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Many of the prevention and treatment studies in progress for Alzheimer’s and related dementias do not involve drug candidates that interfere with disease pathways. Instead, these NIH-funded studies are exploring lifestyle and behavioral interventions .
Lifestyle and behavioral interventions include cognitive training, a healthy diet, and exercise, as well as combinations of these strategies. These interventions are being studied as ways to help prevent dementia or slow the progression from mild cognitive impairment to dementia.
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Carefully controlled clinical trials randomly assign research participants to an intervention, such as increased physical activity or a healthy diet, and compare their rate of dementia to a group that did not have that intervention. Clinical trials designed to investigate certain lifestyle choices and behavioral patterns are based on previous population studies that identified groups of people who seemed to have a lower risk of dementia because of certain healthy behaviors.
After a population study has identified a strong association between a lifestyle factor and dementia, a next step in research is to test an intervention in a controlled clinical trial. Clinical trials are a way of testing whether certain lifestyle habits and behaviors really explain why a group of people has a lower rate of dementia.
NIH is funding multiple studies of healthy behaviors to reduce the risk of dementia. Examples of recent progress include:
- Analysis of previous cognitive training clinical trials: A recent NIA-supported meta-analysis of 215 clinical trials showed that the various cognitive training tools under study can help older adults who are healthy or have mild cognitive impairment to improve cognitive health and perhaps their everyday functioning.
The research team also found that the overall benefits of cognitive training, while modest in size, were similar for both healthy older adults and those with mild cognitive impairment. This may mean that some forms of cognitive training can help reduce or delay the development of cognitive impairment and dementia. - Clinical trial to test computerized games to improve brain speed: NIA is funding a clinical trial to test the usefulness of computerized brain games designed to accelerate how fast the brain works. Specifically, this study is testing whether this kind of brain training can reduce mild cognitive impairment or dementia. It is also exploring whether an individual’s risk factors for Alzheimer’s — such as having amyloid plaques in the brain or having the APOE ε4 gene — can make brain games less likely to work.
- Clinical trial of taking aspirin for brain health: A recent analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) trial found that daily low-dose aspirin did not reduce the risk of dementia , mild cognitive impairment, or cognitive decline among ASPREE trial participants. ASPREE is a large clinical trial supported in part by NIH and designed to determine the risks and benefits of daily low-dose aspirin in more than 19,000 healthy older adults without signs of heart disease. Among people with heart disease, aspirin may reduce the risk of stroke, but it was unknown whether aspirin would benefit healthy adults.
The research team noted that a limitation of the five-year study is that not many cases of dementia were detected during that time, making it difficult to compare the aspirin and placebo groups. The ASPREE team continues to monitor trial participants to assess longer-term outcomes, including the effects of aspirin on cognitive function and dementia. - Funding opportunities for studies of the motivation for choosing healthy behaviors: Determining how to get people to engage in and sustain healthy behaviors, such as controlling high blood pressure and getting enough exercise , that may prevent or delay cognitive decline, mild cognitive impairment, and Alzheimer’s and related dementias continues to be an NIH research priority. Recognizing that these behaviors may need to start decades before disease onset, understanding the factors that support long-term adherence to lifestyle change will be critical.
In early 2021, NIA released new funding opportunities to support research , including behavior change clinical trials , on the psychology of motivation, value-based decision-making, and social support. The hope is that findings from this line of research will help investigators develop ways to help people choose and sustain healthy behaviors over many years.
Science Spotlight: Choosing healthy lifestyle behaviors to reduce risk
Before controlled clinical trials are designed to test the impact of healthy behaviors on dementia, researchers consider findings from population studies. A recent NIH-funded analysis of data from two population studies found that people who practice several healthy lifestyle behaviors are at substantially lower risk for Alzheimer’s disease.
In this study of nearly 3,000 adults, those who reported adhering to four or five of the following healthy behaviors had the least risk of developing the disease:
- Getting at least 150 minutes per week of physical activity
- Not smoking
- Limiting alcohol use
- Choosing a high-quality diet, such as one that is plant-based
- Keeping the mind active, even later in life
This study provides more evidence on how practicing a combination of healthy behaviors may reduce the risk of Alzheimer’s. This evidence adds to the basis for conducting controlled clinical trials to directly test the ability of interventions to slow or prevent development of Alzheimer’s.
NIA funds many clinical trials on behavior and lifestyle factors and dementia, including combinations of healthy behaviors. Visit the NIA website for a list of current NIA-supported trials testing healthy behaviors .