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Lifestyle changes significantly improve cognition and function in early Alzheimer’s in study first

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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 in a newly-published randomised controlled clinical trial.

The multisite clinical study was published in the peer-reviewed Alzheimer’s translational research journal, Alzheimer’s Research and Therapy.

The study was directed by lifestyle medicine pioneer Dean Ornish, M.D., founder and president of the non-profit Preventive Medicine Research Institute and clinical professor of medicine at the University of California, San Francisco.

Dr Ornish said: “I’m cautiously optimistic and very encouraged by these findings, which may empower many people with new hope and new choices.

“We do not yet have a cure for Alzheimer’s, but as the scientific community continues to pursue all avenues to identify potential treatments, we are now able to offer an improved quality of life to many people suffering from this terrible disease.”

The research team recruited 51 participants with a diagnosis of mild cognitive impairment or early dementia due to Alzheimer’s disease and randomly assigned them to either an intensive lifestyle intervention group (no drugs added) or a usual-care control (comparison) group.

Members of the control group were instructed not to make any lifestyle changes during the 20-week trial.

The intervention group participated in an intensive lifestyle programme with four components:

1. A whole-foods, minimally processed plant-based diet low in harmful fats, refined carbohydrates, alcohol and sweeteners

2. Moderate aerobic exercise and strength training for at least 30 minutes per day

3. Stress management, including meditation, stretching, breathing and imagery, for one hour per day

4. Support groups for patients and their spouses or study partners, for one hour three times per week.

To measure pre- and post-trial cognitive function, the researchers utilised four standard tests used in FDA drug trials: 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).

Results after 20 weeks showed overall statistically significant differences between the intervention group and the randomised control group in cognition and function in three of these measures (CGIC, p = 0.001; CDR-SB, p = 0.032; CDR-G, p = 0.037), and differences of borderline significance in the fourth test (ADAS-Cog, p = 0.053).

When a mathematical outlier was excluded, all four measures showed significant differences in cognition and function in the experimental group.

Three of these measures showed improvement in cognition and function in the intervention group and one test showed significantly less disease progression.

In contrast, the randomised control group worsened in all four of these measures.

Not all patients in the intervention group improved; in the CGIC test, 71 per cent improved or were unchanged. In contrast, none of the patients in the control group improved, eight were unchanged and 17 (68 per cent) worsened.

Many patients who experienced improvement reported regaining lost cognition and function.

For example, several patients in the intervention group reported that they had been unable to read a book or watch a film because they kept forgetting what they had just read or viewed and had to keep starting over, but now they were able to do so and retain most of this information.

One individual reported that it used to take him weeks to finish reading a book, but after participating in the study he was able to do so in only three or four days and was able to remember most of what he read.

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.

In addition to improvements in cognition and function, the intervention group also demonstrated significant improvements in several key blood-based biomarkers.

One of the most clinically relevant biomarkers is called the Aβ42/40 ratio, which is a measure of amyloid, thought to be an important mechanism in Alzheimer’s disease.

This measure improved in the lifestyle intervention group (with the presumption that this improvement reflected amyloid moving out of the brain and into the blood), but it worsened in the randomized control group, and these differences were statistically significant.

There was also a statistically significant dose-response correlation between the degree of lifestyle change and the degree of improvement in this amyloid ratio (p = 0.035).

This direction of change in amyloid was also a major finding with lecanemab, a drug approved for treating Alzheimer’s disease last year.

Also, the gut microbiome in the intervention group showed a significant decrease in organisms that raise the risk of Alzheimer’s disease and an increase in organisms that are protective against Alzheimer’s disease.

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