People with early Alzheimer’s disease may be highly motivated to protect their brain health, but that does not necessarily make everyday behavior change easy.
In an observational study published in The Journal of Prevention of Alzheimer’s Disease, researchers assessed 267 people with mild cognitive impairment or mild dementia due to Alzheimer’s disease. Some were pursuing treatment with the anti-amyloid drug lecanemab, while others were not. In both groups, most patients were not meeting all of the researchers’ recommendations related to exercise, diet, sleep, blood pressure, blood sugar and other potentially modifiable factors.
The study did not test whether following more of these recommendations slowed cognitive decline or improved response to Alzheimer’s treatment. Instead, it looked at how closely patients were following behaviors and health targets that have been associated with better brain health more broadly.
“Because patients pursuing anti-amyloid therapy were willing to receive lecanemab infusions every two weeks and tolerate the risks associated with this medication, we thought this highly motivated group might be pursuing every avenue available to protect their brain health,” said lead author Kirk Daffner, a neurologist at the Mass General Brigham Neuroscience Institute. “The results show there is much more work to be done.”
The researchers used a tool called Brain Health Vital Signs to assess 15 areas tied to brain health. These included physical activity, diet, sleep, stress, social and cognitive engagement, blood pressure, blood sugar, hearing, vision and alcohol use.
Fewer than 3% of patients met all 15 recommendations.
That number sounds striking but meeting every target at once is a high bar. The more useful finding may be how common individual gaps were.
Among patients pursuing anti-amyloid treatment, more than 25% were not meeting 11 of the 15 recommendations. More than half were falling short on four.
Physical activity was the most common challenge. About 63% of patients pursuing anti-amyloid therapy were not meeting the study’s goal of at least 25 minutes of activity per day on most days of the week.
Patients also frequently fell short on stress management and targets for A1c, blood pressure and body mass index.
Importantly, the group pursuing lecanemab did not perform significantly better overall than patients who were not seeking anti-amyloid treatment.
That may say less about motivation than about how difficult behavior change can be, particularly for people already managing a complex diagnosis.
“There is a fairly robust, accepted evidence base that a certain set of behaviors and medical factors support brain health, but effective implementation in clinical care is still mostly missing,” said senior author Seth Gale, a neurologist at the Mass General Brigham Neuroscience Institute. “While tools such as Brain Health Vital Signs can help patients and their providers better understand what they are doing well and where they can improve, it’s clear that structured, sustainable interventions are also necessary.”
Diet is one part of that picture, not the whole of it.
The study included heart-healthy eating among its recommended behaviors, alongside exercise, sleep and management of cardiovascular and metabolic risk factors. Research has linked these factors with lower risk of cognitive decline and dementia, but that is different from showing that changing them after an Alzheimer’s diagnosis will slow disease progression.
The researchers argue that patients may need more than advice alone.
They point to ongoing work testing individualized brain health coaching. Earlier research from that program found that patients who received six months of structured coaching improved their adherence to recommended brain health behaviors.
That idea may be especially important in Alzheimer’s care, where treatment conversations can easily center on medications while everyday habits remain harder to address.
The new study does not suggest that lifestyle changes can replace Alzheimer’s treatment, nor does it show that meeting more brain health targets will change the course of the disease.
What it does show is a familiar challenge: knowing which behaviors are associated with better health is not the same as being able to carry them out consistently.
For patients and caregivers, that may shift the question from simply “What should we be doing?” to something more practical: “What support would make these changes realistic?”
The study was funded through the Gaudet Family Research Fund, the Wimberly Family Clinical Care Research Fund, the Arnold and Barbara Barron Fund and the Alzheimer Innovation Fund, all through Brigham and Women’s Hospital.