
Dr. Dean Ornish says intense lifestyle changes may be able to slow or reverse cognitive decline.
In 1990, internal medicine specialist Dr. Dean Ornish did what no other doctor had been able to do: He published results of a randomized clinical trial that used advanced imagery scans to show coronary artery disease could be reversed with nothing more than diet, exercise, stress reduction and social support.
“I think our unique contribution has been to use these very high-tech, expensive, state-of-the-art scientific measures to prove how powerful these very low-tech and low-cost interventions can be,” said Ornish, a professor of medicine at the University of California, San Francisco.
Today, Ornish is trying to do for the brain what he did for the heart. At his nonprofit Preventive Medicine Research Institutein California, he’s using the same four lifestyle interventions to see if early-stage Alzheimer’s can be “slowed, stopped or even reversed” without the use of drugs, devices or surgeries.
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“What’s good for your heart is good for your brain and vice versa,” Ornish said. “Prior studies have shown moderate changes in lifestyle can slow the rate of progression of dementia and Alzheimer’s. So, my hypothesis is that more intense lifestyle changes could stop or even reverse the decline.”
Aggressive lifestyle changes
The original study on heart disease was small — 28 people were in the experimental group Ornish then followed for five years. Some skeptics criticized the program for its small sample size and said there was no way people could remain on the program’s stringent plant-based diet without supervision.

Ornish’s program includes walking or other aerobic exercise.
In the Ornish meal plan, no more than 10% of one’s daily calories can come from fat. To accomplish that, all animal products besides egg whites and one cup of nonfat milk or yogurt each day are banned. (This doesn’t apply to the Alzheimer’s study.) Whole grains, fruits, vegetables and legumes are the basis of the diet, along with a few nuts and seeds. Refined carbohydrates, oils and excessive caffeine are avoided, but up to two cups a day of green tea are allowed.
“It’s low-fat, but that’s just a small part of the overall diet,” Ornish said. “It’s essentially a vegan diet, low in fat and sugar, eating foods as close as possible to nature.”
The program also includes an hour a day of yoga-based stress management using stretching, breathing, meditation and relaxation techniques. Strength training and walking or other aerobic exercise are required for 30 minutes a day or an hour three times a week. Smoking is not allowed.
“There are also support groups,” Ornish told CNN, “not just helping people stay on the diet but creating a safe environment where people can let down their emotional defenses and talk openly and authentically about what’s really going on in their lives, warts and all.
“That was the part that surprised me the most — these support groups are really intimate,” he added. “Sharing things like ‘I may look like the perfect father, but my kids are on heroin,’ or whatever. Even by Zoom, they’re getting to the same level of intimacy within one or two sessions because there’s such a hunger for that.”
Ornish calls that part of his program “Love More.” He answers skeptics who wonder why intimacy is such an integral part of a plan to reverse disease by pointing to studies on people who are lonely, depressed or isolated.
Those people are “three to 10 times more likely to get sick and die prematurely from pretty much everything” when compared with people who say they have a sense of love, connection and community, Ornish maintained.
“Why? In part because you’re more likely to smoke, overeat, stop exercising and other unhealthy things when you’re feeling lonely and depressed,” Ornish said.
Impact on other chronic diseases
By 1993, insurance giant Mutual of Omaha began reimbursing policyholders for the cost of Ornish’s program, making it the first alternative therapy besides chiropractic to win insurance reimbursement. Medicare began covering lifestyle interventions for heart disease in 2006.
“And in October 2021 Medicare agreed to cover my reversing heart disease program when it’s done via Zoom, which is really a game changer,” Ornish said. “Now we can reach people at home, in rural areas and food deserts wherever they live, which will help reduce health inequities and health disparities.”
In the last two decades, Ornish’s research has shown the same four-part program can lower blood sugars and heart disease risk for patients with diabetes, reduce prostate cancer cell growth, improve depression within 12 weeks, reduce “bad cholesterol” by an average of 40%, and more.
“With all this interest in personalized medicine, just how is it that these same lifestyle changes stop, and often reverse, the progression of such a wide spectrum of the most common and costly chronic diseases?” Ornish asked.
“Because they all share the same underlying biological mechanisms: chronic inflammation, oxidative stress, changes in the microbiome, changes in gene expression, overstimulation of the sympathetic nervous system, changes in immune function and so on,” he said.
“And in turn, each one of these is directly influenced by what we eat, how we respond to stress, how much exercise we get and how much love and support we have,” Ornish said.
Those lifestyle improvements likely change the body at a cellular level, he said. A 2008 study found the Ornish program affected some 500 genes in the body via epigenetics, chemical reactions that can activate or dismantle how a gene is expressed.
“After just three months on the Ornish lifestyle program, the research found a number of genes that regulate or prevent disease are turned on, and genes that cause many of the mechanisms that cause all these different conditions are turned off,” Ornish said.
“You’re not technically changing your genes, but you’re changing the expression of those genes with chemical switches, turning them on or off,” he said. “So, that means it’s no longer all in our genes, making us victims of our genetic fate. We’re not victims. There’s a lot we can do.”
Ornish lifestyle interventions have also been shown to lengthen telomeres, the tips of chromosomes that control longevity and shorten as we age. Ornish did a 2013 pilot study with UC San Francisco biochemist Elizabeth Blackburn, who won the 2009 Nobel Prize in physiology or medicine for her work on telomeres.
“We found that telomerase, the enzyme that repairs and lengthens telomeres, increased by 30% after just three months on the program,” Ornish said. “Then we found that people who had been on the program for five years had telomeres that were about 10% longer, a sign that aging is being reversed on the cellular level.”
Will these same lifestyle interventions be enough to slow or even reverse cognitive decline in Alzheimer’s and other dementias? Time will tell. Ornish’s study is still underway and all the data must be gathered, analyzed and peer-reviewed before an outcome can be reported.
“But I believe that it’s not one diet and lifestyle intervention for heart disease, another for diabetes or prostate cancer, and yet a different one for Alzheimer’s. It’s really the same for all these different conditions,” Ornish told CNN.
“To reverse the disease, you need to follow the interventions nearly 100%. If you’re just trying to prevent disease, then the more you change, the more you improve. But what matters most is your overall way of eating, living and loving so that we can all die young as old as possible.”
10 potential early signs of dementia
10 potential early signs of dementia

According to The Centers for Disease Control and Prevention (CDC), “Dementia is not a specific disease, but is rather a general term for the impaired ability to remember, think, or make decisions that interfere with doing everyday activities.” The most common type of dementia is Alzheimer’s disease, though there are several types of dementia including frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and vascular dementia (VaD) to name a few. Globally, more than 50 million people have dementia, and an estimated 10 million new cases are reported each year. Projections show that the number of affected individuals will reach 82 million in 2030 and 152 million by 2050.
A dementia diagnosis comes after a series of tests of memory, problem-solving, and other cognitive abilities performed by a health care provider. Blood tests, brain scans, and physicals are carried out to help doctors figure out the underlying cause. Dementia is broken down into early, mid, and late stages, with a worsening of symptoms as the condition progresses.
The long-term effects of dementia can be difficult for both those affected and their caregivers, family, and friends, and can include a lack of family recognition, difficulty walking, and significant memory impairment. The afflicted person becomes completely dependent on others for care. Early diagnosis is especially important and can help with planning both at home, with preventive care and other measures such as reminders, and at work. It also enables dementia patients to access clinical trials and available therapies that may improve cognitive functioning and overall quality of life.
Neural Effects consulted the CDC’s list of warning signs for dementia and Alzheimer’s disease to review what adults should look for before seeking an official medical diagnosis. This list may also prove helpful for those who’ve noticed loved ones who are experiencing one or more early signs of dementia.
Memory loss that disrupts daily life

Forgetting recently learned information is one of the earliest signs of dementia. Name recall, as well as remembering important dates and events, becomes difficult for people in the early stages of dementia. Often they need to rely on memory aids, like wall calendars, sticky notes, digital reminders, or help from family members for things like taking medications at the correct time and arriving on the right date to appointments. Asking the same question several times or repeating stories is very common. While this sign is seen often in dementia, it is also a typical sign of aging as well as mild cognitive impairment, which can be, but is not always, an early warning indicator of Alzheimer’s disease. Memory loss may also be a sign of depression; B12 deficiency; kidney, brain, thyroid, or liver disorders; or a side effect of certain medications.
Challenges in planning or solving problems

An occasional mix-up while balancing a checkbook can be a common sign of aging. Losing track of monthly bills can be a more serious sign. An inability to concentrate or difficulty following a familiar recipe may warrant a doctor’s visit. Planning may become almost impossible for those in the earliest stages of dementia and indicates a deficit in executive functioning. Difficulties with problem-solving can also signal other health issues ranging from serious conditions like a brain tumor to less insidious conditions such as stress.
Difficulty completing familiar tasks at home, at work, or at leisure

Often in early dementia, the simplest tasks become increasingly difficult. While older people may have trouble with operating a computer or the settings on a television remote—and this can be a normal symptom of aging—those with dementia can’t perform daily tasks that were once a part of their routine. Getting dressed can become a major undertaking. The real difficulty actually comes with the sequence or order of doing things. Writing out the steps to tasks such as preparing a meal and leaving them in easily accessible places can be helpful.
Confusion with time or place

Often people in the early stages of dementia forget the time and even lose track of months and seasons. While many retired people may forget what day it is because they no longer go to work and live by a calendar, the sort of confusion surrounding time is much more severe in those with dementia. Losing track of where they are or how they got to certain places is common and should be investigated by a doctor. This type of confusion may be acute and occur suddenly or may happen over time. Those afflicted will often experience periods of confusion surrounding time and place and then revert to their old selves. Perception of time and time distortion are also issues for those struggling with dementia. They may believe they haven’t seen a loved one for months or years, when in fact it was only days ago.
Trouble understanding visual images and spatial relations

Difficulty understanding visual images and spatial relations can impact depth perception, which can cause an increased risk of falling and can make feeding and bathing more challenging. Driving difficulty due to problems with spatial relations is quite common, and navigating turns and changing lanes can become dangerous. Often people with dementia are forced to give up driving. Reading also becomes a problem, not only because of the visuospatial issues, but also due to an inability to understand words. A 2016 study of visuospatial skills in dementia patients found that those with certain types of dementia, including Alzheimer’s disease, dementia of Lewy bodies, and vascular dementia, performed poorly in comparison to controls when examining space and object perception. The study found that significant impairment of visuospatial functions occurs in the early stages of dementia and worsens as the disease progresses.
New problems with words in speaking or writing

While aging can cause an occasional problem with finding the right word, communication issues are much more significant in the early stages of dementia. Following conversations and finding the correct words for objects is difficult for those with dementia, and this early warning sign should be brought to a doctor’s attention. Aphasia, a type of language disorder, impacts communication including speech, writing, and language comprehension. According to the Mayo Clinic, “Primary progressive aphasia is a type of frontotemporal dementia.” Of course, there are other medical conditions that can cause language and communication issues including strokes, brain tumors, and brain injuries.
Misplacing things and losing the ability to retrace steps

Misplacing things could mean putting objects in strange places, like placing car keys in the microwave, and it is a common sign of dementia. Those struggling may also have difficulty in retracing their steps to find the things they’ve lost. This lack of ability to retrace steps differentiates this as a sign of dementia versus a normal sign of aging. It can be both dangerous and frustrating. As the disease progresses, the afflicted person may accuse others of stealing things that have been misplaced.
Decreased or poor judgment

During the early stages of dementia, decision-making is impacted and can cause poor judgment. People may spend money foolishly or have a hard time remembering to feed and walk a pet. They may also pay less attention to grooming and personal hygiene. Those struggling with dementia are especially susceptible to scams involving money. One poor decision should not be considered an indicator of dementia though. Instead, look for a pattern which might include things like constantly wearing summer dresses even though it’s winter, or walking in a busy area and not paying attention to traffic lights.
Withdrawal from work or social activities

Not wanting to participate in social activities once enjoyed, like golf or going to church, may be a sign of dementia. Because of an inability to follow conversations or participate in hobbies and comprehend them in a familiar way, things like watching a favorite sport or going to family dinners might become less enjoyable. This may cause people with dementia to withdraw. They may sleep more frequently or spend more time sitting in front of the television. Social withdrawal could also be a symptom of depression, anxiety, or post-traumatic stress disorder.
Changes in mood and personality

While being sad or experiencing a shift in mood can happen to almost anyone occasionally, mood and personality changes may be early indicators of serious health issues. These can include mental health conditions, hormonal changes, or substance abuse problems. When those with dementia experience these symptoms, they can manifest as fear, suspicion, and getting easily upset or becoming irritable over minor things. Things that never would have bothered them before often will now. They may also lose patience more quickly. The National Institute on Aging recommends doing several things to help navigate these changes in mood and personality, including having a daily routine and using humor when appropriate.
This story originally appeared on Neural Effects and was produced and distributed in partnership with Stacker Studio.
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