Alzheimer's patients 'not changing brain health behaviours'

Researchers in the US have found that most people with early Alzheimer's disease are not following guidelines for promoting brain health, even if they are being prescribed anti-amyloid therapies.

The team at the Mass General Brigham Neuroscience Institute found that fewer than 3% of 267 people with Alzheimer's assessed in their study were following recommendations like exercising, getting adequate sleep, preventing hypertension, and eating a heart-healthy diet.

There was no significant difference between those taking Eisai and Biogen's anti-amyloid therapy Leqembi (lecanemab) and those not taking the drug, which was a surprising result.

"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 MassGen neurologist Kirk Daffner, the lead author of the study, which has been published in The Journal of Prevention of Alzheimer's Disease.

"The results show there is much more work to be done," he added.

Anti-amyloid drugs like Leqembi have shown modest benefits on Alzheimer's disease progression in clinical trials, which as a rule did not require enrolled subjects to adhere to any lifestyle changes.

Despite that, a real-world study of Leqembi reported at this year's Alzheimer’s Association International Conference (AAIC) found that 77% of in the early stages of the disease who started the drug remained at the same stage of disease after an average of 17 months of treatment.

One potential implication of the new research is that patients diagnosed with early Alzheimer's may be able to see even more benefit from anti-amyloid therapy if they make lifestyle changes.

The researchers developed a panel of 15 lifestyle changes – what they call Brain Health Vital Signs – that also included factors like social and cognitive engagement, controlled blood sugar, good vision and hearing, and low levels of alcohol consumption, to score patients in the study.

Among patients pursuing anti-amyloid therapy, more than 25% were not optimally adhering to 11 of the 15 studied brain health recommendations, and more than 50% were not optimally adhering to four of the recommendations, which was much the same as the untreated group.

Patients most commonly fell short of the recommendation to get at least 25 minutes of physical activity per day on most days of the week.

"There is a fairly robust, accepted evidence base that a certain set of behaviours and medical factors support brain health, but effective implementation in clinical care is still mostly missing,” said Seth Gale, another MassGen neurologist and a senior author of the study.

“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."

Daffner and Gale et al are also running the large-scale Brain Health Champion Study, which is testing a coaching system – backed by mobile technology – in people with mild cognitive impairment or risk factors for dementia. Preliminary results suggest the approach can improve adherence to recommended brain health behaviours.

Photo by Centre for Ageing Better on Unsplash