Memory, Movement and Mood: Applying the Science and Harvesting 

Ideas

Stephan Esser MD

www.esserhealth.com

Exercise?

Fingers, Feet and ForksFingers, Feet and Forks

I want you to……

• Be familiar with basic mood disorders

• Know what Alzheimer’s is

• Understand the basics of Exercise

• Prepare to apply the information to your health

Mood Disorders

• A group of mental disorders involving a disturbance of mood, along with either a full or partial excessively happy (manic) or extremely sad (depressive) syndrome not caused by any other physical or mental disorder. Mood refers to a prolonged emotion

• Depression• Bipolar: Cyclic lows and highs

http://medical-dictionary.thefreedictionary.com/mood+disorder

The mind is i ts own place, and in i tself can

make a Heav'n of Hell……a Hell of Heav'n.

JOHN MILTON (1608-1674)

The mind is i ts own place, and in i tself can

make a Heav'n of Hell……a Hell of Heav'n.

JOHN MILTON (1608-1674)

Mood Disorders

Depression• Epidemiology: 

– about 121 million people worldwide.– NIMH: In any given 1-year period, 9.5 percent of the population, or about 20.9 

million American adults, suffer from a depressive illness– 1 in 10 Adults

• Cost of Care:– leading cause of disability as measured by YLDs – By 2020, depression is projected to reach 2nd place in the ranking of DALYs 

calculated for all ages, both sexes with more spending then on CV disease.– Workplace: annual workplace cost of depression in America     at over $40 billion– Personal:  Incalculable

• Associated Factors:-ass. with 850,000 suicides/yr

"Men are disturbed not by "Men are disturbed not by things, but by the view things, but by the view which they take of them.“which they take of them.“EpicletusEpicletus -The Enchiridion- -The Enchiridion-

"Men are disturbed not by "Men are disturbed not by things, but by the view things, but by the view which they take of them.“which they take of them.“EpicletusEpicletus -The Enchiridion- -The Enchiridion-

Depression

A: one of the criteria from category 1 and three of the criteria from category 2 for most of the day nearly every day for at least 2 weeks

– Category 1:• Persistent depressed mood• Anhedonia

– Category 2:• SIGECAPS

B: symptoms do not meet criteria for mixed episode

C: symptoms cause significant impairment

D: symptoms not due to substance or GMC

Etiology

• Combination:–Genetic– Environmental• Psychosocial• Neurophysiologic• Nutritional• Pharmacologic

We can Nurture Nature

We can Nurture Nature

Risk Factors• Gender: Women• Family: • Marital Status: Divorced, widowed, separated

• Social Class: Poverty• Life Events/Traumas• Medical Co-morbidities• Obesity

• Gender: M=F• Family:   • Marital Status: Divorced, widowed, separated

• Social Class: =

Exercise, Nutrition, Sleep, Sunlight (Vitamin D Status), Metabolic DysfunctionExercise, Nutrition, Sleep, Sunlight (Vitamin D Status), Metabolic Dysfunction

What we know about Mood Disorders

• Common

• Many Risk Factors: Multifactorial etiology

• Expensive: $135 Billion SAMSHA 2012

• Debilitating

• Complex

• Prevention must be primary

TransitionTransition

Alzheimer’s

The most common form of Dementia

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

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

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

Mortality Statistics

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

Cause

?

Outcomes

Beta-amyloid plaquesBeta-amyloid plaques

Neurofibrilary TanglesNeurofibrilary Tangles

Cause

?

Risk Factors

Non-Modifiable• Age >65

– 5 yrs = double risk

• Gender ?• Family History• Ethnicity• Genetics

– risk– Apo-E

Modifiable• HBP/HLD/CAD• Homocysteine• Obesity 78%• Diabetes• Smoking 200%• Head Trauma• Exercise• Nutrition• Education

2 of 3 2 of 3

The Problem

• High Blood Pressure:– 1 in 3 adults

1:3 adults1:3 adults

1:6 adults1:6 adults

The Problem

1:9 adults 1:9 adults

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

Nutrition

Consume Recommended Servings of Fruits and Vegetables:

-Adolescents: 0.9%

-Men: 2.2%

-Women: 3.5%

Consume Recommended Servings of Fruits and Vegetables:

-Adolescents: 0.9%

-Men: 2.2%

-Women: 3.5%

What we know

• Basics of Alzheimer’s

• Foundational Statistics

• Risk Factors

We “Ain’t doing so good”

Treatment

• No Proven Universal Cure

• Medications:

– Delay institutionalization

• Symptom Focused

– Behavior, incontinence, depression

• Environmental

To Maintain Mood and Memory

Prevention is Essential

Risk Factors

•Gender: Women

•Family

•Marital Status

•Social Class

•Events/Traumas

•Medical Co-morbidities

•Obesity

Exercise

Definitions

• Exercise:– movement of the body resulting in the

enhancement of health and improvement of function

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.

Exercise

• Flexibility: 2-3 x’s/wk

• Balance: 2-3 x’s/wk

• Strength: 2-3 days/wk

• Cardiovascular: 150 min/wk

How could we hypothesize exercise might reduce

Alzheimer’s risk?

Risk Factors

Non-Modifiable• Age >65– 5 yrs = double risk

• Gender ?• Family History• Ethnicity• Genetics– risk– Apo-E

Modifiable• HBP/HLD/CAD• Homocysteine• Obesity 78%• Diabetes• Smoking 200%• Head Trauma• Exercise• Nutrition• Education

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

Exercise and Physical Health• Reduces risk of – Heart Disease ≈ 40%– Obesity: ≈ 30-100%– Stroke ≈ 50%– Type 2 Diabetes ≈ 50%– Hypertension ≈ 50%– Disability delayed ≈15 years– Colon Cancer ≈ 25-40%– Breast Cancer ≈ 20%-44%– Osteoporosis ≈ 20+%

• As many as 250,000 deaths per year in the United States are attributable to a lack of regular physical activity

Benefits of Exercise

• Obvious physiologic benefits

• Cognitive value

• Multi-system

– Cognitive, balance, coordination, strength, CV etc

– Executive, purpose, intention, goal-setting etc

Exercise and Alzheimers

• Delays the onset and reduces incidence

• Those who are in the top 10% of exercisers have a 250% lower risk of alzheimers

“A simple exercise program, 1 hour twicea week, led to significantly slower decline

in ADL score inpatients with AD living in a nursing home than routine

medical care.” 2007

“A simple exercise program, 1 hour twicea week, led to significantly slower decline

in ADL score inpatients with AD living in a nursing home than routine

medical care.” 2007

Exercise training for depressed older adults with Alzheimer's disease 2008

“…with severe AD evidenced a clear benefit to participants in this study “

Exercise training for depressed older adults with Alzheimer's disease 2008

“…with severe AD evidenced a clear benefit to participants in this study “

Depression

Exercise and Depression

• The Antidepressive Effects of Exercise CJSM 2009

– Meta Analysis of 58 randomized studies (n = 2982)

– Participants in the exercise treatment had significantly lower depression scores

– In many studies, similar outcomes to medication

– Dropout rates for the exercise treatment were similar to those found in psychotherapeutic and drug interventions.

How could we hypothesize exercise might influence

Depression?

How does it Work?

• Psychology

• Neurogenesis

• Neuro-Biochemistry

Psychology

• Exercise and clinical depression: examining two psychological mechanisms Psych. of Sport and Exercise 2005

– 2 Groups: Exercise vs Control– 9 wk program– Exercisers: • Dec. Depression Scores• Inc. Coping and Self Efficacy• Less Rumination• Less evidence that increased distraction was etiology

Neurogenesis

• Antidepressant effects of exercise: Evidence for an adult-neurogenesis hypothesis? Journal of

Psychiatry and Neuroscience 2006

– Exercise increases synthesis of new neurons in the adult brain

– Up to 2-3 x’s growth in Hippocampus

– Facilitates improved memory, completion of functional tasks, learning of new tasks/materials

– Opposite effect seen with excessive stress

Neuro-Chemistry

• Exercise results in increased production of

– Norepinephrine

– Serotonin

– B-Endorphins

Transition

Stages of Change (Prochaska and DiClemente)

1: Pre-contemplation

2: Contemplation

3: Preparation/planning

4: Action

5: Maintenance

6: Permanent Maintenance (Termination)

My Reasons to Exercise• Feel good in my skin• Increase energy, Reduce stress• Increase my confidence, discipline• Be a role model, socialize, family time• It’s fun, I love to sweat and work hard• I love challenges• Reduce disease risk• Lower disability risk• Maintain independence

Reduce my risk of Alzheimer’s and Depression

Reduce my risk of Alzheimer’s and Depression

What are your reasons?

My Reasons NOT to Exercise

• Time• I’m tired or lazy• Inconvenience (I forgot my clothes etc…)• Money (shoes, travel, racquets) • Other priorities• Hate Change• Don’t know what to do• I’m Injured

What are your reasons

NOT

to Exercise?

“Physical fitness can neither be achieved by wishful thinking nor

outright purchase.”

Joseph Pilates

You are never too old to set another goal or to dream a new dream

C.S. Lewis

Defining Success

• What is success for you?

• Are such goals achievable, legitimate?

• What will you do if you fail to “succeed”?

Setting Goals

• Specific

• Measureable

• Achievable

• Realistic

• Timely

• “You have to work at living, period. You’ve got to train like you are training for an athletic event. Most older people just give up. They think, “I’m too old for that,” because they have an ache here or a pain there. Life is a pain in the butt; you’ve got to work at it.”

- Jack LaLanne -

Establishing Priorities

• Potential responsibilities, limitations

• Discover balance

• Be dynamic, flexible

If you have decided

to start or increase

your activity level…….now what?

FITT

• Frequency

• Intensity

• Time

• Type

Lasting Change

• Track your efforts and progress

• Re-visit your goals regularly

• Adjust to meet your needs

• Thrive!

“Eating alone will not keep a man well; he must also take exercise. For food and exercise……

work together to produce health.”Hippocrates

Regimen 400 BC

“Exercise is just as essential as a rational diet”

Dr. William Esser N.D. DC.

“First say to yourself what you would be; and then do what you have to do”

Epictectus Greek Stoic Philosopher AD 55–AD 135

Thank You!Thank You!

www.Esserhealth.com

Thank You!

Stephan Esser MDwww.esserhealth.com