Drastic lifestyle changes slow progression of Alzheimer's disease

Intensive lifestyle modification improved cognitive outcomes in a Phase II trial of early-stage Alzheimer's disease.

Alzheimer's disease patients with mild cognitive impairment or early dementia saw significantly improved scores on three measures of cognition and function after 20 weeks of a multifaceted intervention compared with usual care, reported Dean Ornish, MD, PhD, of the University of California, San Francisco, and his coauthors.

The intervention resulted in improvement in Clinical Global Impression of Change (CGIC). P=0.001) and Clinical Dementia Rating (CDR) Global Rating (P=0.037), and the usual care control group did worse on both measures, the researchers wrote. Alzheimer's Research and Treatment.

The CDR-Sum of Boxes (CDR-SB) showed that the intervention group showed a slower decline in cognitive function compared to the control group (P= 0.032). Scores on the Alzheimer's Disease Assessment Scale (ADAS-Cog) improved with treatment and worsened in the control group, but the difference was not significant (P=0.053).

Ornish called the findings “cautiously optimistic.” “Our findings are plausible and biologically plausible for all the reasons we outline in the paper, but all studies need to be replicated,” he said. Medpage Today“We hope that our randomized controlled trial will inspire other researchers to conduct larger studies, with more diverse populations, and over a longer period of time.”

“In the meantime, physicians should encourage these lifestyle changes in their Alzheimer's patients, because they are more likely to improve cognition and function than simply slow the progression of symptoms,” Ornish added. “Lifestyle changes cost nothing and have only positive side effects.”

This study is not the first to show positive cognitive outcomes from a multimodal intervention. One of the largest studies finger Trials have shown that a two-year program targeting exercise, diet, cognitive stimulation, and self-monitoring of cardiac and metabolic risk factors has a protective effect on cognitive function. smart The trial demonstrated that individualized instruction targeting multiple risk factors resulted in small improvements in cognitive function compared to a control group.

Ornish and his colleagues studied 51 Alzheimer's disease patients with mild cognitive impairment or early-stage dementia. trial The study was conducted from September 2018 to June 2022. All participants had plasma amyloid beta (Aβ) 42/40 ratios highly suggestive of Alzheimer's disease at baseline. The mean age of the group was 73.5 years.

The researchers randomly assigned 26 participants to a 20-week intervention group and 25 participants to a control group who were asked not to make any lifestyle changes for the duration of the study, after which the intervention was offered.

The intervention program consisted of four components: a whole-food, minimally processed, plant-based diet consisting primarily of fruits, vegetables, whole grains, legumes, and selected supplements, at least 30 minutes per day of moderate aerobic activity (e.g., walking) and strength training, one hour per day of stress management including meditation, stretching, breathing, and imaging, and a one-hour online support group three times per week for participants and their spouses or study partners.

Approximately 14% to 18% of total diet calories were fat, 16% to 18% were protein, and 63% to 68% were primarily complex carbohydrates. There was no calorie restriction. All meals were delivered to each participant's home twice a week.

At week 20, blood levels of Aβ42/40 improved in the intervention group and worsened in the control group (P= 0.003). Microbiome biomarkers improved only in the intervention group (P<0.0001).

“In participants who underwent intensive lifestyle changes, plasma Aβ42/40 abnormalities decreased over 20 weeks, while two other plasma biomarkers associated with Alzheimer's disease, p-tau181, were reduced. [phosphorylated-tau181] and GFAP [glial fibrillary acidic protein] “There was no change,” said Suzanne Schindler, MD, PhD, of Washington University in St. Louis, who was not involved in the study.

“Plasma biomarker levels may be influenced by factors such as body mass index and renal function, and it is unclear whether the changes in plasma Aβ42/40 in this study are related to Alzheimer's disease pathology or are nonspecific effects related to the intervention,” Schindler said. Medpage Today.

There was a dose-response relationship between the degree of lifestyle change and most measures of cognitive function testing over the 20 weeks, but not everyone in the intervention group improved. For example, on the CGIC test, 10 of 24 people in the intervention group improved, 7 remained unchanged, and 7 worsened; in the control group, no one improved, 8 remained unchanged, and 17 worsened.

This study had several limitations: the sample size was small and the study duration was short. Although assessors were blinded, participants were not blinded.