Dementia is a complex and growing public health challenge, but emerging research shows that lifestyle interventions can play a significant role in preventing, slowing, or even reversing cognitive decline. Pioneers in lifestyle medicine—including Dr. Dean Ornish, Dr. Neal Barnard, and Drs. Dean and Ayesha Sherzai have contributed compelling evidence that diet, exercise, stress management, and social engagement can profoundly impact brain health. Occupational therapists are uniquely positioned to help individuals and families implement these life-changing strategies.
The Power of Lifestyle Medicine: What the Research Shows
Dr. Dean Ornish’s Groundbreaking Study
In 2024, Dr. Dean Ornish led a landmark randomized controlled trial demonstrating that an intensive lifestyle medicine program, without drugs, significantly improved cognition and daily function in many patients with early dementia and Alzheimer’s disease. The intervention included a whole-food, plant-based diet, daily exercise, stress management techniques, and social support. After just 20 weeks, 71% of participants in the intervention group either improved or remained stable, while none in the control group improved and 68% worsened. Some regained abilities they had lost, such as reading books or managing finances. The study also found a dose-response relationship: the more participants adhered to lifestyle changes, the greater their cognitive improvement.
Dr. Neal Barnard’s Dietary Approach
Dr. Neal Barnard’s research emphasizes the brain-protective power of a plant-based diet low in saturated and trans fats, rich in vegetables, fruits, whole grains, legumes, and nuts. He highlights the importance of vitamin E from food sources, B12 supplementation, and avoiding excess metals (like iron and copper) that may increase risk. Barnard’s work shows that these dietary changes can reduce amyloid plaque buildup and lower dementia risk.
Drs. Dean and Ayesha Sherzai’s Comprehensive Plan
Drs. Sherzai have shown that up to 90% of Alzheimer’s cases may be preventable through their NEURO plan, which includes:
- Nutrition (primarily plant-based)
- Exercise (aerobic and strength training)
- Unwind (stress management)
- Restorative sleep
- Optimization of cognitive and social activity
Their research and clinical experience demonstrate that multidomain interventions are more effective than single changes alone.
Global Evidence: The FINGER Study and Others
The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a large, ongoing trial confirming that multidomain interventions—combining diet, exercise, cognitive training, and vascular risk management—improve cognition by about 25% over two years in older adults at risk for dementia. Benefits were seen across all cognitive domains and were independent of genetic risk factors. Other meta-analyses reinforce that exercise is particularly effective in improving cognitive function in people with mild cognitive impairment (MCI) and dementia.
Occupational Therapy and Lifestyle Medicine
1. Alignment with Lifestyle Medicine Pillars
Occupational therapists are recognized for their holistic, client-centered approach, which aligns closely with the six pillars of lifestyle medicine: nutrition, physical activity, stress management, restorative sleep, social connection, and avoidance of risky substances. OTs are trained to assess clients’ habits, routines, and environments, enabling them to provide practical, individualized strategies to support positive lifestyle changes across these domains.
2. Health Promotion and Chronic Disease Management
The American Occupational Therapy Association (AOTA) and recent literature highlight OTs’ critical roles in health promotion and prevention, including education and training on healthy eating habits, physical activity, and stress management. OTs frequently work with adults managing chronic diseases, supporting lifestyle changes even when these are not the primary reason for referral1. Their interventions are designed to be embedded into daily routines, increasing the likelihood of sustained behavior change.
3. Integration into Health Professions Education
There is a movement to integrate lifestyle medicine content into OT education and practice, empowering future clinicians to deliver therapeutic lifestyle interventions. This includes teaching OTs to use evidence-based behavior change models (such as Motivational Interviewing and Cognitive-Behavioral Therapy) to help clients adopt and maintain healthy habits. The Accreditation Council of Occupational Therapy Education (ACOTE) and the Occupational Therapy Practice Framework (OTPF-4) both support the inclusion of lifestyle medicine principles in OT curricula.
4. Evidence of Effectiveness
Research demonstrates that OT-led interventions can effectively promote physical activity, healthy eating, stress reduction, and other lifestyle changes, leading to improved physical and mental health outcomes. OTs’ expertise in embedding meaningful activities into daily routines and addressing barriers to participation makes them well-suited to facilitate lasting lifestyle changes.
5. Interdisciplinary Collaboration
OTs are increasingly recognized as key members of interdisciplinary teams delivering lifestyle medicine interventions in both clinical and community settings. Their unique skills in adapting environments and routines complement the work of other health professionals, enhancing the effectiveness of lifestyle interventions.
How Occupational Therapists Can Integrate Lifestyle Medicine into interventions for persons with dementia or at risk for dementia?
Occupational therapists (OTs) are essential in translating lifestyle medicine research into practical, sustainable daily habits for individuals with dementia and their caregivers. Here’s how OTs can support these interventions:
- Personalized Assessment: OTs evaluate current routines, abilities, and barriers to adopting healthy habits.
- Dietary Support: While not replacing dietitians, OTs help clients plan and prepare plant-based meals, adapt kitchen tasks to cognitive or physical limitations, and establish grocery shopping routines. They can also educate about the benefits of plant-based diets and safe food preparation.
- Exercise Programs: OTs design individualized physical activity plans—incorporating aerobic, strength, and balance exercises—tailored to interests and abilities, and ensure safety.
- Stress and Sleep Management: OTs teach relaxation techniques, mindfulness, and sleep hygiene, and help establish calming routines.
- Social and Cognitive Engagement: OTs facilitate participation in meaningful activities, group programs, and cognitive exercises to stimulate the mind and foster social connections.
- Caregiver Training: OTs educate caregivers on supporting lifestyle changes, structuring routines, and using cues and environmental modifications to encourage independence.
Conclusion
The collective work of Dr. Dean Ornish, Dr. Neal Barnard, Drs. Sherzai, and international research teams like FINGER provides robust evidence that lifestyle interventions—especially when multidomain and intensive—can prevent, slow, or even reverse dementia symptoms in some cases. Occupational therapists are at the forefront of making these interventions accessible and sustainable for individuals and families, empowering them to take charge of brain health and quality of life through daily choices and supportive routines.
OTs are well-positioned to deliver and reinforce lifestyle interventions that address nutrition, physical activity, stress, sleep, social connection, and substance avoidance, ultimately improving health outcomes and quality of life for diverse populations, including persons with or at risk for dementia.
REFERENCES:
Brown, Z., Freeman, K., & Räisänen, A. M. (2025). Integrating Lifestyle Medicine Content into Health Professions Programs. American journal of lifestyle medicine, 15598276251321418. Advance online publication. https://doi.org/10.1177/15598276251321418
Chippala, P. (2024). Ornish Lifestyle Therapy for Dementia: A Comprehensive Approach. LinkedIn. Retrieved from: https://www.linkedin.com/pulse/ornish-lifestyle-therapy-dementia-comprehensive-purusotham-chippala-pmhlc/
Kidsfirst, (2025). The role of occupational therapy in promoting physical activity. Retrieved from: https://www.kidsfirstservices.com/first-insights/the-role-of-occupational-therapy-in-promoting-physical-activity
Ornish, D., Madison, C., Kivipelto, M. et al. (2024). Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial. Alz Res Therapy 16, 122. https://doi.org/10.1186/s13195-024-01482-z
Park, A. (2024). Changing Your Diet and Lifestyle May Slow Down Alzheimer’s. Time. Retrieved from: https://time.com/6986373/how-to-slow-alzheimers-lifestyle/
Phillips, A. L., Räisänen, A. M., & St Clair, T. T. (2024). Lifestyle Medicine as a Curricular Thread in Occupational Therapy Education: A Scoping Review and Discussion of Feasibility. American journal of lifestyle medicine, 15598276241247759. Advance online publication. https://doi.org/10.1177/15598276241247759
Rosenberg A, Ngandu T, Rusanen M, et al. Multidomain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of baseline characteristics: The FINGER trial. Alzheimer’s & Dementia. 2018 Mar;14(3):263-270.
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