's risk and possibly slow cognitive decline, but what type of exercise and who can exactly benefit from it are questions still largely unknown. A study from the University of Wisconsin found that people over 60 who performed 30 minutes of moderate exercise 5 days a week had a lower risk of developing the disease and fewer memory and cognitive problems.

Another study from the University of Kansas found that some participants with Alzheimer's were able to increase their scores on memory tests after routinely exercising and even increased the size of their brains' hippocampus.

But on the flip side, exercise studies have been too small to be definitive or have had mixed results regarding the impact on memory and brain function 

A promising investigation is EXERT, one of the largest and most rigorous studies to date, testing how 2 intensities of exercise can impact memory and cognitive decline

Experiment 1

For the first 12 months of the EXERT study, 300 Alzheimers participants exercised for 45 minutes for four days a week under the supervision of a trainer at their local YMCA

Physical exercise, such as aerobic, stretching, resistance, or combined exercises, may delay and prevent cognitive decline in seniors with AD. 

High levels of aerobic exercise have been shown to improve brain volume and factors of cognitive decline. Other studies have shown that aerobic exercise can help reduce hippocampal atrophy. Physical exercise seems to affect the brain positively. Cognitive impairment is one of the forms of brain atrophy ( the loss of brain cells and their connections, causing the brain to shrink), which results in difficulty controlling physical mobility. Regular exercise with the right intensity and physical energy may activate some cognitive functions in older adults. Therefore, physical exercise is one of the most effective strategies for tolerating and preventing the decline of brain shrinkage. However, systematic reviews cannot analyze the type, intensity, frequency, and duration of physical exercise.

Experiment 2  

An experiment was conducted for an exercise trial: a randomized, controlled program by J Am Geriatr Soc. Its entire objective was to examine whether regular, long-term exercise programs performed by individuals with Alzheimer's at home or in a group-based exercise at an adult daycare had beneficial effects on cognitive abilities. 

How it worked 

210 individuals with AD and their caregivers were categorized and randomized into 3 groups 

There were 2 types of interventions: a home-based customized exercise program (HE) and a group- based exercise (GE), twice a week for 1 year, compared to a control group (CG) who received usual community care.

The cognitive function was measured using the clock drawing test, exactly what the name insuates (CDT), verbal fluency (VF), clinical dementia rating (CDR), and a mini-mental state examination (MMSE) at baseline for 3, 6, and 12 months 

Verbal fluency(VF): The verbal fluency test assesses your brain's word-finding ability by asking you to name as many words as possible from a category

Clinical dementia rating (CDR): a scale used to stage dementia severity by assessing 6 domains, yielding scores from 0 to 3.

Mini-Mental State Examination (MMSE): A 30-point questionnaire and screening tool for cognitive impairments.

Executive functioning was measured using CDT; it improved in the HE group, and changes in the score were drastically improved compared to those of the CG at 12 months. All groups deteriorated in VF and MMSE score during the experiment, and no significant differences between the groups were detected at the 12 months follow up 

Overall, regular long-term customized HE improved the executive function, but the effects were mild and were not observed in other areas of cognition.

Cognitive Activity Study 1 

A total of 22 RCTs involving 1647 AD participants were included in the study. Participants were from communities, social centres, social clubs, memory clinics, and hospitals. There were nine study interventions, which included: supervised aerobics, stretching, or mixed exercise. 

This study tested the hypothesis that frequent participation in cognitive stimulating activities is beneficial to brain health and cognition for patients at increased risk for AD. 329 cognitively normal middle-aged adults from age 43 to 73 enrolled in the Wisconsin registry for Alzheimer's prevention (WRAP) participated in this study; many of the participants had a family history of Alzheimer's, as there were great genetic risk factors.

We found it interesting that this study does not directly test Alzheimer's patients;  instead, it provided strong evidence that cognitive simulation activates memory-related brain regions that are vulnerable to Alzheimer's, which supports the idea that similar activities may temporarily activate short-term memory in patients

Participants reported how often they engaged in cognitive activities, completed memory and thinking tests, and received MRI brain scans. They had a special focus on the Cognitive Activity Scale (CAS), which included board games and card games. They would then undergo structural MRI scans. Researchers measured gray matter (GM) volume using FreeSurfer software. It focused on Alzheimer's-related brain regions, including the hippocampus, posterior cingulate cortex, anterior cingulate cortex, and middle frontal gyrus.

Participants who played games showed greater gray matter volume in several Alzheimer's vulnerable brain regions, especially in the hippocampus. This suggests that cognitively stimulating activities may help preserve brain structure associated with memory. Higher  CAS-games scores were associated with better performances in immediate memory, verbal learning and memory, speed, and cognitive flexibility. These are all core components of short-term and working memory, which are impaired in early AD.

Cognitive research study 2 

A 2024 research study investigated whether physical exercises and cognitive training could improve biological markers linked to people with mild cognitive impairments (MCI). MCI is considered an early stage of AD. Since many people with MCI develop Alzheimer's, researchers are interested in finding non-medicated methods that can slow down this progression. 

The study included 74-year-old adults diagnosed with MCI. Participants were randomly divided into 3 groups. A control group that did not participate in any exercises or cognitive activities, a physical activity group, and a mixed group that completed both physical and cognitive training. The exercise program lasted 3 months and involved moderate-intensity activities performed several times per week. The cognitive training focused on skills such as attention, memory, language, and executive functioning.

Blood samples were collected before and after the intervention period to measure inflammation markers and Alzheimer's-related biomarkers. The result showed that participants who engaged in physical exercise experienced reduced levels of inflammatory markers compared to the control group. Exercise alone was especially effective in improving amyloid beta biomarkers, which are associated with plaque buildup in the brain. Participants who completed both exercises and cognitive training showed the greatest improvements in related biomarkers, which are linked to brain cell damage and disease progression.  In contrast, participants in the control group showed increased inflammation and worsening Alzheimer’s biomarkers over time. The researchers also found a connection between reduced inflammation and improved biomarker levels, especially in the group that combined physical exercise with cognitive training. Overall, the findings suggest that regular physical activity, particularly when paired with cognitive training, may help protect brain health and slow the biological processes associated with Alzheimer’s disease in individuals with mild cognitive impairment.

Mental Activity Experiment 

A report from the Cochrane Library in 2012 reviews whether mentally challenging tasks may be beneficial for Alzheimer's patients 

Scientists analyzed 15 studies involving over 700+ people diagnosed with Alzheimer's. They encompassed a wide range of mental activities that simulate the mind's thinking and memory skills. These exercises included word games, puzzles, music, and daily practical activities like watching TV, going to physical therapy, or discussing current events 

These activities were facilitated by trained staff who met with small groups of these participants for 45 minutes, twice a week, to engage with them in these simulated exercises to notice if they had any positive effect on the participants’ memory or skills. 

Scientists noticed that mental simulation improved scores on memory and thinking tests. There was a six to nine-month delay in the progressive symptoms. Those who engaged in these activities had a positive effect on their well-being and quality of life overall. However, while it affects short-term memory and thinking skills directly, it will not improve a dementia patient's mood and independence. They still require assistance with daily tasks. 

Benefits were shown in participants who were in the mild to moderate stage of dementia, but those with severe dementia did not gain any advantages from the extra simulation 

From our research, we concluded that the best physical exercise was aerobics, as high-level aerobic activity tends to improve brain volume and factors of cognitive decline, and also reduces hippocampal atrophy. The most effective mental activity is puzzles, as it builds neural pathways in your brain that are activated to strategize, recognize, and memorize patterns and placement.  With upcoming research, scientists could inspect and explore programs that focus on combining light physical exercises with memory games, such as walking while recalling and remembering words, to see if this improves cognitive functions more effectively. Although each method has its benefits, it varies for each person, as every patient has a different mental, physical, and emotional state.

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We'd like to acknowledge Aema Memon for helping and assisting with the idea of this project, and our grandma, who was the inspiration behind this project