Lifestyle Changes Improved Cognition, Function, Aβ Biomarkers in People with Early Alzheimer Disease According to RCT

Lifestyle changes, including diet, exercise, stress management, and participation in support groups, were associated with improved cognition and function in people with mild cognitive impairment (MCI) or early dementia due to Alzheimer disease (AD). People who received usual care showed no improvements, with cognitive outcomes either remaining unchanged or worsening. Additionally, people who underwent lifestyle changes showed significant changes in plasma biomarkers for AD compared with those who did not. The results of this multisite study were published in Alzheimer’s Research and Therapy.

The 20-week study was directed by Dean Ornish, MD, Founder and President of the Preventive Medicine Research Institute, and conducted in collaboration with researchers and neurologists at multiple academic medical centers in the United States and abroad. The study included 51 participants with a diagnosis of MCI or early dementia due to AD. Participants were randomized to either undergo lifestyle changes as an intervention group (n=26) or to receive usual care with no lifestyle changes as a control group (n=25).

Lifestyle interventions included:

• A wholefoods, plant-based, minimally processed diet low in harmful fats, carbohydrates, alcohol, and sweeteners
• Moderate aerobic exercise and strength training for ≥30 minutes each day
• Stress management activities for ≥1 hour per day, including meditation, stretching, breathing, and imagery
• Participation in support groups for ≥1 hour 3 times per week for participants and their spouses or partners

Cognition and function were assessed before and after the 20-week study period, measured according to 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-G).

There were statistically significant differences between the intervention and control groups in CGIC (P=.001), CDR-SB (P=.032), and CDR-G (P=.037) after 20 weeks, and a difference of borderline significance in ADAS-Cog (P=.053). CGIC, CDR-G, and CDR-SB all showed improvements in cognition and function for the intervention group and worsening for the control group, while CDR-SB showed improved disease progression in the intervention group compared with the control group. After exclusion of mathematical outlier, all 4 measures showed statistically significant differences in cognition and function between the groups.

Additionally, AD and dementia biomarkers were assessed before and after the study period. Amyloid beta (Aβ) 40/42 ratio, a biomarker of clinical relevance, increased by 6.4% in the intervention group and decreased by 8.3% in the control group (P=.003, 2-tailed). This change may indicate that lifestyle changes were associated with increased removal of amyloid from the brain into the bloodstream. Improvements also were found in other biomarkers after the implementation of lifestyle changes.

There were significant dose-response correlations for the changes in cognition and function and clinically relevant biomarkers, indicating that the more lifestyle changes a person with AD makes, the more benefits they may experience.

Miia Kivipelto, MD, PhD, Study Author and Professor at the Karolinska Institutet, said, “These findings add to the growing body of evidence that moderate multimodal lifestyle changes may help prevent Alzheimer's disease or slow its progression, and also suggest that more intensive multimodal lifestyle changes may have additional benefits for improving cognition in patients with early Alzheimer's disease.”