A recent clinical trial has revealed that intensive lifestyle modifications can significantly improve cognition and daily functioning in patients with mild cognitive impairment (MCI) or early dementia due to Alzheimer’s disease. Published in Alzheimer’s Research & Therapy, this multisite study is the first randomized controlled trial to show that non-drug interventions can offer substantial benefits to those already diagnosed with these conditions.
Alzheimer’s disease is a progressive neurodegenerative disorder primarily affecting older adults, leading to gradual memory and cognitive function loss. It is the most common cause of dementia, characterized by a decline in cognitive abilities severe enough to interfere with daily life. The disease typically progresses through several stages, starting with MCI and advancing to early, moderate, and eventually severe dementia.
Mild cognitive impairment is an early stage of memory loss or other cognitive decline that is noticeable but not severe enough to significantly interfere with daily activities. Individuals with MCI may experience memory problems, language difficulties, and challenges in thinking and judgment greater than expected for their age, yet they generally maintain their independence. While not everyone with MCI will develop Alzheimer’s disease, they are at a higher risk compared to those without cognitive impairment.
Early dementia, often resulting from Alzheimer’s disease, involves more pronounced cognitive decline. Symptoms include increasing forgetfulness, confusion, difficulty managing finances, trouble remembering names and events, and impaired reasoning. As the disease progresses, these symptoms worsen, making it increasingly challenging for individuals to perform everyday activities and live independently.
The study was motivated by growing evidence linking lifestyle factors to the onset and progression of Alzheimer’s disease. Factors such as unhealthy diets, physical inactivity, emotional stress, and social isolation have been implicated in cognitive decline. Previous research suggested that addressing these risk factors through lifestyle changes could potentially prevent or slow the progression of dementia.
However, no study had conclusively shown whether such changes could benefit individuals already diagnosed with MCI or early dementia due to Alzheimer’s disease. This gap in research inspired the team to investigate whether a comprehensive, intensive lifestyle intervention could improve cognitive function and daily living in these patients.
The study was led by Dean Ornish, founder of the nonprofit Preventive Medicine Research Institute and clinical professor of medicine at the University of California, San Francisco. Ornish has a deeply personal connection to Alzheimer’s disease: “My mother and all of her siblings died of Alzheimer’s disease, and I have one of the genes for it,” he shared with PsyPost. This personal motivation has driven his commitment to exploring lifestyle interventions as a means to combat this devastating condition.
The study was a randomized controlled trial designed to examine whether an intensive lifestyle intervention could improve cognitive function and daily living activities in patients with mild cognitive impairment (MCI) or early dementia due to Alzheimer’s disease. The trial enrolled 51 participants aged 45 to 90, all diagnosed with MCI or early dementia. These participants were divided into two groups: an intervention group that received the lifestyle modifications and a control group that continued with their usual care.
The lifestyle intervention consisted of four main components:
- Whole Foods, Plant-Based Diet: Emphasized minimally processed plant-based foods low in harmful fats and refined sugars. Meals and snacks were provided to ensure adherence.
- Regular Physical Exercise: Participants were encouraged to engage in daily aerobic exercise and strength training three times a week.
- Stress Management Techniques: Included practices such as yoga, meditation, and other relaxation exercises to help manage stress.
- Social Support Groups: Participants took part in group sessions to foster social connections and provide emotional support.
This comprehensive approach aimed to address multiple lifestyle factors simultaneously, providing a holistic strategy to improve cognitive function and quality of life for those with MCI or early dementia.
The study’s lifestyle intervention was conducted under professional supervision to ensure effectiveness and safety:
- Whole Foods, Plant-Based Diet: Participants followed a diet emphasizing minimally processed plant-based foods, low in harmful fats and refined sugars, with meals and snacks provided to ensure adherence.
- Regular Physical Exercise: Under the guidance of an exercise physiologist, participants engaged in daily aerobic exercise and strength training three times a week.
- Stress Management Techniques: Stress management practices included meditation, yoga-based poses, and relaxation exercises, supervised by a certified stress management specialist.
- Social Support Groups: Social support was provided through regular group sessions led by mental health professionals, fostering social connections and offering emotional support.
This comprehensive approach aimed to simultaneously address multiple lifestyle factors, improving cognitive function and quality of life for individuals with MCI or early dementia.
The study measured cognitive and functional changes using standard tests, including the Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog), Clinical Global Impression of Change (CGIC), Clinical Dementia Rating Sum of Boxes (CDR-SB), and Clinical Dementia Rating Global (CDR Global). Additionally, various biomarkers related to Alzheimer’s disease, such as the plasma Aβ42/40 ratio, were monitored to assess biological changes. Participants were evaluated at baseline and after 20 weeks to determine the effects of the intervention.
The results revealed significant improvements in cognitive function and daily living activities among participants in the intervention group compared to those in the control group. The intervention group showed better scores on the CGIC, CDR-SB, and CDR Global tests, with borderline significance in the ADAS-Cog test.
Specifically, the intervention group exhibited improvements in cognitive measures and daily functioning, while the control group experienced declines across these metrics. For example, the CGIC scores improved in the intervention group, indicating better overall cognitive functioning and daily living capabilities.
In terms of biomarkers, the intervention group demonstrated beneficial changes, particularly in the plasma Aβ42/40 ratio. This ratio increased by 6.4% in the intervention group but decreased by 8.3% in the control group, indicating a positive impact of the lifestyle intervention on Alzheimer’s disease pathology by promoting amyloid movement from the brain to the blood.
Other biomarkers also showed significant beneficial changes in the intervention group, providing further evidence of the intervention’s positive effects on biological mechanisms underlying Alzheimer’s disease. These biomarkers included:
- Hemoglobin A1c: Improved blood sugar control
- Insulin: Improved insulin sensitivity
- Glycoprotein acetyls: Reduced inflammation
- LDL-cholesterol: Lowered bad cholesterol levels
- β-Hydroxybutyrate: Increased ketone levels, indicating improved metabolic health
Additionally, there was a significant correlation between the degree of lifestyle change and improvements in cognitive function and biomarkers. Participants who adhered more closely to the lifestyle intervention experienced greater cognitive and functional benefits. This dose-response relationship underscores the potential of lifestyle modifications in managing Alzheimer’s disease.
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