Researchers at the Mass General Brigham Neuroscience Institute found that most patients with early Alzheimer's disease are not optimally adhering to recommendations for improving their brain health, including exercising, getting adequate sleep, preventing hypertension, and eating a heart-healthy diet. Results, published in The Journal of Prevention of Alzheimer's Disease , show that fewer than 3% of the studied patients followed all 15 brain health recommendations the researchers examined. Both patients with early Alzheimer's disease who pursued treatment with lecanemab, an anti-amyloid antibody medication for Alzheimer's disease, and patients who did not pursue anti-amyloid therapy, had poor adherence to brain health recommendations, with no significant difference between those groups.
"Because patients pursuing anti-amyloid therapy were willing to receive lecanemab infusions every two weeks and tolerate the risks associated with this medication, we thought this highly motivated group might be pursuing every avenue available to protect their brain health," said Kirk Daffner, MD, lead author of the study and a neurologist at the Mass General Brigham Neuroscience Institute. "The results show there is much more work to be done."
Growing evidence links adequate physical activity, a healthy diet, sufficient sleep, social and cognitive engagement, controlled blood pressure and blood sugar, good vision and hearing, and low levels of alcohol consumption with a lower risk of cognitive decline and dementia. Brain Health Vital Signs, developed by Daffner, Seth Gale, MD, and colleagues, assesses 15 of these potentially modifiable factors to provide an overall brain health "score" and recommendations for improvement.
The researchers studied 150 patients with mild cognitive impairment or mild dementia due to Alzheimer's disease who were seeking anti-amyloid antibody therapy and compared them with 117 patients with mild cognitive impairment or mild dementia who were not pursuing the therapy.
Among patients pursuing anti-amyloid therapy, more than 25% were not optimally adhering to 11 of the 15 studied brain health recommendations and more than 50% were not optimally adhering to four of the recommendations. Similar low adherence rates were observed in patients with early Alzheimer's disease who did not pursue anti-amyloid therapy.
Patients most commonly fell short of the recommendation to get at least 25 minutes of physical activity per day on most days of the week (63% of patients pursuing anti-amyloid therapy did not meet this recommendation). Other especially challenging guidelines to meet included reducing stress and achieving low A1c levels, blood pressure and body mass index.
"There is a fairly robust, accepted evidence base that a certain set of behaviors and medical factors support brain health, but effective implementation in clinical care is still mostly missing," said Seth Gale, MD, senior author and neurologist at the Mass General Brigham Neuroscience Institute. "While tools such as Brain Health Vital Signs can help patients and their providers better understand what they are doing well and where they can improve, it's clear that structured, sustainable interventions are also necessary."
The ongoing Brain Health Champion Study , led by Gale, Daffner and colleagues, with results from its first cohort of patients published in 2019, found that those who received six months of individualized brain health coaching markedly improved their adherence to recommended brain health behaviors. Daffner and Gale say that offering more effective tools to providers and their teams, grounded in health psychology-based techniques, may best help support behavior change in patients.
Authorship: In addition to Daffner and Gale, Mass General Brigham authors include Kayla Riera, George R. Ghorayeb, Brittany M. McFeeley, Emma Weizenbaum and Kim Willment.
Paper cited: Daffner, K., et al. "Suboptimal adherence to brain health recommendations in patients pursuing anti-amyloid antibody therapy for Alzheimer's disease: Report from the Brain Health Vital Signs project." The Journal of Prevention of Alzheimer's Disease. DOI: 10.1016/j.tjpad.2026.100640
Funding and disclosures: Funding for this work came from the Gaudet Family Research Fund, the Wimberly Family Clinical Care Research Fund, the Arnold and Barbara Barron Fund, and the Alzheimer Innovation Fund, all through Brigham and Women's Hospital. The funders had no role in the design and conduct of the study; in the collection, analysis and interpretation of data; in the preparation of the manuscript; or in the review or approval of the manuscript.
