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You can fight existing signs of dementia with a healthy lifestyle, a new study suggests
Living a healthy lifestyle with a focus on a nutritious diet, regular exercise, minimum alcohol consumption and other healthy habits can help keep your brain sharp into old age, doctors say.
But what if your brain already has signs of beta amyloid or tau — two of the hallmark signs of Alzheimer’s and other brain pathologies? Will a healthy lifestyle still protect you from cognitive decline?
The answer is yes, according to observational research that examined the brains of 586 people during autopsies and compared the findings with up to 24 years of data on their lifestyles.
“We found that the lifestyle-cognition association was independent of Alzheimer’s disease pathology burden, suggesting that (a healthy) lifestyle may provide cognitive benefits even for people who have begun to accumulate dementia-related pathologies in their brains,” said lead author Dr. Klodian Dhana, an assistant professor of geriatrics and palliative medicine at the Rush Institute for Healthy Aging in Chicago, via email.
In other words, the study found the presence of Alzheimer’s or another neurological disorder “didn’t seem to matter — the lifestyle changes provided the brain resilience against some of the most common causes of dementia,” said Dr. Richard Isaacson, director of research at the Institute for Neurodegenerative Diseases in Florida.
“It’s like a video game where you are shooting monsters,” said Isaacson, who wasn’t involved in the study. “The gun —the lifestyle changes — was able to defeat the ghosts, ghouls, goblins, vampires and zombies.”
Five healthy habits were tracked
For the study, autopsies were performed on 586 people living in retirement communities, senior housing and individual residences in the Chicago area who had participated in the Rush Memory and Aging Project between 1997 and 2022. The participants, who lived to an average age of 91, underwent regular cognitive and physical testing and filled out annual questionnaires on their lifestyles for over two decades before they died.
People in the study were categorized as living a low-risk or healthy lifestyle if they scored top marks in five different categories: they did not smoke; they did moderate to vigorous exercise for at least 150 minutes a week; they kept their alcohol consumption to about one drink a day for women and two for men; and they regularly stimulated their brain by reading, visiting museums, and playing games like cards, checkers, crosswords or puzzles.
The fifth category measured how well they followed the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay or MIND diet. Developed in 2015 by researchers at Rush University in Chicago, the MIND diet incorporates much of the plant-based Mediterranean diet, which focuses on fruits, vegetables, whole grains, beans, seeds, nuts and a lot of extra-virgin olive oil. Red meat and sweets are eaten rarely, but fish, which are packed with good-for-you omega-3 fatty acids, are a staple.
The MIND diet also assimilates elements of the Dietary Approaches to Stop Hypertension (or DASH) diet. The DASH diet focuses on lowering blood pressure and cholesterol, which can lead to heart attacks, strokes and constriction of small blood vessels that can lead to dementia. The standard DASH diet limits salt to 2,300 milligrams a day, less than a teaspoon of table salt.
Use of autopsies was unique
The study team then compared lifestyle data to various measures of pathology in the brain, including levels of beta-amyloid, tau tangles, and signs of vascular brain damage, or injury to the small blood vessels in the brain that occur from high blood pressure, heart disease and diabetes.
Not everyone who has signs of Alzheimer’s or vascular dementia goes on to develop cognitive issues, but many do.
Researchers also measured markers of three other brain diseases, including drug-resistant epilepsy, frontotemporal degeneration and Lewy body dementia, a neurological disorder that can create problems with behavior, mood, movement and cognition.
For every 1-point increase in the healthy lifestyle score used in the study, there were 0.120 units less beta-amyloid load in the brain, and a 0.22 standardized unit higher score in cognitive performance, which was measured by a test of about 30 items that examined attention, memory, language and visuospatial skills.
The cognitive benefits remained regardless of the existence of any of the five types of neurological conditions. In fact, “a higher healthy lifestyle score was associated with better cognition even after accounting for the combined burden of brain pathologies,” according to Yaffe and Leng.
More than 88% of a person’s global cognition score was a “direct association of lifestyle,” they said, leaving slightly less than 12% affected by the presence of beta-amyloid.
As an observational study, it’s not possible to prove a direct cause and effect, Yaffe and Leng said. However the study is “an important step” in understanding the ways people can modify their lives to reduce the risk of Alzheimer’s disease and other types of dementia.
注释：
autopsy: n
表示" 验尸；解剖"，means "an examination and dissection of a dead body to determine cause of death or the changes produced by disease"，如：They're carrying out an autopsy on the victim. 他们正在给受害者验尸。
Ghoul: n
表示"食尸鬼"，means "someone who takes bodies from graves and sells them for anatomical dissection"，如：It has a ghoul in the attic and gnomes in the garden. 陋居的阁楼上有食尸鬼，花园里住着地精。
tangle: v; n
表示"纠缠"，means " make confused, disordered; twist and twine into a confused mass;twisted and tangled mass that is highly interwoven"，如：The little girl tangled the yarn her mother was knitting. 小女孩把她妈妈在编结的毛线弄得纠结在一起了。His financial affairs are in such a tangle. 他的钱财是糊涂帐。
Epilepsia: n
表示"[医] 癫痫(羊痫疯"，如：Epilepsia is a frequent neural system disease of pediatrics,treatment based on syndrome differentiation in Traditional Chinese Medicine is more efficacious to certain extent. 癫痫是小儿神经系统常见疾病,中医辨证治疗有一定的优势。
frontotemporal: adj
表示"[医] 额颞[骨]的"，如：Within a few years, frontotemporal dementia can lead to death. 额颞叶失智可在几年内导致患者身亡。
中文简要说明：
失智症普遍被认为是不可逆的退化疾病，不过一项刊登在《美国医学会神经学期刊》（JAMA Neurology）的研究显示，即使患者脑部已经出现病变，仍有可能透过改变生活习惯，来减缓认知上的衰退。这也是首次有研究透过大脑病理解剖，来探索风险因素与认知衰退的关系。
美国有线新闻网（CNN）报导，这项研究的对象是586名住在芝加哥、平均年龄91岁的长者，他们在去世之前，于1997至2022年间连续20多年定期接受生理与认知能力检验，并每年接受生活方式问卷调查。
研究人员分析这586名长者的大脑解剖报告，与他们的生活习惯进行比较。结果显示，生活方式较健康的长者，即使罹患了大脑相关疾病，认知能力仍较高。
事实上，超过88%受试者的整体认知能力「与生活方式直接相关」，只有不到12%的受试者明显受到β淀粉样蛋白（Beta-amyloid，堆积成大脑斑块并导致退化）影响。
研究列出的健康生活方式包括：
1. 不抽烟。
2. 进行中度至剧烈程度的运动，每周至少150分钟。
3. 有限度的饮酒，女性每天不超过1杯，男性每天不超过2杯。
4. 经常参加活动来刺激大脑，像是打牌、下棋、参观博物馆、玩拼图或阅读等。
5. 依循地中海式的饮食方式，以大量植物、全谷类、坚果、富含Omega-3的鱼类，以及初榨橄榄油为主，避免高盐并减少摄取红肉和甜食。
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