Recently, the new drugs that target amyloid have brought a lot of excitement in the field because for the first time we have a treatment for Alzheimer’s disease. At the same time, we have known for a long time that lifestyle interventions can improve brain health and reduce the risk of Alzheimer’s disease. The question I wanted to address was, how do the results of these clinical trials for anti-amyloid medications compare with the results for randomized controlled trials that combine diet, exercise, and cognitive training? I reviewed the literature with my colleagues in multiple institutions, including my colleagues at Johns Hopkins, and we only selected studies that use the same outcome measure called ADAS-COG...
Recently, the new drugs that target amyloid have brought a lot of excitement in the field because for the first time we have a treatment for Alzheimer’s disease. At the same time, we have known for a long time that lifestyle interventions can improve brain health and reduce the risk of Alzheimer’s disease. The question I wanted to address was, how do the results of these clinical trials for anti-amyloid medications compare with the results for randomized controlled trials that combine diet, exercise, and cognitive training? I reviewed the literature with my colleagues in multiple institutions, including my colleagues at Johns Hopkins, and we only selected studies that use the same outcome measure called ADAS-COG. So we can compare these different clinical trials with the same outcome measure, so comparing apples to apples. What we found is that both of these randomized controlled trials, five for multimodal lifestyle interventions and three for the new medications, recruited patients with MCI and early-stage Alzheimer’s disease who did not have significant other comorbidities. So when we looked at the results, we saw that the lifestyle interventions were quite effective in increasing the scores for ADAS-COG, whereas the anti-amyloid monoclonal antibodies only reduced the rate of decline. They did not help patients improve their cognitive functions. These medications were very effective in reducing the amyloid, significantly almost clearing the whole brain of the amyloid, but the results were very subtle. They were not something that either the patients or the caregivers could tell. So this is what we found exciting, and we have looked at the percent difference in terms of control versus intervention group. With the anti-amyloid medications, it’s usually about 25%, 32% difference in rate of decline. But for the multimodal lifestyle interventions, the control group was 200 or 400 percent better than the control group because they actually improved. It’s not that just the rate of decline was less. So in summary, the combination of lifestyle interventions such as exercise, eating a Mediterranean diet, and doing cognitive training appears to be quite powerful in improving cognitive functions, whereas these anti-amyloid medications are powerful in reducing the amount of amyloid in the brain, and they prove subtle improvements in cognitive differences, cognitive functions. The one thing that I found interesting was that one of the randomized control trials for lifestyle interventions measured the biomarkers for amyloid, and it showed that even the biomarkers for amyloid improved with the lifestyle intervention similar to the way it had improved for the medication intervention. So I’m quite excited about the possibility that these lifestyle interventions could be an effective treatment for patients with MCI and Alzheimer’s disease in combination with these anti-amyloid medications.
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