Controlling & Preventing the Progression of Alzheimer's: Medications vs. Lifestyle Changes
At this year’s 4th of July neighborhood breakfast, I met my new friend, Dr. Bruce
Jasper, a neuropsychologist. After explaining why my husband wasn’t with me (he died
3 years ago of Alzheimer’s) and his wife wasn’t with him (the breakfast food didn’t
fit into her healthy lifestyle), we had a very interesting discussion about lecanemab,
the latest FDA approved drug purported to slow down the progression of Alzheimer’s,
and how its effects compare with those of intensive lifestyle changes.
Since my husband’s diagnosis, I have been very interested in any medical discoveries regarding how Alzheimer’s might be prevented or at least controlled. I was excited about the wealth of information Bruce was willing to share with me. To supplement our conversation, he sent me a 48-slide PowerPoint presentation from the 2024 Conference of the American Academy of Clinical Neuropsychology titled, “What does every neuropsychologist need to know about lecanemab?”1 and a 17-page research paper on a clinical trial that studied the “Effects of intensive lifestyle changes on the progression of MCI or early dementia due to Alzheimer’s disease.”2
What I hope to do in this blog is to summarize what I learned from the studies Bruce sent me and from some additional online research from reliable websites. It is important for all adults to learn everything we can regarding this dreaded disease. Then I encourage you to do your own research, to discuss your findings with your provider, and only then to make choices that will be best for you and your loved ones. (See Sources below.)
Lecanemab (Leqembi®): Limitations & Possible Benefits
The media reports that Lecanemab is the first “disease-modifying” drug for Alzheimer’s to receive traditional FDA approval and Medicare coverage, and it is the first to show even modest success. According to my research, it is one of several recent advances that give us hope doctors will be able to transform how they diagnose, treat, and eventually prevent one of our most-feared diseases.
One precautionary tale is that almost 150 other drugs that were developed to treat Alzheimer’s Disease (AD) have had limited benefits, problematic side effects and don’t successfully treat what has been thought to be the most likely and most tested cause of AD, an unusual build up of amyloid plaques in the brain. The other drug you might have heard about is aducanumab. Although three years ago it received a rushed FDA approval, it was recently discontinued because it failed to have a measurable impact on the cognitive decline of patients.
Lecanemab (Leqembi®) is an intravenous (IV) infusion therapy that is given every two
weeks to people who have mild cognitive impairment (MCI) or mild dementia due to AD,
and who have tested positive for elevated beta-amyloid in the brain. In a 2023 community-based
Mayo Clinic study, only 8 to 17 percent of sufferers were eligible based on the trial
criteria. At least one-third of people with early-stage Alzheimer’s progress to a
more severe stage in about three years, disqualifying them from lecanemab and other
early-stage treatments. And the cost—an estimated $6,636 annually, even with Medicare
coverage—is prohibitive for many others who are eligible.
Lecanemab is not what we might call a miracle drug. It does not stop, reverse or cure Alzheimer’s. Early studies show that, on average, it can slow mental decline by five months over an 18-month treatment period. It also has notable risks and side effects, including brain bleeding and swelling. Other reported side effects were infusion-related reactions, amyloid-related imaging abnormalities (ARIA) and headaches.
Fortunately, because of what has been learned from lecanemab, “For the first time, we can bend the curve of cognitive decline,” says Harvard Medical School neurologist Reisa Sperling, M.D., director of the Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital in Boston. She is heading a study looking at lecanemab to prevent Alzheimer’s in people who are at risk but do not yet test positive for it.
Extensive Lifestyle Changes: Limitations & Possible Benefits
The 17-page paper Bruce sent me contains the results of a recent medical trial. Its
goal was to determine if the same lifestyle changes that Dr. Dean Ornish discovered
could reverse coronary heart disease might slow, stop, or reverse the progression
of mild cognitive impairment due to Alzheimer’s Disease.
“What’s good for your heart is also good for your brain, because they share many of the same underlying biological mechanisms,” Ornish says. The catch to this way of measurably preventing or slowing the progression of Alzheimer’s disease is that the lifestyle changes necessary really are intensive, at least compared to the way most of us in America live.
They include:
- A whole food, minimally processed plant-based diet (essentially vegan) low in harmful fats, refined carbohydrates, and sweeteners, with doctor-selected supplements
- Moderate aerobic exercise 30 minutes a day, and mild strength training at least three times a week
- Stress management techniques: meditation, yoga, relaxation, breathing and imagery one hour per day
- Support group participation one hour/per day 3 days/week supervised by a professional
Participants in the 20-week study were ages 45 to 90, had a current diagnosis of MCI due to AD, were approved by a physician, were willing and had the ability to participate in all aspects of the study, and had a spouse or caregiver who gave both mental and physical support. Results after 20 weeks showed overall statistically significant differences in cognition and function between the intervention group and the control group.
Of course, if we want to have the same favorable results throughout the remainder of our lives, we cannot stop after 20 weeks. Of note: This method of controlling AD symptoms and progression does not require expensive drugs and does not have a risk of side effects. The results are more positive than those from the existing medications, and this lifestyle might also prevent AD from developing in the first place.
Conclusions
In the future, the hope is that drugs like lecanemab could be started before memory troubles appear—the way people with high cholesterol take statins to lower risk for a heart attack and those with diabetes take blood-sugar-lowering drugs to protect against complications such as kidney disease. Despite the costs and possible side effects, Neurologist and Alzheimer’s researcher Randall Bateman, M.D., says: “This is the beginning of the ability to treat and change the course of Alzheimer’s disease.”
The Centers for Medicare & Medicaid Services (CMS) announced they will cover—co-pays excluded—all traditionally FDA-approved monoclonal antibodies for the treatment of Alzheimer's disease. Currently this includes lecanemab (Leqembi) and (available later this year) donanemab (KisunlaTM), as long as an individual's provider enrolls them in a CMS-approved registry. Taking a drug is a personal decision that each individual must make with the help of qualified professionals.
A 2022 University of Minnesota study found that an estimated 41 percent of Alzheimer’s and related dementias were attributed to a dozen modifiable risk factors, of which high blood pressure, obesity and physical inactivity had the most impact. In that way, late-life Alzheimer’s can be compared to heart disease, diabetes and other chronic conditions linked to aging. Even if we improve in just one or more of these lifestyle changes, we can still experience positive changes in our overall health. Whether it is good news or bad news for us, one of the most important weapons for AD prevention and to slow its progression is healthy living, and it’s up to us how many of the lifestyle changes we are willing to make.
Resources
- What does every neuropsychologist need to know about lecanemab? Presentation by Kevin Duff, Ph.D., ABPP
- “Effects of intensive lifestyle changes on the progression of MCI or early dementia due to Alzheimer’s disease,” by Open Access Research, Dean Ornish, et al
- Navigating Treatment Options | alz.org
- Lecanemab Approved for Treatment of Early Alzheimer’s | alz.org
- Donanemab Approved for Treatment of Early Alzheimer’s | alz.org
- Can Alzheimer’s Be Treated? Finally, There’s Some Hope (aarp.org)
- Lifestyle Changes May Slow, Prevent Alzheimer's in People at High Risk (healthday.com)
- Alternative Treatments | Alzheimer's Association