The arrival of disease-modifying treatments capable of slowing Alzheimer’s progression has offered patients newfound hope. However, a recent study reveals that only about 3% of patients prescribed these breakthrough medications successfully adopt the essential lifestyle changes that should accompany treatment.
Leqembi (generic name lecanemab), jointly developed by Eisai of Japan and Biogen of the United States, works by targeting and clearing toxic amyloid-beta proteins in the brain. While it cannot reverse advanced dementia, clinical trials demonstrate that when administered to patients with mild cognitive impairment or early-stage Alzheimer’s disease, it slows cognitive decline by approximately 27%.
To evaluate real-world habits alongside treatment, a research team at Harvard Medical School and Brigham and Women’s Hospital analyzed lifestyle adjustments among patients prescribed Leqembi. Researchers hypothesized that patients investing in costly, cutting-edge therapies would naturally adopt supporting habits to protect their brain health.
Fewer Than 3% Maintain Essential Brain-Healthy Habits
The study tracked 150 patients with mild cognitive impairment or early-stage Alzheimer’s disease who were taking Leqembi, assessing their adherence to 15 key lifestyle practices. These included getting at least 25 minutes of daily exercise, eating regular meals, securing adequate sleep, engaging in cognitive and social activities, undergoing hearing and vision training, avoiding smoking and alcohol, managing stress, establishing a sense of purpose, and controlling blood pressure, body fat, cholesterol, and blood sugar levels.
The results showed that fewer than 3% of participants managed all 15 lifestyle habits effectively. More than 97% failed to control at least one risk factor, leaving an average of five lifestyle practices unaddressed.
Exercise was the most frequently neglected habit, with 63% of patients failing to get at least 25 minutes of daily physical activity. Over half also fell short in managing blood sugar levels (59%), stress control (56%), and body fat maintenance (55%). Conversely, smoking cessation showed high compliance, with 99% of participants remaining smoke-free after receiving their prescription.
Researchers noted that the lifestyle habits of patients receiving treatments costing tens of thousands of dollars closely mirrored those of average patients, highlighting an urgent need for structured clinical intervention and ongoing patient management.
Similar Challenges in South Korea Point to Systemic Gaps
Although the U.S. study involved a small cohort, leading dementia specialists in South Korea observe a nearly identical pattern.
“Every time I prescribe Leqembi, I educate patients on the absolute necessity of lifestyle modifications, emphasizing regular strength training in particular,” said Park Ki-hyung, chair of the Korean Dementia Association and a professor of neurology at Gachon University Gil Medical Center, in an interview with medical news outlet Kormedi.com. “Yet, the majority of patients fail to follow through.”
In older adults, declining muscle mass directly accelerates cognitive impairment. While Park emphasizes exercise and lifestyle maintenance during clinical visits, he noted that many patients remain overly optimistic that the drug alone will resolve their condition.
“It is well established that blood pressure, diabetes, and sleep quality significantly influence dementia outcomes,” Park added. “A patient’s prognosis naturally improves when these risk factors are managed in tandem with Leqembi.”
However, Park stressed that systemic healthcare reform must precede expectations of patient self-management.
“Leqembi requires extensive counseling for both patients and caregivers beyond simply administering an infusion,” Park emphasized. “In a medical system where no reimbursement fees are set for patient education or lifestyle counseling, expecting patients to manage these habits independently is overly idealistic. Ultimately, insurance reimbursement structures must be reformed so clinicians can dedicate the necessary time to ensure patients are actually making sustainable lifestyle changes.”
