Lately, the biggest news in Alzheimer’s has been about a that can delay cognitive decline by almost 30% among early-stage patients. The U.S. Food and Drug Administration is expected to decide on another promising therapy in the coming months.
However, a new study suggests that in addition to expensive and invasive pharmaceutical interventions, making sustained lifestyle changes can also delay the progression of the disease and potentially prevent further decline.
An intensive program involving diet, exercise, stress reduction, and social interaction slowed the progression of cognitive decline in a trial and even improved symptoms in some participants. The study was conducted by Dr. Dean Ornish, founder and president of the nonprofit Preventive Medicine Research Institute and professor of medicine at the University of California, San Francisco, and a team of scientists. It was published in the journal Alzheimer’s Research and Therapy.
Previous studies have shown that moderate lifestyle changes can help slow cognitive decline, so Ornish and his team investigated whether a more intensive, structured program of behavior changes could lead to further delays. Ornish had previously developed the program to address heart disease risk and demonstrated that a combination of improved diet, exercise, stress reduction, and social engagement could greatly reduce the risk of atherosclerosis and heart disease.
“I have a unifying theory that various 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 immune system changes. That’s why what is beneficial for the heart is also beneficial for the brain—these mechanisms affect different conditions, and lifestyle choices can make them better or worse.”
In the study, 49 individuals with mild cognitive impairment or early Alzheimer’s dementia agreed to participate. Half implemented the lifestyle changes outlined in Ornish’s program for 20 weeks, while the other half continued their usual habits (although this latter group was offered the opportunity to join the program after the study ended). Blood and fecal samples were collected from all participants to monitor changes in Alzheimer’s markers and microbiome, respectively.
The program was more accessible in the study setting than it would be in real life. The researchers delivered three daily vegan meals and two snacks to participants in the lifestyle change group and their partners twice a week. These participants also engaged in 30 minutes of daily aerobic exercise (primarily walking) and strength training at least three times a week. A stress-management specialist guided them in meditation, yoga, stretching, and relaxation exercises for an hour daily to improve concentration and relaxation. Finally, participants and their partners attended a support group three times a week to discuss mental health and emotional issues. They also took vitamins and supplements, including omega-3 supplements, a multivitamin, Lion’s mane mushrooms, and probiotics for cognition.
By the end of the 20-week study, those who made the lifestyle changes showed statistically significant improvements in three out of four standard cognitive tests and near-significant changes in the fourth test—compared to the control group, who showed worsening scores on all four tests.
While the improvements were modest, Ornish notes that 20 weeks is a relatively short period, and other metrics support the encouraging changes observed in the tests. For instance, those who adhered most closely to the lifestyle changes experienced the greatest improvements. Additionally, blood markers for amyloid protein, which accumulates in the brains of Alzheimer’s patients, showed positive changes similar to those observed in individuals taking the new Alzheimer’s medication, .
“This is a first step,” says Ornish. “This is not the definitive study. But it shows for the first time that intensive lifestyle changes can improve cognition and function in Alzheimer’s patients.”
Ornish hopes these results will encourage insurers to cover the program, which is already covered by Medicare for heart disease treatment. He also hopes the findings will provide more people with access to a method for slowing the progression of their disease or even preventing it. “This was designed as an intervention that anyone can follow,” he says. “We didn’t want it to be exclusive. And we have data on 15,000 people who have completed the cardiac program, which is essentially the same. More significant lifestyle changes can lead to better clinical outcomes, cost savings, and better adherence.”
Ornish emphasizes the importance of positive reinforcement when making behavioral changes, countering the notion that people cannot stick to a vegan diet, exercise regimen, stress management, and support group schedule. “When people feel better and see changes, that reframes the motivation from fear of dying to joy of living, which is more sustainable,” he says. Anecdotally, some participants in the program reported being able to resume reading, an activity they had given up when their Alzheimer’s made it impossible to follow storylines and remember characters, Ornish says.
“When you implement changes that quickly make people feel so much better, it gives them renewed hope that they can accomplish things they were told they would never be able to do again,” says Ornish.
His team plans to continue following this group of patients and include more participants from diverse backgrounds to strengthen the data. He is also keen to examine how the program might interact with lecanemab and other Alzheimer’s drugs that may be approved.
