1. A presentation at NAVS
Summerfest 6/29/12
Stephan Esser MD
www.esserhealth.com

2. Exercise and Alzheimers: Exploring
connections, setting goals
Stephan Esser MD
www.esserhealth.com

3. Goals
• Review the basics
• Overview of the Statistics
• Visit the classroom: anatomy,
physiology
• Review some evidence
• Discuss opportunities for application

4. I want you to……
• Know what Alzheimer’s is
• Understand the basics of Exercise
• Be able to make informed decisions about
your health

5. Alzheimer’s
The most common form of Dementia

6. Definitions
• Dementia:
– Latin roots: De (absence) ment-(mind)
– loss of cognitive ability in a previously healthy
person, that is greater then what would be
expected from natural aging alone
– Frequent Deficits:
• Memory
• Attention
• Language
• Problem solving

7. Dementia
• Types:
– Alzheimer’s
– Vascular
– Fronto-Temporal
– Dementia with Lewy Bodies
– Mixed
– Other: Metabolic, Vitamin Deficiency’s, Syphillis,
HIV, Medication s/e’s, dementia pugilistica etc

8. Alzheimer’s
• 1906: Described by German psychiatrist Alois
Alzheimer MD
• “Alzheimer’s disease is an irreversible,
progressive brain disease that slowly destroys
memory and thinking skills and, eventually
even the ability to carry out the simplest tasks
of daily living.” National Institute of Aging, NIH 2012

9. Cause
?

10. Progression
• Early: independent
– Short term memory loss
– Attentiveness, planning, flexibility, abstract
thinking, decreased fluency and word finding
• Moderate: variable
– Progressive impairments in function, self care,
mood
• Later: dependent
– Confusion, agitation, violence, bowel and bladder
dysfunction, loss of appetite, require 24hr care

11. Mortality Statistics

12. Statistics
• 5.4 mill. Americans have Alzheimer’s
• 1 in 8 adults over 65 y/o
• Spending:
– 300% higher Medicare costs if pt has dementia
– Projected thru 2050 a 500% increase in combined
Medicare and Medicaid spending

13. Cause
?

14. Outcomes
Neurofibrilary Tangles
Beta-amyloid plaques

15. Cause
?

16. Risk Factors
Modifiable
Non-Modifiable • High Blood Pressure
• Age >65
• High Cholesterol
– 5 yrs = double risk
• Obesity
• Gender
• Diabetes
– Female Survival?
• Family History • Smoking
• Ethnicity • Head Trauma
• Genetics • Exercise
– ApoE-4 • Nutrition
–  risk • Education

17. The “graying” of America

19. 2 of 3

20. The Problem
1:9 adults

21. The Problem
• High Blood Pressure:
– 1 in 3 adults
1:3 adults

22. 1:6 adults

23. Exercise
• Achieve recommended levels of Exercise:
– 20% of all adults >20 y/o
– 13% of those age 65-74 y/o
– 6% of those >75 y/o

24. Nutrition
Consume Recommended Servings of Fruits and
Vegetables:
-Adolescents: 0.9%
-Men: 2.2%
-Women: 3.5%

25. What we know
• Basics of Alzheimer’s
• Foundational Statistics
• Risk Factors
We “Ain’t doing so good”

26. Treatment
• No Cure
• Medications:
– Delay institutionalization
• Symptom Focused
– Behavior, incontinence, depression
• Environmental

27. Prevention is Essential

28. Risk Factors
Modifiable
Non-Modifiable • High Blood Pressure
• Age >65
• High Cholesterol
– 5 yrs = double risk
• Obesity
• Gender
• Diabetes
– Female Survival?
• Family History • Smoking
• Ethnicity • Head Trauma
• Genetics • Exercise
–  risk • Nutrition
• Education

29. Exercise

30. Definitions
• Exercise:
– movement of the body resulting in the
enhancement of health and improvement
of function

31. Categories
• Leisure time Exercise: organized sports,
running, gym activities, rehabilitation etc.
• Lifestyle Exercise: activity incorporated into our
daily pattern of life
– eg: parking in the distant portion of the parking lot rather then the first
bumper, taking the stairs instead of the elevator, mowing your own lawn,
sweeping the house etc.

32. Exercise
• Flexibility
• Balance
• Strength
• Cardiovascular

33. How could we hypothesize
exercise might prevent
Alzheimer’s?

34. Risk Factors
Modifiable
Non-Modifiable
• HBP/HCL/CAD
• Age >65
– 5 yrs = double risk • Homocysteine
• Gender ? • Obesity 78%
• Family History • Diabetes
• Ethnicity • Smoking 200%
• Genetics • Head Trauma
–  risk • Exercise
• Nutrition
• Education

35. Benefits of Exercise
•  risk of HBP/Hchol/CAD
•  risk of Obesity
•  risk of Type 2 Diabetes
• Less likely to smoke
• More likely to eat health promoting foods

36. Benefits of Exercise
• Obvious physiologic benefits
• Cognitive value
• Multi-system
– Cognitive, balance, coordination, strength, CV etc
– Executive, purpose, intention, goal-setting etc

37. Exercise Science
• Delays the onset and reduces incidence
• Those who are in the top 10% of exercisers
have a 250% lower risk of alzheimers

38. Tough Question
• Is it only for prevention?
• Any benefit to those with Alzheimers?

39. Exercise training for depressed older adults with
Alzheimer's disease 2008
“…with severe AD evidenced a clear benefit to
participants in this study “
“A simple exercise program, 1 hour twice
a week, led to significantly slower decline
in ADL score inpatients with
AD living in a nursing home than routine
medical care.” 2007

40. "Regular physical exercise is probably the best
means we have of preventing Alzheimer's disease
today, better than medications, better than
intellectual activity, better than supplements and
diet.” Dr Ronald Petersen MD

41. I want you to……
• Know what Alzheimer’s is
• Understand the basics of Exercise
• Be able to make informed decisions about
your health

42. What Next?
• Learn more about Alzheimer’s
• Identify your risk factors
• Develop a preventive plan of action
• Incorporate in your own life
• Re-evaluate weekly/monthly
• Never stop actively learning and actively living

44. Thank you

45. Enjoy more powerpoints and
educational resources at
www.esserhealth.com