Why modifying your lifestyle is more important than ever

Until very recently, the dominant theory for explaining Alzheimer’s disease has been the ‘amyloid hypothesis’. This is the idea that sticky amyloid proteins build up in the brain causing plaques, and in later life, Alzheimer’s-related dementia. Clearing them would thereby restore cognitive function. Since this theory came to light, billions of pounds have been spent on research funding and clinical trials to see if a drug can be created to reverse this plaque build up.

Last month, the Cochrane review, often thought of as the gold standard of evidence-based medicine, analysed 17 clinical trials involving 20,342 patients and seven different anti-amyloid drugs. Participants were assessed on their memory, behaviour and wider brain function using established dementia tests. The Cochrane review came to the conclusion that while the drugs targeting the amyloid plaques do successfully clear proteins from the brain, it provided “no clinical benefit” and that statistical improvements found in previous trials did not translate into the real world. Though ‘gold standard’, the Cochrane findings may not tell the whole story because it brought together ‘old’ drug and ‘new’ drug data. The ‘new’ drugs, like Lecanemab and Donanemab target the immune system and promote the removal of plaques. One reason why these new drugs may be more successful is that they depend on early diagnosis. 

While these ‘anti-amyloid findings’ might not be the result hoped for, it’s still a very positive step forward in the journey of finding a cure for Alzheimer’s disease. It shows that amyloid plaques may actually be a consequence of cognitive decline, rather than a primary cause. The results of the Cochrane review are not about failure, they are about adjusting and recalibrating – changing the course of our thinking.

Over the last few years, scientists have been moving away from the ‘amyloid hypothesis’, for many reasons. One big anomaly is amyloid’s weak connection with clinical symptoms: many cognitively healthy people possess massive amounts of amyloid plaques, while others experience severe Alzheimer’s Disease (AD) with little or no amyloid. Increasing evidence shows that true causal triggers for AD stem from metabolic (turning food into energy for cells), vascular (relating to blood flow) or immune (the body’s defence system) issues. ‘Amyloid’ is now perceived simply to be an early and secondary biomarker.

As research continues to develop, there is a strong emphasis on the link between lifestyle and environmental factors in managing the risk of cognitive decline and the progression of dementia in later life. Diet, exercise, cognitive reserve, sleep, and stress have all been shown to play a significant role, and these are reflected in Brain Health Network’s six core pillars of Nutrition, Gut Health, Exercise, Sleep, Active Mind and living a Healthy Life. 

If we act on each of these pillars and seek to change our lifestyle by adopting relatively simple new habits, we can build our cognitive resilience. The hippocampus (an important centre of learning and memory) starts to decline around the age of 30, which means that this resilience will serve our brain health well in later life  and help to reduce the risk of dementia. While some changes may start earlier in life, as Professor James Goodwin says, “it’s never too late or too early to start looking after your brain health”. 

Recent findings from the US Pointer study (see our recent article on this here) tested two lifestyle programmes in more than 2,000 older adults. One programme, based on the careful enforcement of an evidence based lifestyle, appeared to be more successful at preventing dementia than the second programme, in which people were allowed to guide themselves. None of the lifestyle changes were difficult to understand. One neurologist involved in the research noted that most people already know they should exercise, eat well and sleep better. The difference came down to discipline. It’s quite difficult to change our habits across many different lifestyle areas – but it is possible. 

‘Prevention’ is better than care, and at Brain Health Network, the reliable evidence on which we base our six pillars has the power to positively impact cognitive resilience and wellbeing. We focus on a nutrient-rich diet (think the Mediterranean and MIND diets) to provide the brain with the essential fuel for cognitive function while protecting neurons against oxidative damage. A healthy diet also supports the good bacteria in our gut microbiome, which strongly influences our brain health via the gut-brain axis. Regular movement and exercise work to encourage better blood flow around the body, and therefore how much oxygen is delivered to the brain, while a good night of quality sleep activates the glymphatic system, which helps clear toxic waste from the brain that has accumulated throughout the day. Keeping the mind active and being socially active are also key, as not only do they reduce chronic stress but they also encourage neuroplasticity – the connections of new neural pathways. 

Together these dynamic and responsive pillars have the ability to shape our cognitive resilience and future wellbeing, and perhaps might just be the most effective medicine within our reach. 

For more information on our six core pillars, please visit www.brain.health