Alzheimer’s is a progressive neurodegenerative disease characterized by the death of nerve cells through programmed cell death called apoptosis.  In 2007, an estimated 450,000 Canadians over the age of 65 will be living with the disease and an estimated 97,000 Canadians will develop Alzheimer’s Disease (AD) within the next year.  This disease causes both thinking and memory to become seriously impaired.  The disease was first identified by Dr. Alois Alzheimer in 1906. He described the two main factors of the disease: "plaques" which are numerous tiny dense deposits scattered throughout the brain which become toxic to brain cells at excessive levels, and "tangles" which interfere with vital processes and eventually choke off the living cells. As well, when brain cells degenerate and die, the brain markedly shrinks in size in some regions. 

Currently, there is not a cure for this disease.  However, new medications and therapies are on the horizon based upon new research within the last decade.  The primary symptoms of Alzheimer’s disease include memory loss, disorientation, confusion, and problems with reasoning and thinking. These symptoms worsen as brain cells die and the connections between cells are lost. Although current drugs cannot alter the progressive loss of cells, they may help minimize or stabilize symptoms.  The first Alzheimer’s medications to be approved were cholinesterase inhibitors.  There are currently three cholinesterase inhibitors available, they include, donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Razadyne®).  Alternative treatments include the use of Omega 3 fatty acids, Coral Calcium, and Coenzyme Q10 among others. 

Several studies have been conducted that music therapy can assist in altering the behaviors of Alzheimer’s patients.  These studies emphasize their therapeutic role in decreasing agitated behaviours.  Alzheimer’s patients, even though they may exhibit deteriorating levels of functioning may continue to play an active role in organized music activities.  Sufferers of this disease may be able to retain musical perception and learn new information when presented in a musical context.  Therefore, many researchers believe this is an alternative way to communicate with Alzheimer’s patients. 

In 1998, my great grandmother, Marion Lovegrove was diagnosed with Alzheimer’s Disease.  Throughout her time suffering with this disease, she was able to function normally, being able to express her thoughts and feelings with myself and other family members. However, in the last couple of months before she died, her behaviours and lifestyle took a drastic change for the worse.  She began to lose all knowledge of what she was doing and who the people around her were.  She died a few months later in October 2000.  This disease not only caused stress for my great grandmother, but also for my entire family.  To watch my grandmother loose all perception of who she was, and who we were was heartbreaking.  Thus, I have now been inspired to work towards helping patients suffering with Alzheimer’s retain their emotions.   

It’s a Small World After All
Studies have determined that music therapy and the sense of hearing can alter the behaviors of Alzheimer’s patients. Therefore, these findings bring forth the question as to whether other senses such as: see, touch, and smell have the same impact, and to what degree they affect the Alzheimer’s patients. The purpose of this experiment is to determine if the fictional story “It’s a Small World After All”, an interactive story using four senses (see, hear, touch, smell) is an effective and useful tool in assisting Alzheimer’s patients with altering their behaviors and with the recognition of the six universal human emotions (happiness, sadness, surprise, fear, disgust, anger). This project attempts to analyze the correlations between numerous variables. Specifically this project attempts to:

(i) Determine if, “It’s a Small World After All”, can assists patients with recognizing the six humans emotions.
(ii) Determine which emotions patients are most easily able to recognize and demonstrate.
(iii) Determine which senses can detect emotions the quickest.
(iv)Determine if the agitated behaviours of Alzheimer’s patients can be treated with this book.

Alzheimer’s Awareness
The purpose of this study is to determine how much the public knows about Alzheimer’s Disease and its causes based upon a persons age, sex, location of residence, and level of education. This study aims to determine the different trends in society, using anonymous subjects.

It’s a Small World After All
It is hypothesized that the storybook “It’s a Small World After All” will be an effective and useful tool in assisting Alzheimer’s patients to maintain their behavioral state.  It is also believed that the results will identify that along with the sense of hearing, other senses such as touch and smell will have the same impact as hearing in terms of recognizing emotions and altering their      behaviors.  Alzheimer’s patients will be able to recognize all six of the human emotions portrayed in this story.  However, they will have an easier time recognizing emotions such as happiness, sadness, and anger and have a more difficult time recognizing emotions such as disgust, surprise, and fear.  The emotions happiness, and surprise are hypothesized to trigger positive behavioral symptoms and other emotions such as disgust, sadness, and anger will trigger negative behavioral symptoms.  

Alzheimer’s Awareness
Based upon the results of this study, it is believed that it will be determined that the public is not aware of the specifics of Alzheimer’s disease and has a lot of questions regarding the disease.  Generally, people with more education will have a better understanding of the disease.  Also, individuals who live in an urban or suburban setting will know more than a person of lives in a rural setting. 

For the purpose of providing reliable and valid results the use of human subjects was required.  Twenty (20) Alzheimer’s patients participated in the experimentation of “It’s a Small World After All”.  Also, two hundred (200) individuals participated in the “Alzheimer’s Awareness” survey.  In both cases these individuals were of both the male and female gender and were anonymous people.  To ensure the psychological safety of the test subjects they were made aware that they could withdraw from the survey at any time without suffering any negative consequences.  The participants of the survey went to "www.attackingalzheimers.ca" and completed the survey.  Before beginning the survey, individuals were to read through a permission letter (see the “Alzheimer’s Awareness” section for details.)  They were also made aware of the purpose of the project and ensured that all information from this study would be kept confidential.  The patients of the experimentation involved in this project were diagnosed Alzheimer’s patients from the Coleman Care Centre in Barrie.  Permission was given to work with these individuals and all necessary forms and procedures were completed. 

Alzheimer’s is a disease characterized by the death of brain cells causing thinking and memory to become impaired.  In the earliest stages of Alzheimer’s before symptoms can be detected, plaques and tangles begin to form in areas that affect learning, memory, thinking, and planning.  In mild to moderate stages of Alzheimer’s, regions in the brain that involve memory, thinking and planning develop more plaques and tangles.  It is at this stage that patients begin to experience difficulties performing everyday tasks.  Also during this stage, plaques and tangles spread to regions that affect speaking and understanding speech.  Alzheimer’s patients may also begin to lose all concept of where their body is in relation to objects around them.  It is at this stage that the behaviors of many patients take a turn for the worse.  In light of recent studies that have determined music as an alternative communication method for patients with AD, the possibility that other senses have similar effects should be considered.  “It’s a Small World After All” examines and tests this idea. 

“It a Small World After All” is a storybook that incorporates the six basic human emotions into four of the senses being see, hear, touch and smell.  The main character in this story a young girl named Isabella who travels around the world and visits every continent.  In each continent, three to six of the emotions are connected to a sense.  The emotions and senses are evenly spread throughout this book.  Two of the continents, North America and South America, have all six emotions within them. The purpose of this was to analyze whether mixing emotions up in a shorter amount of space can have a different impact than having emotions spread out.  Thus, the remaining continents have three emotions each.

The Alzheimer’s Awareness survey is a 12 question survey that attempts to analyze one’s knowledge on Alzheimer’s Disease.  This survey focuses on specific knowledge as well as general knowledge questions.  Personal information that was factored into the results were a person’s age, location of residence, level of education and gender. 

Prior to the creation of both the storybook “It’s a Small World After All” and the survey entitled Alzheimer’s Awareness extensive research was completed on Alzheimer’s Disease. 

Independent Variables:
-Patients being tested (Dementia, Alzheimer’s)
-Status of storybook
-Time Period patients were tested in
-Status of online survey

Dependent Variables:
-Responses to emotions
-Number of Excellent, Satisfactory, and Non-Responsive scores
-Presence of Agitated and Non-Agitated patients
-Changes in the patients behaviour

Controlled Variables:
-Large sample sizes were used in both the experiment and study
-Length of time the storybook was read to each patient
-The same storybook and materials were used each time
-The experimentation took place in the same location and the same time on different days
-Examination completed in the same location
-All Dementia patients came from the same treatment facility
-Volume of CD’s remained the same
-All surveys were analyzed using the same computer software