4 lifestyle changes may help improve or prevent decline

Alzheimer’s disease is a condition that results in brain changes and impacts over six million people in the United States alone.

People with Alzheimer’s disease often experience a progressive decline in their cognitive function and memory. They may struggle with memory loss, personality changes, and declines in judgment. Alzheimer’s disease is also the most common dementia type, making it a particularly important area for research focus.

Shannel Kassis Elhelou, Psy.D., geropsychology and neuropsychology fellow at Pacific Neuroscience Institute’s Brain Wellness and Lifestyle Programs in Santa Monica, CA, who was not involved in the study, noted the following about Alzheimer’s disease to Medical News Today:

“Alzheimer’s disease significantly impacts quality of life and function through progressive declines in memory, cognitive functioning (attention, processing speed, problem-solving, word finding), tasks of daily living (managing finances, driving, medication management, household duties), as well as changes in mood (increased irritability, anxiety, depression, or apathy).”

“Over time, Alzheimer’s disease leads to declines in physical health, reducing mobility and increasing the risk of falls. Overall, these effects result in social isolation and substantial caregiver burden, further impacting the individual and caregivers’ quality of life,” Elhelou said.

There are medications that help people with Alzheimer’s disease, but experts are also interested in how lifestyle interventions can also help. These lifestyle interventions were the focus of the current study.

For the current study, researchers wanted to examine if a combination of non-medication interventions could help people in the early stages of Alzheimer’s disease.

This study was a randomized, controlled clinical trial that included fifty-one participants. All participants had mild cognitive impairment or early dementia from Alzheimer’s disease. The average age for participants was 73.5 years. Researchers excluded participants who had moderate or severe dementia and those who could not participate in regular exercise.

Researchers divided participants into two groups. The control group received standard care, and the intervention group received standard care and took part in four key lifestyle interventions:

1. Implementation of a whole-foods, minimally processed plant-based diet with specific supplements and low levels of harmful fats and refined carbohydrates,
2. Moderate exercise for at least thirty minutes daily and mild strength training three times a week or more,
3. Stress management techniques like meditation, yoga, and breathing exercises,
4. Regular use of support groups three times a week.

Overall, the intervention period lasted 20 weeks, and two participants from the intervention group withdrew. Researchers provided intervention participants with food, assistance with exercise, supervision of stress management techniques, and access to support group meetings.

Researchers used several measurements to assess the success of the interventions, including four assessment tools: the AD assessment Scale—cognitive Subscale, Clinical Global Impression of Change, Clinical Dementia Rating Sum of Boxes, and Clinical Dementia Rating Global. They also examined certain biomarkers and microbiome taxa.

The control group showed declines in all four assessments of cognition and function. In contrast, the intervention group showed improvement in three of the assessments. In the last assessment, the intervention group showed less progression than the control group.

In addition, the intervention group showed improvement in microbiome configuration and improvement in clinically relevant biomarkers compared to controls.

Study author Dean Ornish, founder and president of the nonprofit Preventive Medicine Research Institute and clinical professor of medicine at the University of California, San Francisco, noted the following highlights of the research to Medical News Today:

“What makes our research unique is that it’s the first time a randomized controlled clinical trial has demonstrated that an intensive lifestyle intervention, without drugs, significantly improved cognition and function after 20 weeks in many patients with mild cognitive impairment or early dementia due to Alzheimer’s disease.”

“There was a statistically significant dose-response correlation between the degree of lifestyle changes in both groups and the degree of change in most measures of cognition and function testing. In short, the more these patients changed their lifestyle in the prescribed ways, the greater was the beneficial impact on their cognition and function.”
— Dean Ornish, study author

While the results don’t mean that everyone in the intervention group experienced an improvement in cognition, they do mark superior outcomes to standard care interventions. Ornish noted that “Not all patients in the intervention group improved; in the CGIC test, 71% improved or were unchanged. In contrast, none of the patients in the control group improved, eight were unchanged, and 17 (68%) worsened.”

Should future research confirm these findings, the interventions could see greater emphasis as a way to help people with early Alzheimer’s disease. It may also have implications for Alzheimer’s disease prevention.

This research does have several limitations.

First, it included a fairly small sample size, so it could help to replicate the findings with larger groups, and the results cannot be generalized. Researchers were also unable to include certain individuals in the intervention, such as those who didn’t have a caregiver who could help with study adherence.

Since the research focused on Alzheimer’s disease, it’s also unclear how the interventions would help individuals with other dementia types. Researchers note the increased likelihood of a type II error in certain measurements related to ethnic and racial diversity.

The study is also limited by its design, such as how it was not double-blinded. Researchers also did not conduct brain structure measurements, which could have given an even better picture of the results.

The intervention period lasted only 20 weeks, so future research could have more extended intervention and follow-up times and include more diversity among study participants. The interventions were also complex, making it not entirely clear if any of them are superior in how they help people with Alzheimer’s disease.

In addition, some data relied on participant reporting, which is not the most accurate data collection method.

The researchers acknowledge that some participants may have been better able to adhere to the intervention, which may have been why these participants saw improved cognition.

The researchers also acknowledge that “The findings on the degree of lifestyle change required to stop the worsening or improve cognition and function need to be interpreted with caution. Since data from both groups were combined, it was no longer a randomized trial for this specific analysis, so there could be unknown confounding influences.”

However, the results still offer hope for people and their loved ones who are impacted by Alzheimer’s disease and point to more extensive research in the future.

Elhelou noted the following:

“I hope to see more providers discussing this information with their patients and I am enthusiastic about future research in this area. These findings underscore the potential of non-pharmacological interventions in the treatment of MCI [mild cognitive impairment] and early-stage Alzheimer’s disease. Ongoing research can further support their ability to influence healthcare guidelines by promoting lifestyle modifications as a crucial strategy for slowing the progression of MCI and early-stage Alzheimer’s disease.”