Researchers at the Mass General Brigham Neuroscience Institute found that most patients with early Alzheimer’s disease are not closely following recommendations that could support brain health. These include regular exercise, adequate sleep, managing blood pressure and eating a heart-healthy diet. The findings were published in The Journal of Prevention of Alzheimer’s Disease.
Fewer than 3% of patients in the study followed all 15 brain health recommendations examined by the researchers. Poor adherence was found both among patients who pursued treatment with lecanemab, an anti-amyloid antibody medication for Alzheimer’s disease, and those who did not pursue anti-amyloid therapy. Researchers found no significant difference between the two groups.
The researchers had expected patients pursuing anti-amyloid therapy to be particularly motivated to protect their brain health. These patients were willing to receive lecanemab infusions every two weeks and accept the risks associated with treatment. However, lead author Kirk Daffner, MD, said the findings indicate that considerably more work is needed to help patients adopt brain-healthy behaviours.
Growing evidence suggests that several modifiable lifestyle and medical factors may help reduce the risk of cognitive decline and dementia. These include physical activity, a healthy diet, sufficient sleep, social and cognitive engagement, controlled blood pressure and blood sugar, good vision and hearing, and low alcohol consumption.
To assess these factors, Daffner, Seth Gale, MD, and colleagues developed Brain Health Vital Signs, a tool that evaluates 15 potentially modifiable factors. It provides patients with an overall brain health score while identifying areas where changes could potentially improve their brain health.
The study included 150 patients with mild cognitive impairment or mild dementia due to Alzheimer’s disease who were seeking anti-amyloid antibody therapy. Researchers compared them with 117 patients who had mild cognitive impairment or mild dementia but were not pursuing the treatment. Among those seeking anti-amyloid therapy, more than 25% fell short on 11 of the 15 brain health recommendations, while more than half fell short on four recommendations.
Physical activity was the most commonly missed recommendation. About 63% of patients pursuing anti-amyloid therapy did not achieve at least 25 minutes of physical activity per day on most days of the week. Other particularly challenging recommendations included reducing stress and maintaining optimal A1c levels, blood pressure and body mass index. Similar patterns of low adherence were seen among patients who were not pursuing anti-amyloid treatment.
Senior author Seth Gale, MD, said that although there is substantial evidence supporting behaviours and medical factors that promote brain health, effectively putting this knowledge into routine clinical care remains a challenge. The researchers suggest that structured interventions may help. Their ongoing Brain Health Champion Study found that patients receiving six months of personalised brain health coaching substantially improved their adherence to recommended behaviours. Daffner and Gale say providing healthcare teams with practical tools grounded in health psychology may help patients make sustainable changes that support brain health.
More information: Kirk Daffner et al, Suboptimal adherence to brain health recommendations in patients pursuing anti-amyloid antibody therapy for Alzheimer’s disease: Report from the Brain Health Vital Signs project, The Journal of Prevention of Alzheimer’s Disease. DOI: 10.1016/j.tjpad.2026.100640
Journal information: The Journal of Prevention of Alzheimer’s Disease Provided by Mass General Brigham
