James' World 2

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When Juli comes home after work, her husband doesn’t regale her with stories about his photography business the way he once did. Instead, he proudly shows her a pill container emptied of the 20 supplements and medications he takes every day. Rather than griping about traffic, he tells her about his walk. When they go out to a favorite Mexican restaurant, he might opt for a side salad instead of tortilla chips with his quesadilla. “He’s actually consuming green food, which is new,” says Juli, who asked to be identified by only her first name to protect her husband’s privacy.

Over the past year, Juli’s husband has agreed to change his daily habits in hopes of halting the steady progression of Alzheimer’s disease, which he was diagnosed with in December 2023 at age 62. Juli and her husband are both self-employed, and their insurance plans didn’t cover the positron-emission tomography scans for disease tracking that a neurologist prescribed, which would have cost thousands of dollars. So they decided to spend that money on a doctor who promises that diet and lifestyle changes can treat Alzheimer’s. He recommended a keto diet, along with light cardio exercise and strength training. He also prescribed a bevy of supplements, such as creatine, which Juli’s husband takes alongside the memantine and donepezil prescribed by his neurologist. Juli doesn’t expect the diet and daily walks to cure her husband, but she hopes the healthy lifestyle will help manage and even improve his condition. It feels like common sense. “You stop eating fried food, you move your butt, and you feel better,” she says.

Increasingly, evidence suggests that addressing health problems such as vision and hearing loss, stress, poor diet, diabetes, obesity, high cholesterol, and high blood pressure can help slow or even prevent Alzheimer’s symptoms. It’s a tantalizingly simple solution to a complicated condition that has proved difficult to treat. For families like Juli’s that have been left with a grim diagnosis and few options, lifestyle changes bring a much-needed sense of hope and agency. But researchers worry about overpromising on the efficacy of these changes, especially for people already experiencing dementia symptoms. Evidence around the importance of different diets, exercises, and activities—when to start them and which to prioritize—is mixed, and only in a few high-quality studies have researchers examined large, diverse groups of people. It’s a promising but nascent field of research, one that scientists worry gives patients dangerous and heartbreaking hope for a cure that doesn’t exist.

“There are a lot of claims,” says Miia Kivipelto, a dementia researcher at the Karolinska Institute in Sweden. She worries about expensive but unproven regimens that promise to reverse cognitive decline, restore and protect the brain, or significantly improve cognition for people with early-stage Alzheimer’s or other dementias. “Of course, people want to have hope,” she says. But she cautions against making promises that can’t be upheld. “It’s risk reduction,” she says. “That’s maybe what we can promise.”

Kivipelto led the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), a trial that enrolled more than 1,200 residents of Finland between the ages of 60 and 77. Results were published in 2017. They showed that after two years, participants who were given nutritional advice, exercise regimens, and brain-training games had improved their executive function, processing speeds, and complex memory by about 83, 150, and 40 percent, respectively, compared with those who didn’t take those measures. Kivipelto has continued to follow that initial FINGER cohort and found that several years after the initial trial, their health in general continues to be better than that of their counterparts. The participants had a lower risk of stroke, had fewer medical emergency room visits, and needed less inpatient care. Now Kivipelto is running World Wide FINGERS, a global network of studies investigating the same interventions in different countries and populations.

It’s not clear whether these interventions prevent disease onset or simply delay it.

 

Similarly encouraging data have come from the Systematic Multi-Domain Alzheimer Risk Reduction Trial (SMARRT), a two-year randomized, controlled study. Researchers tested the effect of treating modifiable risk factors such as uncontrolled hypertension, social isolation, and physical inactivity with more than 170 septuagenarians and octogenarians at high risk for dementia. Participants chose a few interventions to prioritize out of eight options, such as improved physical fitness or social connection. After two years, no matter which intervention people opted for, those who received individualized treatments had reduced risk factors for dementia and a 74 percent greater increase in cognition compared with their counterparts in the control group.

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Luisa Jung

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