Intensive lifestyle interventions have been shown to reduce and even reverse some of the damage. … [+]
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Alzheimer’s is a devastating disease. It usually begins with difficulty remembering events. As memory loss worsens, other symptoms appear, such as confusion and difficulty completing complex tasks. Patients may become irritable and depressed.
As the disease progresses, memory fades. People become agitated and have trouble dressing and bathing. People with Alzheimer’s wander around. In the final stages, they are unable to communicate coherently. They become completely dependent on caregivers. Patients typically become bedridden and die from infections or organ failure. This process can take anywhere from 3 to 20 years.
The progression of Alzheimer’s seemed inevitable. Medications exist to suppress symptoms, but they’re not particularly effective. Newer drugs have emerged, such as lecanemab, sold under the brand name Leqembi, a monoclonal antibody. It’s late It reduces cognitive ability by 27% over 18 months compared to a placebo, but it requires regular infusions, has side effects and is expensive, costing $26,500 a year.
Emerging data suggests that intensive lifestyle changes may be an effective option in the early stages of Alzheimer’s disease. trial A study published by Dr. Dean Ornish and colleagues found that a combination of a whole food, plant-based vegan diet, regular exercise, stress management, support groups, and supplements can significantly slow and in some cases reverse early cognitive decline in Alzheimer’s disease. The results were published in the June 2024 journal Alzheimer’s Research and Treatment.
The study was relatively small compared with the thousands of people typically studied in drug trials. Fifty-one patients, aged 45 to 90 years, with early Alzheimer’s disease and mild cognitive impairment were randomized to receive either intensive lifestyle modification or usual care. Outcomes included cognition, functional tests, and biomarkers.
In just 20 weeks, the intervention group showed surprisingly large improvements in outcomes compared to the control group, which either showed no change or worsened. For example, the way doctors rated patients’ symptoms improved in 10 intervention patients versus no control patients. The intervention led to a 4% improvement in overall measures of cognitive, functional and behavioral health, compared to 12% worsening in the control group.
The plasma Aβ42/40 ratio, a biomarker for Alzheimer’s disease, increased by 6.4% in the intervention group and decreased by 8.3% in the control group. This can occur when Alzheimer’s brain damage (called amyloid plaques) dissolves and moves into the blood, suggesting that the intervention may be clearing damaged tissue. However, other biomarkers such as p-tau 181, another marker of Alzheimer’s disease activity, and glial fibrillary acidic protein, which correlates with symptoms, did not change.
Because of the small numbers, the results should be considered preliminary. But they are also surprisingly promising, given that many patients saw rapid improvement. What remains to be answered is which factor was most effective: diet, exercise, supplements, support groups, or a combination of all three? Larger studies are needed to find out.
Another issue is adherence. Going vegan, on a whole-foods diet, and exercising regularly means changing your daily habits, which can make it hard for people who aren’t particularly motivated to reap the benefits. Many people can’t fit such a protocol into their schedule or afford to follow it.
Challenges like these often lead people, and many doctors, to think of medical care less as infusions, pills and surgery, even though lifestyle changes can be equally, or sometimes more, effective.
Dietary habits are particularly ingrained: people cringe when their doctor recommends eating more arugula, berries, and kale. Many resist breaking away from the so-called “standard American diet,” which is high in calories, full of processed foods, and unfortunately lacking in essential nutrients, yet incredibly tasty. Adopting regular exercise is similarly difficult. In this study, adherence was essential to the effectiveness of the intervention, and benefits were strongly correlated with adherence.
So what should people with Alzheimer’s disease or mild cognitive impairment do now? The answer is to work with their doctors to consider adding lifestyle changes to their treatment strategy.
Another group that should take note of these results are those at high risk of developing Alzheimer’s disease, particularly those with one or two copies of the apolipoprotein E4 (APOE4) gene. Their benefits may be just as great, especially if lifestyle changes are started early. Downregulation APOE4 activity.
Ultimately, this study is a ray of hope for this terrible disease that has few effective treatments. Perhaps it will give some people the knowledge and motivation to change and adopt a healthier lifestyle.
Robert Glatter, MD, contributed to this article.
