The Improvement of Cognitive Function and Decrease the Level of Stress in the Elderly with Brain Gym

Abstract

The decline in cognitive function in the elderly, which is part of the aging process can result in long-term memory problems and information processes, so it is often regarded as a stressor that causes stress and perceived as an adverse threat. Brain gym can improve memory, decreased emotional stress and the clearer mind. The aim of the study analyzed the effectiveness of brain gym in improving cognitive function and decreased the level of stress of elderly. Pre-experimental study of one group pretest-posttest design with 35 samples selected by simple random sampling. The frequency of Brain Gym exercise twice a week with duration of every 15 minutes and done in four weeks. Measurement of stress level using DASS, while Cognitive function with MMSE. Data analyzed using Wilcoxon signed rank test. The results showed improvement of cognitive function in elderly and decreased stress level after brain gym (p = 0.001 and p = 0.009 at α = 0.05). Brain gyms are more effective at lowering stress levels than older cognitive function improvements that require longer and more intense time to improve concentration and elderly memory. Keywords: Brain Gym, Kognitif, Stress, Elderly

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© 2017 International Journal Of Nursing and Midwifery
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0
International License which permits unrestricted non-commercial use, distribution, and reproduction
in any medium, provided the original work is properly cited.
http://ijnms.net/index.php/ijnms
ORIGINAL RESEARCH
THE IMPROVEMENT OF COGNITIVE FUNCTION AND DECREASE THE
LEVEL OF STRESS IN THE ELDERLY WITH BRAIN GYM
Lilik Ma’rifatul Azizah1, Tri Martiana2, Oedojo Soedirham2
1Doctoral Program in Public Health, Airlangga University Surabaya, Indonesia
2Faculty of Public Health, Airlangga University Surabaya, Indonesia
ABSTRACT
Keywords
The decline in cognitive function in the elderly, which is part of the aging
process can result in long-term memory problems and information processes, so
it is often regarded as a stressor that causes stress and perceived as an adverse
threat. Brain gym can improve memory, decreased emotional stress and the clearer
mind. The aim of the study analyzed the effectiveness of brain gym in improving
cognitive function and decreased the level of stress of elderly. Pre-experimental
study of one group pretest-posttest design with 35 samples older adult age 60 years
till 75 years old selected by simple random sampling. The frequency of Brain Gym
exercised twice a week with duration of every 15 minutes and done in four weeks.
Measurement of stress level using DASS, during Cognitive function with MMSE.
Data analyzed using Wilcoxon signed rank test. The results showed improvement
of cognitive function in elderly and decreased stress level after brain gym (p =
0.001 and p = 0.009 at α = 0.05). Brain gym had a significant effect on improving
cognitive function of elderly and reduced the level of stress in the elderly face a
life stressor.
The
improvement
of cognitive
function and
decrease the
level of stress
in the elderly
with brain
gym
.
e-ISSN : 2597-9345
p-ISSN : 2597-761X

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INTRODUCTION
The aging process can cause many changes in
the elderly, one of which is the nervous system
decreases the function of the brain and the
decline of cognitive function (Trouillet, 2011).
Decreased cognitive abilities such as
forgetfulness, the decline in time orientation,
place, space, and not easy to accept new ideas.
This decrease can lead to problems such as
long-term memory in revealing stories or
events that are not so interesting and new
information (Morano, 2003).
In the elderly, the weight of the brain decreases
10-20%, although, in the absence of
neurodegenerative disease, there is a change in
the structure of the human brain. The impact of
pathological changes in elderly
cerebrovascular disease is Alzheimer's
dementia, which occurs about 10-15% in older
adults over 65 years and to date an estimated ±
30 million people worldwide experience
dementia for various reasons (Lumbantobing,
2006).
Changes resulting from the aging process are
often regarded as stressors that cause stress and
are perceived as an adverse threat. Problems
that often cause stress in the elderly is post
power syndrome, feelings of disappointment
because no longer respected as before, less
attention by children and grandchildren, feel
lonely and solitude. In retirement, the elderly
lost his busyness and position. Coinciding with
that the children are married and leave home,
while the body began to weak and not allow
travel, so often cause stress (Azizah, 2011).
Holmes and Rahe (1967) in Hawari (1999),
suggested that stress in elderly retirement was
ranked the 10th of 43 life events that caused
stress based on Social Readjustment Rating
Scale (SRRS).
There are several ways in improving cognitive
function, one with a brain gym because it can
release stress, clear the mind, and improve
memory (Muhammad, 2013). Brain gym is a
series of simple motion exercises to facilitate
learning activities and adjustments to everyday
demands. Brain gym attempts to activate the
left and right brain optimally. Brain gymnastic
exercise is made to stimulate the left brain and
right brain (dimension of laterality), relieve or
execute the back of the brain and the front of
the brain (focusing dimension), stimulates the
emotional or emotional system (central
dimension) the brain can be done without
special time. (Yanuarita, 2012: Nurdin, 2015).
Brain gymnastics can be performed by all ages,
ranging from infants to elderly (Muhammad,
2013).
When a person is afraid, nervous, or stressed
then reflexively the energy is pulled into the
back of the brain so that the front of the brain
has a lack of energy, consequently, the answer
that was ready, suddenly forgotten or not able
to be answered perfectly. The frontal brain
barrier is passive and the ability to pay less
attention (Muhammad, 2013). Exercises in
brain gym according to research conducted by
Ayinosa (2009) can provide a positive effect
on improving the concentration, attention,
alertness, and ability of brain functions to do
planning, response and decision making. Many
people who find it helpful with a brain gym,
such as relieving stress, increasing the
concentration of learning to clear the mind, and
improve memory (Nuryana, 2010).
The aim of this study proves the influence of
brain gym in improving cognitive function and
decrease stress level of elderly.

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MATERIALS AND METHODS
1. Design and Participants
The research design was pre-experimental,
with a one-group pretest-posttest design. The
multistage random sampling selected to obtain
the sample of 35 elderly from 18 villages in
Mojokerto East Java from March 2016 till May
2016. The inclusion criteria were older adult
age 60 years till 75 years old and married.
2. Research tools
The variables depend on the cognitive function
measured using the MMSE Status (Mini-
Mental State Examination) of Folstein MF
(Burn Et.al, 1999), which measures cognitive
function in 6 domains, namely orientation,
registration, attention, recall, language and
imitate. Scores for each domain are not the
same. Domain orientation scores 10,
registration 3, attention 5, recall 3, language 8
and mimic 1. The reliability of the checklist
was 0.69 (95% confidence interval).
The stress levels were measured using the
DASS 42 instrument from Lovibond and
Lovibond 1995 in Burn. Et.al. (1999). DASS
42 is a set of subjective scales established to
measure the negative emotional states of
depression, anxiety, and stress. Consisting of
42 item statements covering three sub-
variables namely physical, emotional, and
behavioral. For inter-rater reliability was 0.54
with confidence interval 95%. The Brain gym
guide consists of 9 steps from Dennison
(2008), which includes the activation of lateral
dimensions, focusing, and dimensioning
dimensions.
3. Statistical analysis
The statistical test using the Wilcoxon Signed
Rank compares two groups with the same
ordinal data scale. The assumptions used are
normally distributed data, the distribution of
homogeneous data and samples taken at
random. The probability value p <0.05.
4. Ethical considerations
All participants agreed to sign an informed
consent form. This study has obtained
permission from local authorities and ethical
approval from health research of ethics
committee Faculty of Public Health Airlangga
University Indonesia.
RESULTS
The prevalence of definitive cognitive
impairment in the elderly before brain gym
was (68%) in women and (32%) in men. The
higher level of stress was 71% in women and
29% in men. Individuals with widows/majority
who have the definitive cognitive impairment
(85%), and those with the most severe stress
(45%).
Table 1 shows that almost half of respondents
before being given a brain gym experienced a
very heavy stress level of 11 respondents
(32%) after a brain gym showed that most
respondents experienced normal stress level of
22 respondents (63%). The output in the value
can be z -3,825, with (p = 0.009) at (α 0,05)
which means that brain gym effectively
decreases stress level of elderly.

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Table 1
The influence brain gym to reduce level of
stress
No
Level of Stress
Before
After
F
%
F
%
1
Normal
6
16%
22
63%
2
Lower Stress
4
11%
7
21%
3
Moderate Stress
6
16%
6
16%
4
High Stress
8
25%
0
0%
5
Very High Stress
11
32%
0
0%
Total
35
100%
35
100%
Z
Asymp. Sig. (2-tailed)
α
-3.825a
.009
0.05
Table 1 shows that almost half of respondents
before being given a brain gym experience
probable cognitive impairment as much as 21
respondents (58%) after a brain gym showed a
decline in the number of elderly probable
cognitive impairment with as many as 16
respondents (46%). The output at the value can
be z -3,915. With (p = 0.001) at (α 0,05) which
means that brain gym effectively improves
cognitive function of elderly.
Table 2
The influence brain gym to increase cognitive
function
No
Cognitive
function
Before
After
F
%
F
%
1
Normal
8
27%
14
40%
2
Probable
21
58%
16
46%
3
Definitive
6
15%
5
14%
Total
35
100%
35
100%
Z
Asymp. Sig. (2-tailed)
α
-3.915
.001
0.05
The differences in results before and after the
Brain Gym on stress and age cognitive
function (see Table 1 and 2) showed that brain
gyms were more significant in reducing stress
levels than improving cognitive function of
older adults (p = 0.009 and p = 0.001).
DISCUSSION
Brain gym has a significant effect on the
improvement of cognitive function of elderly.
This is in line with Dennison (2008), that
exercise in the brain gym can provide to
stimulating the brain. It can release stress,
increase learning concentration, clear the
mind, improve memory, improve cognitive
abilities, such as alertness, concentration, and
speed in the learning process, as well as
memory, problem-solving, or creativity.
Brain gym activates the right and left brain
balance by providing an improved stimulus to
the fibers in the corpus callosum connecting
the second cortical area of the brain
hemisphere including the hippocampus and
amygdala, thus facilitating the flow of
electromagnetic energy throughout the body
(Dennison and Dennison, 2009). Brain gyms
align ability activity and thinking at the same
time improves balance and harmonization
between emotional control and logic,
optimizes the function of the senses, maintains
flexibility and balance of the body, enhances
memory, improves auditory and visual acuity,
reduces reading errors, memory and
comprehensive ability in groups the use of
language, to be able to improve the response to
visual stimuli (Muhammad, 2013).
Brain gym has a significant effect to reduce the
level of stress in the face of life stressor. Mild
exercise movements are done in brain
exercises, such as through the hands and feet
that can provide stimulation to the brain. The
stimulation can release stress, improve
concentration learn, clear the mind, improve

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memory, improve cognitive abilities, such as
alertness, concentration, and speed in the
learning process, and memory, problem-
solving, or creativity (Purwanto et al., 2009).
Brain gyms are more effective at lowering
stress levels than older cognitive function
improvements that require longer and more
intense time to improve concentration and
elderly memory. It is in line with Dennison and
Dennison (2009) that brain gyms movement
increases energy and supports a positive
attitude (dimension concentration) activates
the neocortex and thus refocuses electrical
energy to reasonable thinking centers. This
activates the parasympathetic function and
reduces adrenaline release by increase the
electrical tension of nerve membranes, minds,
and actions are coordinated again.
CONCLUSION
Brain gym has a significant effect on
improving cognitive function of elderly and
reduces the level of stress in the elderly face a
life stressor. Brain gyms enable right and left
brain balance by aligning the ability of activity
and thinking at the same time improving
balance and harmonization between emotional
control and logic. Brain gyms can be done by
the elderly at any time and will be more
effective when done with optimal focusing and
concentration with proper scheduling and
training.
ACKNOWLEDGMENTS
We would like to thank the Ministry of
Research and Technology for funding by grant
doctoral dissertation research. The staff,
respondents, and local authorities involved in
this study.
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