Do You Need A “Memory Minder?”

Many people use the services of a fitness coach or personal trainer to help them reach their diet and physical fitness goals. Now, imagine if you could find a similar coach dedicated to helping you avoid Alzheimer’s disease? Or even better, if you have mild cognitive impairment (MCI), stop it from becoming full-blown Alzheimer’s disease?

The latest science shows it’s not a stretch to imagine a coach of this kind working with patients at-risk for Alzheimer’s disease or even with early Alzheimer’s patients, motivating them to make lifestyle changes that would ward off the disease or its progression.

In fact, not only is this a reasonable approach, but the latest research shows a so-called memory minder could make a genuine difference to a person’s cognitive ability and memory health.

There’s no debate that the risk of cognitive decline can be lowered by combining dietary and lifestyle changes. This isn’t theory. The 2015 FINGER trial of 1,260 at-risk Finns aged 60 to 77 provided strong evidence for positive impact of diet and lifestyle on the prevention and progression of Alzheimer’s disease.

The trial confirmed that two years after changing to a healthy diet, taking up exercise, engaging in brain training, receiving comprehensive advice, and having regular meetings with health professionals, cognitive functioning was maintained or improved.1

Researchers wanted to know, could an even more personalized approach customized to each participant be replicated in older Americans?

A SMAART Intervention

A new, two-year study known as “SMARRT, for systematic multi-domain Alzheimer’s risk reduction trial,” was led by researchers at UC San Francisco.2 They enrolled 172 adults aged 70 to 89 who were at high risk for dementia because they had at least two of the following risk factors:

• physically inactive
• uncontrolled hypertension
• uncontrolled diabetes
• poor sleep
• using prescription medications linked to cognitive decline
• high depressive symptoms
• social isolation
• current smoker

Eighty-two participants spoke with a nurse and health coach about the specific risk factors they wanted to address, such as improving their sleep, taking up exercise, or becoming socially engaged. They received regular coaching sessions—except during the COVID-19 pandemic when this had to be switched to phone calls. The rest of the participants received educational material every three months that contained strategies for lowering dementia risk. This group acted as controls.

The findings of this landmark study, published in JAMA Internal Medicine in November, are extremely encouraging.3

Coaching Boosts Cognitive Scores by 74 Percent

The results show that, compared to the control group, coached participants enjoyed an incredible 74 percent improvement in thinking and memory tests, a 145 percent improvement in their dementia risk factors and an eight percent improvement in their quality of life.

First author and lead investigator Kristine Yaffe, M.D. was overjoyed by the findings. “This is the first personalized intervention, focusing on multiple areas of cognition, in which risk factor targets are based on a participant’s risk profile, preferences and priorities, which we think may be more effective than a one-size-fits-all approach.

“Not only did we find a significant reduction in risk factors, this is one of only a few trials that has shown a benefit in cognition that likely translates to lower dementia risk.”

Both FINGER and SMAART demonstrate the benefits of a personalized approach in helping people at risk for Alzheimer’s disease and dementia. Another research group, led by the Institute for Systems Biology (ISB) in Seattle, wanted to see if coaching would help people already diagnosed with Alzheimer’s disease.

These results, too, were astonishing.

Coaching Better Than Any Drug

The Coaching for Cognition in Alzheimer's (COCOA) trial included 55 patients diagnosed with early-stage Alzheimer’s disease. Twenty-four received standard care while the other 31 received the same standard care with the addition of personalized telephone coaching for multiple lifestyle interventions. This coaching was as follows, for:

• Dietary changes based on the MIND diet, which combines the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet.
• Aerobic and strength training recommendations based on U.S. public health guidelines.
• Cognitive training through computer games to develop reserve and resilience.
• Recommendations to improve sleep.
• Stress management strategies.

The findings, published in the Journal of Alzheimer’s disease in November, showed that after two years the coaching intervention group saw Memory Performance Index scores – a verbally administered test of the ability to recall words - improve an average of 2.1 points compared to controls.

They also had slower deterioration in Functional Assessment Staging Test scores, which are used to assess abilities such as dressing, grooming, mobility and feeding. The authors described these results as “better than any known pharmaceutical interventions.”

ISB Senior Research Scientist Dr. Jared Roach, who led the trial, explained, saying, “This is evidence that personalized coaching focused on diet, exercise, brain training and other lifestyle factors should be part of the first line of dementia care and prevention.”4

His colleague Dr. William Shankle added: "The lifestyle intervention results of the COCOA trial provide a treatment that is far more affordable, has no adverse effects, plus has an effect as big as, and potentially larger than, that reported with the most recent, FDA-approved treatments for Alzheimer’s disease.”

Our takeaway

We couldn’t agree more. This natural, lifestyle-based approach is what we’ve heard from countless doctors over the years who are currently leading the field in their natural approaches to preventing and treating Alzheimer’s disease.

The reality is, Big Pharma has yet to come up with a drug that can beat the power, safety or affordability of nutrient-rich food, exercise, stress management, sleep, as well as social and intellectual engagement. And I, for one, won’t be holding my breath.