An important new study about targeting lifestyle changes

Last Thursday, several friends told me about an article in the Wall Street Journal concerning a recent study on lifestyle changes and Alzheimer's disease risk.  I don't get the WSJ, but I did get the published study in the journal Alzheimer's and Dementia that same day.  The study was entitled "Individualized clinical management of patients at risk for Alzheimer's dementia."

The study was unique in a couple of ways.

First, it was new in that, while the researchers manipulated the same lifestyle domains that we discuss in Beating the Dementia Monster and are addressed in other well known studies that we have discussed previously, the researchers first assessed each individual test subject and specified which characteristics of their lifestyle should be changed.  So each individual had a program tailored to their own needs.

Also, the researchers assessed compliance with each individual's tailored program to see how tightly you must adhere to your structured lifestyle to get results... and how much are you hurt by varying degrees of non-compliance.

The study followed 174 individuals ranging in age from 25 to 86 over a period of 18 months.  Subjects were chosen who had a family history of Alzheimer's disease, but did not now display moderate or severe dementia.  Prospective subjects with mild cognitive impairment (MCI) were excluded if they did not show evidence of amyloid accumulation.  In other words, they were looking for people who might soon develop Alzheimer's disease or who had already begun to develop memory loss exclusively from Alzheimer's.  They also needed people who could, shall we say, use some improvement in their lifestyle.

Based on individual assessments, the researchers recommended patient education, genetic counseling, pharmacological approaches (medications/vitamins/supplements aimed at controlling cardiovascular and other risks), nonpharmacological approaches (customized recommendations for exercise, nutrition, vascular risk, sleep, cognitive engagement/training, stress, general medical care), and others.

Study subjects were classified as normal cognition (51.3%), subjective cognitive decline (22.1%), pre-clinical Alzheimer's (3.9%), MCI due to Alzheimer's (22.7%), or early mild Alzheimer's dementia (none that finished).  (I would be in the MCI due to Alzheimer's cohort, but I would have been excluded due to lack of potential for lifestyle improvements.)

Not surprisingly to us, the study found that lifestyle changes improved cognition in people developing Alzheimer's disease, provided compliance exceeded 60%.  Lower levels of compliance, especially below 40%, produced no improvement.

The researchers didn't consider their study conclusive, but that it pointed to the need for more research.  They were disappointed when one researcher dropped the project, and they lost a substantial number of test subjects.

The principal investigator was Dr. Richard Isaacson, director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and New York Presbyterian.  He told the Wall Street Journal that he personally does the following to minimize his risk of developing Alzheimer's:

• Eat a half-cup of blueberries and strawberries two to three times a week.

• Eat two to three servings per week of wild fish, which are high in Omega-3 fatty acids.

• Add powdered cocoa flavanols to coffee, smoothies or skim milk.

• Practice good sleep hygiene: Sleep at least 7.5 hours a day, avoid caffeinated drinks after 1 p.m., go to bed and wake up at the same time every day, and avoid electronics, texting and email 30-45 minutes before bed.

• Exercise at least three times a week with a mix of aerobic and resistance/weight training.

• Have one tablespoon of extra-virgin olive oil daily.

• Cut back on sugar and carbohydrates and look for whole grains and foods with high amounts of fiber.

• Play a musical instrument.

• Learn something new, such as a foreign language.