Exercise and Alzheimer's2012

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  • Cogito ergo sum…………rene decartes challenges our sense of personhood…our sense of identity….
  • Cadaveric study on a woman with an unusual mental illness…..with memory loss, language problems and odd behavior….found some off things in the brain we will talk about..
  • Approx. 1,300,000 new cases per year www.cdc.gov/.../mmwrhtml/ figures/m846qsf.gif www.ncbi.nlm.nih.gov/ bookshelf/picrender.fcgi.. http://www.ctahr.hawaii.edu/CS/blogs/sustainable_agriculture/cdc_logo(2).jpg
  • http://www.alz.org/alzheimers_disease_facts_and_figures.asp
  • http://ladulab.anat.uic.edu/images/ADstain.jpg
  • Obesity inc by 78% Smoking inc by 200%..... Cognitive reserves…… Smoking: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)07541-7/fulltext http://www.neurology.org/content/52/7/1408.short Obesity: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC558283/?rendertype=abstract Diabetes: http://aje.oxfordjournals.org/content/145/4/301.short http://aje.oxfordjournals.org/content/154/7/635.short http://www.alz.org/alzheimers_disease_causes_risk_factors.asp
  • http://www.nationalatlas.gov/articles/people/a_age2000.html
  • --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/obesity.pdf --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm
  • In 2005-2008 11% of adults 20 years of age or older had diabetes. In 2005-2008 the percentage of adults with dm increased with age from 4% of persons 20-44 to 27% of adults 65 years of age or older http://meps.ahrq.gov/mepsweb/ Medical Expenditure Panel survey
  • http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf The prevalence of hypertension (defined as high blood pressure or taking antihypertensive medication) increases with age. In 2005–2008, 33%–34% of men and women 45–54 years of age had hypertension, compared with 67% of men and 80% of women 75 years of age and over (Table 67).
  • http://www.cdc.gov/nchs/data/databriefs/db92_fig1.png
  • http://www.cdc.gov/nchs/fastats/exercise.htm
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654704/ 2003-2004 NHANS Data set…… National Health and Nutrition Examination Survey (NHANES)
  • Cholinesterase Inhibitors……….. Razadyne® (galantamine), Exelon® (rivastigmine), and Aricept® (donepezil). Another drug, Cognex® (tacrine) Namenda® (memantine), an N-methyl D-aspartate (NMDA) antagonistAmantadine,
  • Obesity inc by 78% Smoking inc by 200%..... Cognitive reserves…… Smoking: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)07541-7/fulltext http://www.neurology.org/content/52/7/1408.short Obesity: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC558283/?rendertype=abstract Diabetes: http://aje.oxfordjournals.org/content/145/4/301.short http://aje.oxfordjournals.org/content/154/7/635.short http://www.alz.org/alzheimers_disease_causes_risk_factors.asp
  • Smoking: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)07541-7/fulltext http://www.neurology.org/content/52/7/1408.short Obesity: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC558283/?rendertype=abstract Diabetes: http://aje.oxfordjournals.org/content/145/4/301.short http://aje.oxfordjournals.org/content/154/7/635.short Homocysteine http://www.sciencedirect.com/science/article/pii/S1474442203004381 http://www.alz.org/alzheimers_disease_causes_risk_factors.asp
  • Increases the cognitive reserves…….
  • http://www.neurology.org/content/early/2012/04/18/WNL.0b013e3182535d35.abstract http://articles.latimes.com/2012/apr/18/news/la-heb-alzheimers-physical-activity-elderly-20120418 http://140.116.183.158:100/BFRC/upload/4f3666d911077-exercise_is_associated_with_reduced_risk_for_incident_dementia_among_persons_65_years_of_age_and_older.pdf http://archneur.jamanetwork.com/article.aspx?volume=58&issue=3&page=498
  • Exercise Program for Nursing Home Residents with Alzheimer’s Disease: A 1-Year Randomized, Controlled TrialJ Am Geriatr Soc 55:158–165, 2007.
  • Dr. Ronald Petersen, director of the Alzheimer's Research Center at the Mayo Clinic, said on ABC:
  • Exercise and Alzheimer's2012

    1. 1. A presentation at NAVS Summerfest 6/29/12 Stephan Esser MD www.esserhealth.com
    2. 2. Exercise and Alzheimers: Exploring connections, setting goals Stephan Esser MD www.esserhealth.com
    3. 3. Goals• Review the basics• Overview of the Statistics• Visit the classroom: anatomy, physiology• Review some evidence• Discuss opportunities for application
    4. 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. 5. Alzheimer’sThe most common form of Dementia
    6. 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. 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. 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. 9. Cause?
    10. 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. 11. Mortality Statistics
    12. 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. 13. Cause?
    14. 14. Outcomes Neurofibrilary TanglesBeta-amyloid plaques
    15. 15. Cause?
    16. 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. 17. The “graying” of America
    18. 18. 2 of 3
    19. 19. The Problem1:9 adults
    20. 20. The Problem• High Blood Pressure: – 1 in 3 adults1:3 adults
    21. 21. 1:6 adults
    22. 22. 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
    23. 23. NutritionConsume Recommended Servings of Fruits and Vegetables: -Adolescents: 0.9% -Men: 2.2% -Women: 3.5%
    24. 24. What we know• Basics of Alzheimer’s• Foundational Statistics• Risk Factors We “Ain’t doing so good”
    25. 25. Treatment• No Cure• Medications: – Delay institutionalization• Symptom Focused – Behavior, incontinence, depression• Environmental
    26. 26. Prevention is Essential
    27. 27. 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
    28. 28. Exercise
    29. 29. Definitions• Exercise: – movement of the body resulting in the enhancement of health and improvement of function
    30. 30. 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.
    31. 31. Exercise• Flexibility• Balance• Strength• Cardiovascular
    32. 32. How could we hypothesize exercise might prevent Alzheimer’s?
    33. 33. 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
    34. 34. 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
    35. 35. Benefits of Exercise• Obvious physiologic benefits• Cognitive value• Multi-system – Cognitive, balance, coordination, strength, CV etc – Executive, purpose, intention, goal-setting etc
    36. 36. Exercise Science• Delays the onset and reduces incidence• Those who are in the top 10% of exercisers have a 250% lower risk of alzheimers
    37. 37. Tough Question• Is it only for prevention?• Any benefit to those with Alzheimers?
    38. 38. Exercise training for depressed older adults with Alzheimers disease 2008 “…with severe AD evidenced a clear benefit to participants in this study ““A simple exercise program, 1 hour twicea week, led to significantly slower decline in ADL score inpatients withAD living in a nursing home than routine medical care.” 2007
    39. 39. "Regular physical exercise is probably the bestmeans we have of preventing Alzheimers disease today, better than medications, better thanintellectual activity, better than supplements and diet.” Dr Ronald Petersen MD
    40. 40. I want you to……• Know what Alzheimer’s is• Understand the basics of Exercise• Be able to make informed decisions about your health
    41. 41. 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
    42. 42. Thank you
    43. 43. Enjoy more powerpoints and educational resources at www.esserhealth.com

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