A person who agrees to receive an Alzheimer’s drug by infusion every two weeks might seem likely to do almost anything else that could help protect the brain.
Yet a new study found that even these highly motivated patients often struggled to follow basic recommendations involving movement, sleep, stress, blood pressure, and other areas of health.
Fewer than 3% of patients studied met every recommendation researchers assessed.
The research was conducted by investigators at the Mass General Brigham Neuroscience Institute and published in The Journal of Prevention of Alzheimer’s Disease. It examined people who already had mild cognitive impairment or mild dementia caused by Alzheimer’s disease. At this stage, memory and thinking problems are present, but patients may still be able to take an active role in decisions about treatment and lifestyle.
Scientists increasingly believe that protecting the aging brain involves more than targeting Alzheimer’s-related proteins.
The brain needs healthy blood vessels, adequate sleep, regular movement, social contact, mental stimulation, and good control of conditions such as diabetes and high blood pressure.
Hearing and vision are also important because problems in these areas can reduce communication, independence, and engagement with the world.
To bring these different factors together, researchers developed a tool called Brain Health Vital Signs. It looks at 15 areas that people may be able to change or manage. The aim is to show patients and clinicians where brain-supporting habits are already strong and where additional attention may be useful.
For the new study, the team examined 150 patients who were seeking treatment with an anti-amyloid antibody and 117 patients with early Alzheimer’s disease who were not pursuing such therapy. Anti-amyloid medicines target amyloid, a protein that accumulates in the Alzheimer’s brain. Lecanemab is one of these treatments and is given through repeated infusions.
Treatment is not simple. Patients need ongoing appointments and monitoring, and anti-amyloid medicines can cause potentially serious side effects, including swelling or small areas of bleeding in the brain. Because patients accepting this burden appear strongly committed to fighting the disease, the researchers wondered whether they would also score better on everyday brain-health behaviors.
They did not. The study found no significant difference in overall adherence between patients pursuing anti-amyloid therapy and those who were not. Across the study, fewer than three people out of every 100 were optimally following all 15 recommendations.
The treatment-seeking group had many areas that could potentially be improved. More than 25% were below the recommended level in 11 of the 15 categories. In four categories, more than half of these patients were not meeting the researchers’ goals.
Exercise stood out as the biggest problem. The recommendation called for at least 25 minutes of physical activity on most days of the week, but 63% of the patients seeking anti-amyloid treatment did not reach it. This matters because physical activity supports the heart and blood vessels and has been linked in many studies with better brain health.
Patients also commonly struggled with stress and with health measures such as blood pressure, body mass index, and A1c. A1c is a blood test that gives an estimate of average blood sugar over the previous few months. High levels can be a sign that diabetes or blood sugar control needs more attention.
These results show why Alzheimer’s care can be difficult even when patients understand that healthy habits matter. Memory problems themselves can make it harder to remember routines, organize exercise, prepare healthy food, take medicines correctly, or attend appointments. Fatigue, depression, physical limitations, finances, transportation, and caregiver demands can create additional barriers.
The researchers argue that health care needs to move beyond simply giving advice. A patient may already know that exercise is helpful but still have no realistic plan for becoming active. Structured coaching, specific goals, reminders, family involvement, and regular follow-up may make recommendations easier to turn into lasting routines.
There is some evidence that this approach can work. In an earlier Brain Health Champion Study, the same research group tested six months of personalized brain-health coaching. Results from its first group of patients, published in 2019, showed meaningful improvements in adherence to recommended brain-health behaviors.
The current study is valuable because it looks at a practical problem that can be overlooked when attention is focused on new drugs. It also includes patients actively seeking a demanding modern treatment, making their low adherence particularly striking. The comparison group showed that the problem was not limited to people receiving or considering one particular medicine.
However, the research cannot show that failure to meet these recommendations caused patients’ Alzheimer’s disease or made it progress faster. Nor does it prove that reaching every target would slow the disease in every patient. Some recommendations may also be harder or less appropriate for people with other illnesses or physical limitations, so individual medical advice remains important.
The findings therefore should not be interpreted as blaming patients for their disease. Instead, they show that behavior change is difficult and that Alzheimer’s clinics may need to provide more support if lifestyle and medical risk factors are going to become a meaningful part of treatment. New medicines may attack one part of Alzheimer’s biology, while better daily health could address other pressures on an already vulnerable brain.
In the end, the study reveals a large opportunity hidden inside ordinary daily life. Patients and families are being offered increasingly advanced Alzheimer’s treatments, but many still need help with basic goals such as moving more, sleeping well, controlling blood pressure, and managing stress.
Combining medical treatment with practical, sustained brain-health support may provide a more complete approach to caring for people in the early stages of the disease.
If you care about Alzheimer’s disease, please read studies about the protective power of dietary antioxidants against Alzheimer’s, and eating habits linked to higher Alzheimer’s risk.
For more health information, please see recent studies that oral cannabis extract may help reduce Alzheimer’s symptoms, and Vitamin E may help prevent Parkinson’s disease.
Source: Mass General Brigham.
