Recent clinical trials have shown that intensive lifestyle modifications can significantly improve cognitive and daily functioning in patients with mild cognitive impairment or early dementia due to Alzheimer’s disease. Alzheimer’s Research and TreatmentThis multi-centre study is the first randomised controlled trial to demonstrate that a non-pharmacological intervention could have significant benefits for people already diagnosed with these diseases.
Alzheimer’s disease is a progressive neurodegenerative disorder that primarily affects older adults, resulting in a gradual decline in memory and cognitive function. Alzheimer’s disease is the most common cause of dementia, a syndrome characterized by a decline in cognitive abilities that is disruptive to daily life. Alzheimer’s disease typically progresses through several stages, beginning with mild cognitive impairment (MCI) and progressing to early, moderate, and ultimately severe dementia.
Mild cognitive impairment (MCI) is the early stage of memory loss and other cognitive decline that, while noticeable, is not severe enough to significantly interfere with daily activities. People with MCI may experience more memory loss, language problems, and difficulty thinking and making decisions than would be expected for their age; however, they usually remain independent and can carry out most daily tasks. Not everyone with MCI will develop Alzheimer’s disease, but they are at higher risk than those without cognitive impairment.
In the early stages of dementia, often caused by Alzheimer’s disease, the decline in cognitive function becomes more pronounced. Symptoms include increased forgetfulness, confusion, difficulty managing money, difficulty remembering names and events, and reduced reasoning skills. As the disease progresses, these symptoms worsen, making it increasingly difficult to carry out daily activities and live independently.
The motivation for this study stems from growing evidence linking lifestyle habits to the onset and progression of Alzheimer’s disease. Unhealthy diet, lack of exercise, mental stress, and social isolation have all been implicated as contributing factors to cognitive decline. Previous research has shown that addressing these risk factors through lifestyle changes may prevent or slow the progression of dementia.
However, no studies had clearly demonstrated whether such changes would benefit patients who had already been diagnosed with MCI or early dementia due to Alzheimer’s disease. This research gap prompted the research team to investigate whether a comprehensive and intensive lifestyle intervention could improve the cognitive function and daily life of these patients.
The study was led by Dean Ornish, founder of the nonprofit Preventive Medicine Institute and professor of clinical medicine at the University of California, San Francisco. Ornish has a deep personal connection to Alzheimer’s. “My mother and her brothers and sisters all died of Alzheimer’s, and I carry one of the genes,” he told PsyPost. This personal motivation drove his determination to explore lifestyle interventions as a means to combat this devastating disease.
The study was a randomized controlled trial designed to examine whether an intensive lifestyle intervention could improve cognitive function and activities of daily living in patients with mild cognitive impairment (MCI) or early dementia due to Alzheimer’s disease. The study enrolled 51 participants aged 45 to 90 years who had been diagnosed with MCI or early dementia. These participants were divided into two groups: an intervention group that received lifestyle changes and a control group that continued their usual care.
The lifestyle intervention consisted of four main components: a whole-food, plant-based diet, regular exercise, stress management techniques, and participation in a social support group. The diet emphasized minimally processed, plant-based foods low in harmful fats and refined sugars, and meals and snacks were provided to ensure adherence. Participants were encouraged to perform aerobic exercise daily and strength training three times a week under the guidance of an exercise physiologist. Stress management practices included meditation, yoga-based postures, and relaxation exercises under the supervision of a certified stress management specialist. Social support was provided through regular group sessions led by a mental health professional.
The study measured changes in cognitive function using standard tests such as 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 plasma Aβ42/40 ratio, were monitored to assess biological changes. Participants were assessed at baseline and after 20 weeks to determine the effect of the intervention.
The study found that participants in the intervention group showed greater improvements in cognitive function and activities of daily living compared to participants in the control group. The intervention group showed better scores in the CGIC, CDR-SB, and CDR Global tests, with significant differences in the ADAS-Cog test.
Specifically, the intervention group showed improvements in cognitive function and daily living function, whereas the control group saw declines in all of these measures. For example, the intervention group showed improved CGIC scores, indicating improved overall cognitive function and daily living abilities.
In terms of biomarkers, the intervention group showed beneficial changes, notably the plasma Aβ42/40 ratio, which increased by 6.4% in the intervention group but decreased by 8.3% in the control group. This biomarker is related to the movement of amyloid from the brain to the blood, and its improvement suggests that the lifestyle intervention has a positive impact on Alzheimer’s disease pathology.
Other biomarkers, including hemoglobin A1c, insulin, glycoprotein acetylcholine, LDL cholesterol, and β-hydroxybutyrate, also showed significant beneficial changes in the intervention group, providing further evidence of the positive effect of the intervention on the biological mechanisms underlying Alzheimer’s disease.
Furthermore, a significant correlation was found 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 highlights the potential of lifestyle modification in the management of Alzheimer’s disease.
“Comprehensive lifestyle changes have the potential to improve cognition and function for many people suffering from early-stage Alzheimer’s disease,” Ornish told PsyPost.
“Despite billions of dollars spent over the past 20 years, only three drugs have been approved to treat Alzheimer’s. Most people diagnosed with Alzheimer’s are often told that all three of these drugs only slow the progression of the condition, are very expensive, and often have side effects such as bleeding in the brain and swelling in the brain.”
“Even if the symptoms slowly worsen, they only get worse. They often feel hopeless and hopeless. When they lose their memory, they lose everything,” Ornish explained. “This is why we see a seven-fold increase in suicides in the three months following this diagnosis.”
“These drugs are designed to clear amyloid from the brain. We now know that lifestyle changes can also help clear amyloid from the brain. But amyloid is only one of many mechanisms that cause Alzheimer’s, and lifestyle changes also have a positive effect on many other mechanisms. So lifestyle changes don’t just slow the progression of symptoms, they often lead to improved cognition and function. And the only side effects are good.”
Limitations of this study include a relatively small sample size of 51 participants and a short duration of 20 weeks, which may limit the generalizability and long-term applicability of the findings. Additionally, the lack of racial and ethnic diversity among participants and the inability to inform participants of their group assignment may introduce bias.
“We do not know to what extent these findings can be generalized to more diverse populations, and we do not know the long-term effects of these lifestyle changes on cognition and functioning.”
Future studies should aim to include larger and more diverse populations and extend the duration of interventions to better evaluate long-term effects. Further studies should also explore the mechanisms underlying lifestyle interventions and their potential synergies with existing pharmacological treatments for AD.
“There is a desperate need for a cure for Alzheimer’s disease,” said study co-author Rudolph E. Tange, professor of neurology at Harvard Medical School and director of the McCance Brain Center.
“Biopharmaceutical companies have invested billions of dollars to find treatments for Alzheimer’s, but only two drugs have been approved for the treatment of Alzheimer’s in the past 20 years – one was recently pulled from the market, and the other is largely ineffective and extremely expensive,” said the health director at Massachusetts General Hospital, one of the clinical sites for the study.
“We are excited and honored to be part of this groundbreaking study that shows, for the first time in a controlled clinical trial, what epidemiology has taught us all along: lifestyle habits are crucial in addressing Alzheimer’s. While efforts to develop treatments for this disease will continue, this study provides a blueprint for practical, easily implemented steps that could significantly alter the progression of Alzheimer’s,” said study co-author Eric Verdin, president and CEO of the Buck Institute on Aging.
“This study finally provides scientific data to support a belief that many in the field have instinctively believed for many years: that lifestyle interventions can determine the trajectory of Alzheimer’s,” added Maria Shriver, founder of the Women’s Alzheimer’s Movement (WAM) at the Cleveland Clinic, which provided initial funding for the study. “We opened the WAM Prevention Research Clinic at the Lou Ruvo Brain Health Center in Las Vegas, targeting women ages 30 to 60 who are at higher-than-average risk for developing Alzheimer’s. The protocol we use involves adopting many of the lifestyle interventions employed in this study. So, our success in improving the health trajectory of people already diagnosed with Alzheimer’s clearly gives hope to those who want to delay or prevent the onset of the disease altogether. This is a study that gives us hope.”
Ornish’s latest bestseller, Put it back!The paper, co-authored with Anne Ornish, argues that lifestyle changes can have a positive impact on a range of chronic diseases, including Alzheimer’s, because these diseases share common biological mechanisms that are influenced by diet, exercise, stress management and social support, suggesting that “what’s good for the heart is also good for the brain”.
The study, “Effect of Intensive Lifestyle Modification on the Progression of Mild Cognitive Impairment or Early Dementia Due to Alzheimer’s Disease: A Randomized Controlled Clinical Trial,” was written by Dean Ornish, Katherine Madison, Mia Kivipelto, Colleen Kemp, Charles E. McCulloch, Douglas Galasco, John Aerts, Dorine Lenz, Jue Lin, Kim Norman, Ann Ornish, Sarah Tranter, Nancy Delamarter, Noelle Wingers, Kara Richling, Rima Kadura-Dawuk, Rob Knight, Danielle MacDonald, Lucas Patel, Eric Verdin, Rudolph E. Tanzi and Steven E. Arnold.