Fewer than 3% of people with early Alzheimer's disease are following all of the evidence-based brain health recommendations that could slow cognitive decline, according to new research. This gap persists even among patients actively pursuing anti-amyloid antibody therapy (AAT), a newer drug treatment designed to target the protein buildup in the brain that characterizes Alzheimer's disease.

What Does the Research Show About Alzheimer's Patients and Brain Health Guidelines?

Researchers at Brigham and Women's Hospital and Harvard Medical School examined 150 patients with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease who were seeking AAT, and compared them to 117 patients not pursuing the therapy. The team assessed how well each group adhered to 15 modifiable risk factors for cognitive decline and dementia using a clinical survey tool.

The findings were striking. More than 25% of patients seeking AAT were not following guidelines for 11 of the 15 brain health factors. The five areas with the lowest adherence rates were physical activity, mood and stress management, hemoglobin A1c (a measure of blood sugar control), blood pressure, and body mass index (BMI). Between 44% and 63% of the AAT-seeking group were suboptimally following consensus guidelines in these five categories.

"There is a fairly robust, accepted evidence base that a certain set of behaviors and medical factors support brain health, but effective implementation in clinical care is still mostly missing," stated Seth A. Gale, M.D., senior author of the study.

Seth A. Gale, M.D., Senior Author, Mass General Brigham Neuroscience Institute

Importantly, the researchers found no significant differences in adherence patterns between patients seeking AAT and those not pursuing the therapy. This suggests that even when patients are actively engaged in medical treatment for Alzheimer's disease, they may not be implementing the lifestyle changes that research shows can protect brain health.

How to Protect Your Brain Health: Steps Experts Recommend

Despite the adherence challenges documented in the research, experts have identified clear, actionable steps that can help prevent or slow cognitive decline. These recommendations are backed by rigorous clinical trials and long-term studies:

• Physical Activity: Get 150 minutes per week of moderate aerobic exercise, plus two resistance training sessions per week. A major clinical trial called US POINTER followed over 2,000 American adults at risk of cognitive decline for two years and found that those in a structured exercise program showed statistically significant improvements in overall cognition compared to a self-guided group.
• Sleep Quality: Aim for 7 to 8 hours of unassisted sleep each night, meaning sleep without alcohol or sedative medications. Poor sleep quality can accelerate cognitive decline regardless of age.
• Dietary Approach: Follow the MINDS diet, which combines the Mediterranean diet with the DASH (Dietary Approaches to Stop Hypertension) diet. This means eating fish, leafy greens, vegetables, legumes, berries, nuts, and small amounts of unsaturated fats while limiting red meat, butter, and white bread. A 10-year study of over 1,000 older adults in Chicago retirement communities tested this approach and found it supported long-term cognitive health.
• Chronic Disease Management: Keep conditions like diabetes, high blood pressure, and sleep apnea well controlled through medical care and lifestyle modifications.
• Daily Multivitamin: Take a daily multivitamin as part of a comprehensive brain health strategy.

Equally important is avoiding behaviors that accelerate cognitive decline. These include being sedentary, drinking alcohol regularly, taking sleep aids or anticholinergic medications (such as Benadryl or Unisom) on a regular basis, and mindlessly scrolling through social media.

Why Is the Gap Between Knowledge and Action So Large?

The disconnect between available treatments and lifestyle adherence raises important questions about how healthcare providers communicate with patients. Many people with early Alzheimer's disease may feel overwhelmed by the number of recommendations, or they may not fully understand how each lifestyle factor contributes to brain health. Additionally, implementing major changes to exercise routines, diet, and sleep habits requires sustained effort and support.

The research suggests that simply prescribing a medication like AAT is not enough. Patients need integrated support that addresses both pharmaceutical and lifestyle interventions. Healthcare providers may need to prioritize which recommendations to emphasize first, rather than presenting all 15 factors at once, to improve real-world adherence.

What's Happening in Alzheimer's Research Right Now?

While the adherence study highlights a clinical challenge, the field of Alzheimer's research continues to advance. Washington University School of Medicine recently honored Eisai Co., Ltd., a pharmaceutical company, and CEO Haruo Naito for their longstanding contributions to Alzheimer's disease research and healthcare. The collaboration between WashU Medicine and Eisai includes the Phase II/III Tau NexGen Study, which is exploring the safety and effectiveness of an experimental anti-tau antibody called etalanetug (E2814) for treating dominantly inherited Alzheimer's disease (DIAD). This study uses lecanemab, an anti-amyloid beta antibody, as the backbone therapy.

These research efforts focus on targeting two key proteins involved in Alzheimer's disease: amyloid and tau. Both accumulate in the brains of people with Alzheimer's disease and are believed to drive cognitive decline. The combination of anti-amyloid and anti-tau approaches represents a newer strategy in Alzheimer's treatment.

The challenge ahead is clear: as new treatments become available, healthcare systems must also develop better strategies to help patients adopt and maintain the brain-protective lifestyle changes that research shows are essential for long-term cognitive health.