December 27, 2023
A personal coaching program that focused on health and lifestyle changes led to improvements in memory and thinking skills among older adults at risk for Alzheimer’s disease. The study was conducted among men and women in their 70s and 80s, showing that when it comes to healthy habits to protect brain health, it’s never too late to start.
The study, published in JAMA Internal Medicine, found those who received personal health coaching over a two-year period had a 74 percent boost in their thinking and memory skills compared to their peers who didn’t get coaching. By focusing on such goals as getting more steps in each day or keeping blood pressure or diabetes in check, participants were able to keep their cognitive skills intact. The findings underscore the important role that lifestyle factors may play in helping to delay the onset of dementia.
“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,” said study author Dr. Kristine Yaffe of the University of California, San Francisco.
For the study, researchers looked at 172 men and women, aged 70 to 89, who were enrolled in a health plan in Washington state. All were free of dementia but had at least two of eight characteristics that put them at increased risk for Alzheimer’s disease: physical inactivity, uncontrolled hypertension, uncontrolled diabetes, poor sleep, use of prescription medications (such as sedatives) that are associated with risk of cognitive decline, symptoms of depression, social isolation, or smoking.
About half the participants were enrolled in a personal coaching program. They met with a nurse and health coach to focus on specific risk factors they wanted to address. Then, over the next two years, they received personal coaching sessions every six weeks or so to check their progress. Those with high blood pressure, for example, might be coached to take their heart medications and were given home monitors to track their blood pressure levels. Those who got little exercise were given fitness trackers and encouraged to increase the number of daily steps they took. Those who slept poorly were given sleep workbooks and coaching tips to encourage better sleep. Or those who were socially isolated were encouraged to sign up for a class. The coaching sessions were initially conducted in person but switched to phone calls because of the pandemic.
The other half received educational materials about Alzheimer’s risk factors and ways to reduce risk, mailed to them every three months.
After two years, those receiving the coaching showed modest improvements on tests of cognitive skills compared to their peers who didn’t get coaching. The coaching group, which generally focused on three or four risk factors for dementia, also showed improvements in those risk factors and scored 8 percent higher on assessments of overall quality of life than the non-coaching group. The researchers were also encouraged by the fact that many of these improvements were sustained despite the onset of the pandemic.
“We were pleasantly surprised that the positive results of the trial were not offset by the impact of the pandemic,” said study author Dr. Eric B. Larson, of the University of Washington. “We know that isolation from social distancing took a heavy toll on cognition, social lives, and mental and physical health in some older adults. But participants in the intervention group fared better cognitively and had fewer risk factors after the trial, during the pandemic, than they did before.”
Experts estimate that 30 percent to 40 percent of the cases of Alzheimer’s disease and other forms of dementia could be prevented or delayed by targeting 12 modifiable risk factors throughout life. These risk factors, from The Lancet Commission on Dementia Prevention, Intervention, and Care, include lack of formal schooling; hearing loss; smoking; high blood pressure; obesity; depression; physical inactivity; diabetes; lack of social contact; head injuries; excess alcohol use; and exposure to air pollution.
Anyone can start a new plan for healthy living and, as this and other research suggests, a health coach or workout partner may help. Focusing on activities that you enjoy and that are important to you can help you to stick with a plan. Among the goals that experts recommend for better brain health:
- Try to keep systolic blood pressure (the top number) to 130 or less from age 40 and beyond. Studies show that older adults who regularly took their blood pressure medications had a 26 percent lower risk of developing Alzheimer’s disease and other forms of dementia than their peers with untreated hypertension.
- If you smoke, quit. Quitting smoking at any age has many health benefits that begin immediately.
- Get regular physical activity throughout life. Join a walking group or pickleball class; the social interaction can provide an additional boost to the brain.
- If you are having trouble hearing, get a hearing aid. Even minimal hearing loss can impact the brain, and studies show that hearing loss is the largest modifiable risk factor for developing dementia, exceeding that of smoking, high blood pressure, lack of exercise and social isolation.
- If you drink alcohol, keep it moderate — no more than one to two drinks a day. Drinking alcohol in excess over a long period of time can cause brain damage and increase the risk of developing dementia.
- Try to maintain a healthy weight, which can lower the risk of diabetes and other chronic ailments tied to dementia.
By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Eric Schmidt, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.
Source: Christine Yaffe, MD; Eric Vittinghoff, PhD; Sascha Dubline, MD, PhD; et al; “Effect of personalized risk-reduction strategies on cognition and dementia risk profile among older adults: The SMARRT randomized clinical trial” JAMA Internal Medicine, November 27, 2023