Longevity Briefs: Can Early Alzheimer’s Be Reversed Through Lifestyle Changes?

Longevity briefs provides a short summary of novel research in biology, medicine, or biotechnology that caught the attention of our researchers in Oxford, due to its potential to improve our health, wellbeing, and longevity.

The problem:

Alzheimer’s disease is currently incurable, and while some drugs can slow down its progression slightly, that’s the best they can do and at the cost of side effects. The best cure, then, is prevention. While genetics play a role, we know that modifiable lifestyle factors also have a huge impact on your risk of developing Alzheimer’s, with some evidence suggesting that nearly half of all Alzheimer’s disease and related dementias are preventable. But what if it’s too late? Do people who already have Alzheimer’s benefit from lifestyle changes, and if so, how do these benefits compare to those of drugs? 

The discovery:

In this study, researchers found that comprehensive lifestyle changes were sufficient to significantly improve multiple disease metrics in patients with early Alzheimer’s dementia or mild cognitive impairment (MCI). Participants were randomised to receive either lifestyle interventions or to maintain their current lifestyle for 20 weeks. The participants were of a wide range of ages (45-90), and 49 patients completed the trial. 

The participants in the intervention group adopted a vegan diet with minimal processed foods. The diet contained mostly complex carbohydrates (around 65%) with the remainder split evenly between protein and healthy fats. This diet was complemented by a supplement stack containing omega-3, probiotics as well as various vitamins, minerals and antioxidants. Participants each received a personalised exercise routine with a minimum of 30 minutes of aerobic exercise a day and non-intensive strength training three times a week. Finally, they received a stress management intervention for one hour per day, which included meditation, yoga, stretching and breathing exercises. Participants in both groups continued to receive standard treatments for dementia during the trial.

At the trial’s end, multiple cognitive scores had significantly improved in the intervention group when compared to the controls. For one of these scores (called CGIC) 10 patients in the intervention group scored higher than they did at the start of the study, while 7 worsened. In the control group on the other hand, none of the participants improved, while 17 worsened. The amyloid beta 42/40 ratio, which is a blood marker of Alzheimer’s disease, also improved in the intervention group while worsening in the control group. People in the intervention group who adhered better to the intervention also performed better in cognitive tests, though this could have been due to reverse causation (people with better cognitive scores might find it easier to adhere).

The implications:

These improvements are impressive in comparison to even the best Alzheimer’s drugs. They suggest that combining multiple lifestyle interventions together could be very effective for improving the outcomes for newly diagnosed Alzheimer’s patients. As usual, there are a few caveats. While the trial was randomised, it’s impossible to have a perfect control group in this kind of study because a participant can’t be given a fake lifestyle intervention, so there’s a risk of a placebo effect, though it’s unlikely to explain all of the effects of the intervention.

There’s also a possibility that increased social interaction in the intervention group (due to the presence of supervisors during some of the intervention activities) could have contributed to the observed benefits, since social interaction is known to be associated with protection against dementia. This wouldn’t explain why participants with better adherence performed better, but as already mentioned this could have been due to reverse causation. Finally, the trial didn’t last very long – the researchers did not run the trial for longer than 20 weeks because they did not think it was reasonable to ask patients to deny themselves lifestyle interventions for longer than this. It’s therefore possible that the two groups would have equalised given a longer study duration.