Most early Alzheimer’s patients receiving anti-amyloid therapy overlook brain-health guidelines, study finds

A striking gap between Alzheimer’s treatment and everyday brain-health habits has emerged from a new study by researchers at the Mass General Brigham Neuroscience Institute. Although many patients with early Alzheimer’s disease were willing to undergo intensive evaluation and, in some cases, receive lecanemab infusions every two weeks, most were not consistently following recommendations associated with better cognitive and cardiovascular health. Fewer than 3% of the patients studied met all 15 brain-health recommendations examined by the research team.

The findings, published in The Journal of Prevention of Alzheimer’s Disease, suggest that access to a disease-modifying therapy does not automatically translate into broader lifestyle changes. The study compared 150 people with mild cognitive impairment or mild dementia caused by Alzheimer’s disease who were seeking anti-amyloid antibody treatment with 117 similar patients who were not pursuing that therapy. Both groups showed generally poor adherence, and researchers found no significant difference between them.

“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, the study’s lead author and a neurologist at the Mass General Brigham Neuroscience Institute. “The results show there is much more work to be done.”

Lecanemab is designed to remove amyloid-beta plaques, abnormal protein deposits that accumulate in the brains of people with Alzheimer’s disease. Clinical trials have shown that the medication can modestly slow cognitive decline in carefully selected patients with early disease, but it does not reverse existing damage or eliminate the need for other forms of care. Its use also involves regular intravenous infusions and monitoring for amyloid-related imaging abnormalities, including brain swelling or small areas of bleeding. The new findings underscore that pharmacological treatment is only one component of a broader strategy for preserving brain function.

The researchers assessed brain health using Brain Health Vital Signs, a tool developed by Daffner, Seth Gale, MD, and colleagues. The assessment measures 15 potentially modifiable factors involving physical activity, diet, sleep, social and cognitive engagement, alcohol consumption, stress, blood pressure, blood sugar, body mass index, vision and hearing. These factors are biologically interconnected: hypertension and diabetes can damage small blood vessels that supply the brain, poor sleep may interfere with waste-clearance processes, and physical inactivity can worsen vascular and metabolic risk.

Among those pursuing anti-amyloid therapy, more than one-quarter of patients were not optimally meeting 11 of the 15 recommendations. More than half fell short of four recommendations. The most common problem was physical activity. Sixty-three percent of patients in the treatment-seeking group did not achieve at least 25 minutes of activity per day on most days of the week. Other difficult targets included reducing stress and maintaining favorable levels of hemoglobin A1c, blood pressure and body mass index.

These measures matter because Alzheimer’s disease develops within a biological environment shaped by both amyloid pathology and vascular, metabolic and inflammatory processes. Elevated blood pressure can stiffen and damage cerebral arteries, while chronically high blood glucose may impair blood-vessel function and increase oxidative stress. Sleep disruption may affect memory consolidation and the brain’s ability to clear soluble waste products. Hearing and vision loss can also reduce social and cognitive stimulation, potentially accelerating functional decline through isolation and disengagement.

The study was observational, meaning that researchers measured patient characteristics and behaviors rather than assigning participants to a specific intervention. It therefore cannot establish that failing to follow a particular recommendation directly worsens Alzheimer’s disease, nor can it determine why patients struggled to make changes. Participants were already receiving care in specialized clinical settings, so their adherence patterns may not represent those of the wider population. Even so, the consistency of the results across treatment-seeking and non-treatment groups points to a major weakness in routine clinical care: clinicians may identify modifiable risks without having the time, staffing or behavioral tools needed to help patients change them.

“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 Gale, the study’s senior author. “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.” That possibility is being explored through the ongoing Brain Health Champion Study, which uses individualized coaching and health-psychology techniques. Results from its first cohort indicated that six months of personalized support substantially improved adherence to recommended brain-health behaviors. The researchers argue that similar programs could help transform brain-health advice from a list of aspirations into practical, measurable routines for people living with early Alzheimer’s disease.

News Publication Date: 10-Jul-2026

Web References: https://www.massgeneralbrigham.org/en/about/neuroscience-institute; https://www.sciencedirect.com/science/article/pii/S2274580726001640?via%3Dihub; https://pmc.ncbi.nlm.nih.gov/articles/PMC12726485/

References: 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