Lifestyle Changes Found to be Effective in Preventing Dementia

A recent study has uncovered that customized health and lifestyle interventions can help delay or even prevent memory loss in older individuals who are at greater risk of developing Alzheimer’s. Among the 172 participants in the study, those who received personalized coaching that targeted Alzheimer's risk factors showed significant enhancements in their cognitive scores and general quality of life. These improvements were sustained despite the pandemic, highlighting the advantage of personalized interventions over generic approaches.

Evidence shows that maintaining an active lifestyle, engaging in social interactions, and effectively managing diabetes and blood pressure can lead to improved mental function.

As the federal approval of more Alzheimer’s disease drugs continues, a recent study by UC San Francisco and Kaiser Permanente Washington discovered that custom health and lifestyle changes can hold off or prevent memory loss in older individuals who are at a higher risk.

The two-year study compared cognitive scores, risk factors, and quality of life among 172 participants. Half of them had received custom coaching to better their health and lifestyle in areas known to increase the risk of Alzheimer’s, like physical inactivity and uncontrolled diabetes. These participants demonstrated a minor increase in cognitive testing, which amounted to a 74% improvement over the group that did not receive any intervention.

Differences were also observed between the two groups in terms of risk factors and quality of life measurements, which approximately translated to 145% and 8%, respectively, according to the researchers. The study was recently published in the medical journal JAMA Internal Medicine.

Older adults were highly driven to make changes

This study, known as SMARRT (systematic multi-domain Alzheimer’s risk reduction trial), expands upon the work of other researchers, who have previously reported mixed results about the impacts of health and lifestyle interventions. However, this study provided personal coaching tailored to each participant.

“This is the first personalized intervention that focuses on various areas of cognition. The risk factor targets are based on a participant’s risk profile, preferences, and priorities,” stated Kristine Yaffe, MD, the lead investigator of the study. “We believe this is more effective than a blanket approach.”

Yaffe further noted that in an earlier survey of 600 older adults, most of them expressed concern about Alzheimer's disease and related dementias. They wished to know about their personal risk factors and demonstrated a strong desire to make lifestyle changes that can lower the risk of developing dementia.

Participants in the current study, as well as the earlier one, were enrolled in Kaiser Permanente Washington and aged between 70 to 89 years. They had an incidence of at least two of the eight dementia risk factors: physical inactivity, uncontrolled hypertension, uncontrolled diabetes, poor sleep, taking prescription drugs linked with the risk of cognitive decline, significant depressive symptoms, social isolation, and smoking.

The participants received personalized coaching after discussing their specific risk factors with a nurse and health coach. These coaching sessions were conducted every few months to review their goals, which varied from monitoring hypertension to walking a specified number of steps each day or registering for a class. These sessions initially started in person and later switched to calls during the pandemic.

The control group was similar in age, cognitive scores, and risk factors, and they received educational material about dementia risk reduction every three months via mail.

The pandemic did not counteract the study’s positive results

Larson expressed pleasant surprise that the positive outcomes of the trial were not offset by the pandemic. “We know that social distancing induced isolation had a severe impact on cognition, social lives, and the general mental and physical health of some older adults. However, the participants who received intervention demonstrated better cognitive functioning and had lesser risk factors after the trial, during the pandemic, than before.”

Yaffe shared that unlike anti-amyloid drugs, risk reduction programs are not expensive, do not have rigid eligibility criteria, and do not require extensive monitoring for side effects. Yaffe is also associated with the San Francisco VA Health Care System and the UCSF Weill Institute for Neurosciences.

“Hopefully in the future, treatment of Alzheimer’s and related dementias will be like cardiovascular disease management, with a combination of risk-reduction and specific drugs targeted for disease mechanisms,” she said.