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Adding lifestyle coaching to standard treatment for early-stage Alzheimer’s disease leads to less cognitive decline compared with the standard of care alone, according to the results of a new study. Such coaching is personalized and focused on diet, exercise, sleep, stress management and other lifestyle factors.

In an ISB-led Coaching in Cognition in Alzheimer’s, or COCOA, trial, 24 participants received the standard of care — which includes screening for and treating known causes of dementia, optimizing diet and exercise, and promoting cognitive or social engagement — and 31 participants received the standard of care plus personalized coaching for lifestyle interventions, over the phone. 

An early online version of the paper recently was published. Full publication of the paper is scheduled for the November issue of the Journal of Alzheimer’s Disease

The group that received lifestyle coaching saw their Memory Performance Index scores improve an average of 2.1 points compared with members of the other group. The lifestyle coaching group also experienced slower deterioration in Functional Assessment Staging Test scores.

“Over a two-year period, our trial showed that personalized lifestyle coaching in addition to standard of care decreases the amount of cognitive decline in patients on the Alzheimer’s disease spectrum,” Jared Roach, MD, PhD, Seattle-based Institute for Systems Biology senior research scientist, said in a statement. “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.”

Lifestyle coaching was provided by registered dietitians or certified nutritionists and was delivered via monthly telephone calls, as well as via emails and text messages. Although tailored to each study participant, the COCOA coaching intervention always included dietary recommendations based on the MIND — Mediterranean–DASH Diet Intervention for Neurodegenerative Delay — diet, physical activity recommendations based on US public health guidelines, and recommendations for sleep and stress management.

Researchers called the results “significant” and said they are better than any known pharmaceutical interventions.

“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,” William Shankle, MS, MD, FACP, an expert in neurodegenerative disorders from the University of California, Irvine, and Hoag Memorial Hospital Presbyterian in Newport Beach, CA, said in a statement.

The authors noted that many, if not most, people living with dementia in the United States are not receiving the best current standard of care, and many who are at risk for dementia are not receiving the best preventive care. They recommended that more resources be devoted to fund larger, multicenter trials not only for Alzhimer’s disease, but also for other diseases.

Trial results also should help modify and refine practical, real-world therapies for individuals with or at risk for Alzheimer’s disease, the researchers said. The results also should help with the designing of artificial intelligence-ready clinical trials to improve clinical recommendations and advance basic biomedical understanding of Alzheimer’s disease.

The researchers said they aim to build on their results by combining coaching with drugs such as lecanemab, commercially known as Leqembi.

The study was supported by the Alzheimer’s Translational Pillar of Providence St. Joseph Health.