Personalized interventions may improve cognitive function and reduce Alzheimer’s risk

A new study published in the journal Alzheimer’s & Dementia reported that personalized interventions improved cognitive functions in people with a family history of Alzheimer’s disease [1].

In the US, there are six million people living with Alzheimer’s disease. But beta-amyloid, one of the biological markers of Alzheimer’s, can start to accumulate in people’s brains as early as in their 20’s, decades before experiencing symptoms of Alzheimer’s. Researchers estimate that an additional 46 million people may have this pre-symptomatic form of Alzheimer’s disease [2]. Unfortunately, there are currently no treatments that prevent or cure Alzheimer’s disease. But evidence is growing that lifestyle interventions including a healthy diet, exercise, cognitive training, and management of chronic diseases may improve cognitive functions and memory, particularly in people at risk for Alzheimer’s disease [3].

The latest encouraging findings come from a clinical trial that tested individually tailored medical and lifestyle interventions in 154 people with a family history of Alzheimer’s [1]. Participants ranged from 25-86 years old and most had no cognitive problems while a small subgroup had mild cognitive impairment or mild Alzheimer’s. For each participant, researchers obtained a detailed clinical history, ran blood and genetic tests, and performed physical examination and various cognitive tests. The researchers then gave detailed recommendations tailored based on the clinical and biological data of each participant. On average, a participant received 21 recommendations that included lessons about prevention and risk reduction, genetic counseling (if positive for APOE4, the genetic risk factor for Alzheimer’s), pharmacological interventions (medications/vitamins/supplements to treat high blood pressure, high cholesterol, diabetes, metabolic issues, etc.), and lifestyle changes that included specific exercises based on the participant’s levels of body fat and muscle mass, nutritional recommendations (e.g., the Mediterranean diet), improving sleep quality and patterns, cognitive training, stress reduction, and other health tips. Participants followed these recommendations for 18 months.

Researchers found that the personalized interventions improved cognitive functions and reduced markers associated with Alzheimer’s disease risk. For participants with mild cognitive impairment or mild Alzheimer’s disease, those who followed more than 60 percent of the recommendations showed a significant improvement in their cognitive functions by 8.7 percent, while those who followed fewer than 60 percent of the recommendations and a control group that received no interventions showed cognitive decline. Participants with normal cognitive functions also showed significant improvement in cognitive functions by 6.25 percent, and interestingly, they benefited equally regardless of how closely they followed the recommendations. Researchers also found that the younger the participant, the greater the improvement in cognitive functions.

Based on an analysis of age-related cognitive decline, people with normal cognitive functions who received the individualized interventions had an estimated delay of cognitive decline by approximately three years. Even in people who already had mild cognitive impairment or mild Alzheimer’s, if they were highly compliant to the interventions (following over 60 percent), they showed a delay of cognitive decline by an average of two years.

The results are currently based on participants from a single clinic who were predominantly Caucasian with college degrees. Future studies at other clinical sites and in other populations will inform whether this approach is effective more widely. Future larger studies will also inform which of the 20+ interventions are driving the cognitive benefits.

In the meantime, there are 7 steps to protect your cognitive vitality that you can start following right away, including eating healthy, getting enough sleep, exercising, reducing stress, being social, learning new things, and managing chronic diseases (e.g., high blood pressure, diabetes). There are concrete steps you can take to reduce your risk for age-related cognitive decline and dementia. And the earlier you start the better—so you shouldn’t wait until you get a diagnosis before you take action.

1. Isaacson RS, Hristov H, Saif N et al. (In Press) Individualized clinical management of patients at risk for Alzheimer's dementia. Alzheimers Dement.
2. Brookmeyer R, Abdalla N, Kawas CH et al. (2018) Forecasting the prevalence of preclinical and clinical Alzheimer's disease in the United States. Alzheimers Dement. 14, 121-129.
3. Solomon A, Turunen H, Ngandu T et al. (2018) Effect of the Apolipoprotein E Genotype on Cognitive Change During a Multidomain Lifestyle Intervention: A Subgroup Analysis of a Randomized Clinical Trial. JAMA Neurol 75, 462-470.

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