Alzheimer’s disease is devastating. It typically starts with difficulty in remembering events. As memory loss worsens, other symptoms emerge including episodes of confusion and difficulty completing complex tasks. Patients become irritable and depressed.
As it progresses, recollections fade. There is agitation and trouble with dressing and bathing. Alzheimer’s patients wander away. Towards the end, coherent communication disappears. There is complete caregiver dependance. Patients, bedridden, commonly die from infection and organ failure. The process takes from three to 20 years.
Progression in Alzheimer’s was seemingly inevitable. Drugs exist to control symptoms. But they are not particularly effective. New drugs have emerged. For example, lecanemab—sold under the brand Leqembi—is a monoclonal antibody that slowed cognitive decline 27% over placebo in 18 months. But also requires regular intravenous infusions, comes with side effects and carries a hefty tag of $26,500 per year.
Here’s what’s new. Emerging data show that intensive lifestyle changes are an effective option in early Alzheimer’s. A recent trial published by Dr. Dean Ornish and colleagues found that the combination of a whole food, plant-based vegan diet, regular exercise, stress management, support groups, and supplements significantly slowed and, in some cases, reversed some early decline in cognitive function in Alzheimer’s disease. The results were published in the journal Alzheimer’s Research and Therapy in June 2024.
The trial was relatively small compared to the thousands commonly in drug trials. Fifty-one individuals aged 45 to 90 with early Alzheimer’s disease at the stage of mild cognitive impairment randomly received an intensive lifestyle modification or usual care. Outcomes were cognitive, functional tests and biomarkers.
In a short period—only 20 weeks—the intervention group exhibited surprisingly substantial outcome improvements compared to controls who stayed the same or worsened. For example, how doctors rated their patients’ symptoms improved in 10 intervention and no control patients. The intervention led to a 4% improvement in a global scale of cognitive, functional, and behavioral health while it worsened in 12% of controls.
Plasma Aβ42/40 ratio, a biomarker of Alzheimer’s, increased in the intervention group by 6.4% and decreased 8.3% in controls. This can happen when brain damage in Alzheimer’s—called amyloid plaques—dissolves and moves into the blood suggesting the intervention may be clearing out ravaged tissue. Yet other biomarkers were unchanged, such as p-tau 181—another marker of Alzheimer’s activity—or glial fibrillary acidic protein which correlates with symptoms.
Given the small numbers, results should be seen as preliminary. Yet they’re also surprisingly promising given many patients’ symptoms improved so rapidly. What’s unanswered: which component is most impactful. Was it the diet, the exercise, the supplements, the support groups, or perhaps all of them together? Larger studies are needed to know.
Another issue is compliance. A vegan, whole food diet and regular exercise means modifying daily, ingrained routines. This limits the ability of many—particularly the unmotivated—to reap its benefits. Many may be unable to fit such a protocol into their schedule nor afford it.
Such challenges are often why people—and many physicians—think about medicine more as IV infusions, pills, and surgery than lifestyle change despite the latter being equally or sometimes more effective.
Eating habits are particularly entrenched. Eyes glaze over when doctors recommend more arugula, berries, and kale. Many balk at moving away from what has been termed a Standard American Diet which is calorie-dense, ultra processed and unfortunately low on needed nutrients, yet highly palatable. Integrating regular movement can be a similar struggle. In the study, compliance was vital to the intervention’s effectiveness as benefits correlated strongly with adherence.
So, what should patients with Alzheimer’s and mild cognitive impairment do now? The answer: consider adding lifestyle change to a treatment strategy in coordination with a doctor.
Another group to heed these results are those at high risk for developing Alzheimer’s, specifically those with one or two copies of the Apolipoprotein E4 (APOE4) gene. Their benefit may be similarly substantial, particularly if lifestyle change is started early. Improving diet alone has been shown to downregulate APOE4 activity.
Ultimately, the study is a ray of hope for a ravaging disease with few effective treatments. Perhaps it will empower some with the knowledge to change and motivation to adopt a healthy lifestyle.
Robert Glatter, MD contributed to this article.
