As advancements continue in the development of medications for Alzheimer’s disease seeking federal approval, a groundbreaking study spearheaded by teams from UC San Francisco and Kaiser Permanente Washington reveals that tailored health and lifestyle modifications can stave off or even halt memory deterioration in older adults at elevated risk.
This investigation, which spanned two years, assessed cognitive performance, risk elements, and life quality across 172 subjects. Half of these individuals received bespoke guidance aimed at enhancing their health and lifestyle in aspects deemed to escalate Alzheimer’s risk, such as unchecked diabetes and lack of physical activity. These advised participants witnessed a modest elevation in cognitive test scores, registering a 74% enhancement compared to their counterparts who didn’t receive any intervention.
Further distinctions were observed in the analysis of risk factors and life quality between the groups, with improvements roughly amounting to 145% and 8%, respectively, as reported by the researchers. The findings were published in JAMA Internal Medicine on November 27, 2023.
A notable aspect of this study, dubbed SMARRT (systematic multi-domain Alzheimer’s risk reduction trial), is its departure from previous studies that have delivered mixed outcomes regarding health and lifestyle interventions. This study distinguished itself by offering personalized coaching tailored to each participant’s risk profile, preferences, and priorities.
Kristine Yaffe, MD, the study’s lead author and a prominent figure at UCSF, emphasized the uniqueness of this personalized intervention, which concentrates on diverse cognitive areas. According to Yaffe, unlike the generic one-size-fits-all strategies, this approach could significantly reduce risk factors and is among the few trials demonstrating cognitive benefits likely to lower dementia risk.
In collaboration with Eric B. Larson, MD, MPH, Yaffe highlighted the eagerness of older adults to understand their personal risk factors for Alzheimer’s and their readiness to adopt lifestyle changes to diminish dementia risk based on an earlier survey involving 600 participants.
Study participants and those from the earlier survey were recruited from Kaiser Permanente Washington, aged between 70 and 89, and exhibited at least two of eight identified dementia risk factors.
Those in the intervention group worked with a nurse and a health coach to pinpoint and tackle selected risk factors, receiving periodic coaching to evaluate their goals. These sessions initially took place in person but moved to phone calls due to the pandemic.
Contrastingly, the non-intervention group, matched in age, risk factors, and cognitive scores with the intervention cohort, was provided with educational materials on reducing dementia risk and mailed quarterly.
The study’s outcomes were notably positive and unaffected by the pandemic’s challenges, indicating that participants under the intervention protocol maintained better cognitive function and exhibited fewer risk factors during and after the trial despite the pandemic.
Yaffe, also affiliated with the San Francisco VA Health Care System and the UCSF Weill Institute for Neurosciences, pointed out that unlike costly anti-amyloid medications requiring stringent eligibility and extensive side-effect monitoring, risk-reduction programs offer a cost-effective, accessible alternative.
She expressed hope that future Alzheimer’s treatment would mirror the management of cardiovascular diseases, integrating both risk-reduction strategies and specific drugs targeting the disease mechanisms.
More information: Kristine Yaffe et al, Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults, JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2023.6279
Journal information: JAMA Internal Medicine Provided by University of California, San Francisco
