Every now and then, researchers announce yet another “breakthrough” drug to halt mental declines or clear away the sticky brain plaque (beta-amyloid) that’s the hallmark of Alzheimer’s disease.

Unfortunately, the enthusiasm tends to fade as limitations of these drugs become apparent. The handful of medications that help ease the cognitive symptoms of Alzheimer’s (such as memory loss and confusion) do not stop the disease’s progression (see below to learn what drugs are available).  

What most people don’t realize: Even though medication plays a role in treating Alzheimer’s symptoms, certain lifestyle changes actually can slow the progression of Alzheimer’s disease by 30% or more—something that is impossible with even the newest drugs.

To learn more, Bottom Line Health spoke with Dean Sherzai, MD, one of the country’s leading authorities on Alzheimer’s disease.

The Neuro Approach

When I treat a person at risk for dementia or newly diagnosed with this disease or mild cognitive impairment (a condition that often precedes Alzheimer’s), I recommend a set of lifestyle changes I call NEURO. This stands for Nutrition…Exercise…Unwind…Restful sleep…and Optimize mental/social activities.

People who practice each of these steps—and who also address health conditions, especially high blood pressure and diabetes, that increase the risk for and symptoms of Alzheimer’s—can significantly slow the disease from progressing. Regardless of whether the person is also taking an Alzheimer’s medication, these lifestyle steps are crucial.

What you need to know about the five-step NEURO approach…

STEP 1: Nutrition. With few exceptions (see below), I don’t often recommend individual vitamins, antioxidants or other supplements—the totality of your diet is more important because healthy foods contain a complex mix of nutrients that work together to give maximum benefit.

Best choice: A Mediterranean-style diet. This diet includes lots of fruits, vegetables, whole grains, beans, fatty fish and monounsaturated fats (such as olive oil). Research has shown that a version of this diet that emphasizes certain brain-healthy foods (such as berries and leafy-green vegetables) is especially effective.

Important findings: In a study that was published in Archives of Neurology, researchers tracked nearly 1,400 people—482 of whom had already been diagnosed with mild cognitive impairment—for an average of more than four years. They found that those with this condition who were most careful about following a Mediterranean diet were 48% less likely to develop full-fledged Alzheimer’s disease than those who were more lax in their eating habits. And those who were still healthy at the start of the study were 28% less likely to develop symptoms in the first place.

Will supplements help when you are already eating well? Maybe—but the evidence isn’t conclusive. Supplements to consider…

  • Vitamin B-12. I’ve found that Alzheimer’s patients with B-12 blood levels even at the lower end of the normal range (typically around 180 ng/L) sometimes have fewer cognitive symptoms when they take B-12 supplements.   
  • Omega-3s. Increasing blood levels of omega-3 fatty acids might help as well.
  • Vitamin D. If vitamin D levels are low, a supplement may improve symptoms and help slow Alzheimer’s progression.

STEP 2: Exercise. Exercise can slow progression by about 30% or more. Exercise works on multiple levels—it stimulates growth factors that maintain neurons (brain cells)…and increases circulation of blood in the brain, which promotes healthy cognitive function. My advice: Get 30 minutes of exercise five or more times weekly. What works well for some people: Riding a recumbent bike while watching TV.

STEP 3: Unwind. People who experience a lot of stress are up to two-and-a-half times more likely to develop Alzheimer’s disease than those who have less or who deal with it more effectively.

Why? No one’s sure, although it seems likely that the stress-related surge in cortisol and other hormones is harmful to the brain.

Exercise and volunteering are great stress reducers. Some people manage stress by keeping busy with hobbies…practicing yoga…and/or enlisting help from friends/relatives to deal with daily responsibilities. Do what works best for you—and make stress reduction a priority.

STEP 4: Restful sleep. Many Alzheimer’s patients don’t sleep well. Experts once assumed that poor sleep was merely an Alzheimer’s symptom. But new research suggests that a lack of restful sleep may play a role in the development and progression of the disease.

Important finding: A study in JAMA Neurology that looked at 70 older adults found that those who got less than five hours of sleep a night had higher brain levels of beta-amyloid than those who slept more than seven hours. Researchers speculate that poor sleep impairs the body’s ability to clear beta-amyloid or other toxic molecules from the brain.

Also: Sleep apnea, a very common (and underdiagnosed) condition in which breathing intermittently stops and starts during sleep, reduces brain oxygen and is strongly linked to Alzheimer’s.

If you frequently snore or snort during sleep, or you’re tired in the morning despite having what you thought was a good night’s sleep, your doctor might suggest a sleep study that measures brain waves and blood oxygen levels to detect apnea and other sleep disorders. 

STEP 5: Optimize mental/social activities. People who stay mentally busy with hobbies, for example, and do other stimulating activities (such as playing challenging video games that require memory, problem-solving, hand-eye coordination, etc.) have smaller declines in memory and other cognitive functions…less Alzheimer’s-related brain damage…and slower disease progression. They have a deeper “cognitive reserve,” the neural connections (and brain size) that can forestall future impairments.

Once people start doing these new activities, it’s both motivating and rewarding because the positive changes—including improved cognitive functioning—can occur within a matter of weeks.

Medication Choices for Alzheimer’s

The drugs that are FDA-approved for treating Alzheimer’s disease affect brain chemicals and can improve memory, alertness and concentration. The two classes of these medications…

  • Cholinesterase inhibitors (Aricept, Exelon and Razadyne). These drugs block an enzyme that breaks down acetylcholine, a neurotransmitter that’s vital for memory, language, learning and other cognitive functions. There are no serious side effects, but some patients may experience nausea, vomiting, diarrhea or other problems. If this occurs, an Exelon patch can be used.
  • N-Methyl-D-Aspartate (NMDA) receptor blocker (Namenda). This drug affects glutamate, another brain chemical. It’s approved for treating moderate-to-severe Alzheimer’s, but it can also help patients with milder forms of the disease. In some patients, Namenda, which may cause side effects such as dizziness and/or headache, works best when combined with Aricept or another cholinesterase inhibitor.