LThe biggest news in Alzheimer’s disease right now concerns a new drug treatment that can slow cognitive decline by nearly 30% in people in the early stages of the disease. The U.S. Food and Drug Administration is expected to make a decision on another such promising therapy in the coming months.
But in addition to pharmaceutical interventions, which are expensive and require repeated infusions, making lasting lifestyle changes can also slow the progression of the disease and possibly even prevent further decline, a new study shows.
In the trial, an intensive program of diet, exercise, stress reduction and social interaction slowed the progression of cognitive decline, as measured by standard tests for dementia, and even improved some people’s symptoms. The research was conducted by Dr. Dean Ornish, founder and chairman of the nonprofit Preventive Medicine Research Institute and professor of medicine at the University of California, San Francisco, and a team of scientists. It appeared in the news Alzheimer’s research and therapy.
Previous studies have shown that moderate lifestyle changes can lead to some slowing of cognitive decline. So Ornish and his team decided to test whether a more in-depth, formal program of behavioral changes could slow the brain changes even further. Ornish had previously developed the program to address the risk of cardiovascular disease and showed that the combination of improved nutrition, exercise, stress reduction and social engagement could significantly reduce the risk of atherosclerosis and heart disease.
“I have a unifying theory that many different chronic diseases share the same underlying biological mechanisms,” he says. “These include inflammation, overstimulation of the sympathetic nervous system, changes in the microbiome… gene expressions and changes in the immune system. Therefore, what is good for the heart is also good for the brain: the same mechanisms influence different conditions, and lifestyle choices can make them better or worse.”
In the study, 49 people with mild cognitive impairment or early Alzheimer’s dementia agreed to participate. Half continued the lifestyle changes in Ornish’s program for 20 weeks, and the other half maintained their normal habits (although the latter group was given the opportunity to participate in the program after the study ended). Everyone provided blood samples so the researchers could monitor changes in Alzheimer’s disease markers and fecal samples to provide insight into their microbiome, or gut bacteria.
The program was easier to maintain during the study than in real life. Twice a week, the researchers sent three daily vegan meals and two snacks to people in the lifestyle change group and their partners. These participants also did 30 minutes of aerobics per day (mainly walking) and strength training at least three times a week. A stress management specialist guided them for an hour a day through meditation, yoga, stretching and relaxation exercises to improve their concentration and relaxation. Finally, these participants and their partners joined a support group three times a week to discuss any mental and emotional problems they were experiencing. They also took several vitamins and supplements, including omega-3 supplements, a multivitamin, Lion’s mane mushrooms and probiotics for cognition.
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By the end of the 20-week study, those who made the lifestyle changes showed statistically significant improvements in three of four standard cognitive tests and statistically significant changes in the fourth test, compared to people in the control group, who showed worsening scores on the fourth test. all four tests.
While the improvements were small, Ornish says 20 weeks is a relatively short period of time, and other statistics further support the encouraging changes recorded in those tests. First, the more closely people adhered to the lifestyle changes, the better their improvements; another was that blood markers for amyloid protein, which builds up in the brains of Alzheimer’s patients, showed positive changes similar to those seen in people taking the new Alzheimer’s drug lecanemab.
“This is the first step,” says Ornish. “This is not the investigation that ends all investigations. But it shows for the first time that intensive lifestyle changes can improve cognition and functioning in patients with Alzheimer’s disease.”
Ornish hopes these results will encourage insurers to cover the program; Medicare already does that for heart disease. He also hopes the findings will give more people access to a way to slow or even prevent their disease from progressing. “This is designed as an intervention so that anyone can do it,” he says. “We didn’t want concierge medicine. And we have data on 15,000 people who have done the heart program, which is exactly the same. Greater lifestyle changes can lead to better clinical outcomes, cost savings and better treatment compliance.”
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For those wondering whether people can stick to a vegan diet, exercise regimen, stress management and support group schedule, Ornish points to the power of positive versus negative messages when it comes to making behavioral changes. “When people feel better and see changes, it reframes the motivation from fear of dying to joy of life, which is more sustainable,” he says. Anecdotally, some people who participated in the program reported being able to pick up reading again, which they had to give up when their Alzheimer’s made it impossible to follow storylines and remember characters, Ornish says.
“When you make changes that make people feel much better quickly, it gives them hope that they can do things they were told they would never do again,” Ornish says.
His team then hopes to continue following this group of patients and involve more people from different backgrounds to strengthen the data. He is also eager to see how the program could work together with lecanemab and other drugs that may be approved for Alzheimer’s disease.