Althought heart disease impacts many more people than Alzheimer's Dementia (AD), people fear AD the most due to the loss of control and the deterioration in quality of life. Advances in reversing early AD have been slow and the medications are controversial at best.
At the Kahn Center we discuss the risk of AD and run testing (apoE3 and amyloid ratios) as a routine part of a visit. Evidence links lifestyle factors with Alzheimer’s disease (AD) but the impact of a comprehensive lifestyle program on AD has not been studied until this recent scientific report.
STUDY
This is the frst randomized, controlled clinical trial to determine if intensive lifestyle changes may benefcially afect the progression of mild cognitive impairment (MCI) or early dementia due to AD.
A 1:1 multicenter randomized controlled phase 2 trial, ages 45-90 with MCI or early dementia due to AD and a Montreal Cognitive Assessment (MoCA) score of 18 or higher. The primary outcome measures were changes in cognition and function tests: Clinical Global Impression of Change (CGIC), Alzheimer’s Disease Assessment Scale (ADAS-Cog), Clinical Dementia Rating–Sum of Boxes (CDR-SB), and Clinical Dementia Rating Global (CDR-G) after 20 weeks of an intensive multidomain lifestyle intervention compared to a wait-list usual care control group.
RESULTS
Fifty-one AD patients enrolled, mean age 74. There were no signifcant diferences in any measures at baseline between the lifestyle group and the control group. Only two patients withdrew. All patients had plasma Aβ42/40 ratios <0.0672 at baseline, strongly supporting AD diagnosis.
After 20 weeks, signifcant between-group diferences in the CGIC (p= 0.001), CDR-SB (p= 0.032), and CDR Global (p= 0.037) tests and borderline signifcance in the ADAS-Cog test (p= 0.053). CGIC, CDR Global, and ADAS-Cog showed improvement in cognition and function and CDR-SB showed signifcantly less progression, compared to the control group which worsened in all four measures. Aβ42/40 ratio increased in the intervention group and decreased in the control group (p = 0.003). There was a signifcant correlation between lifestyle and both cognitive function and the plasma Aβ42/40 ratio. The microbiome improved only in the intervention group (p <0.0001).
CONCLUSIONS
Comprehensive lifestyle changes may signifcantly improve cognition and function after 20 weeks in many patients with MCI or early dementia due to AD.
“There was a statistically significant dose-response relationship between the degree of adherence to our lifestyle changes and the degree of improvement we saw on measures of cognition,” said Ornish, creator of the Ornish diet and lifestyle medicine program, founder and president of the nonprofit Preventive Medicine Research Institute and coauthor of “Undo It!: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases.”
The lifestyle intervention Ornish created — “eat well, move more, stress less and love more” — has been tested before. In 1990, Ornish showed for the first time in a randomized clinical trial that coronary artery disease could often be reversed with nothing more than diet, exercise, stress reduction and social support.
Since then, research has shown the same four-part program can lower blood sugars and heart disease risk in patients with diabetes, reduce prostate cancer cell growth, improve depression and reduce “bad cholesterol.”
“How is it that these same four lifestyle changes stop, and often reverse, the progression of such a wide spectrum of the most common and costly chronic diseases?” Ornish asked.
“It’s because they all share many of the same underlying biological mechanisms: chronic inflammation, oxidative stress, changes in the microbiome, changes in gene expression, changes in immune function and so on,” he said.
“And the lifestyle choices we make every day — what we eat, how we respond to stress, how much exercise we get, how much love and social support we have — can activate or downregulate these different mechanisms.”
