Comparative effectiveness of non-pharmacological interventions for preventing cognitive decline in older adults: a systematic review and network meta-analysis

As global populations age, preventing cognitive decline has become a major public health priority. Multiple non-pharmacologic strategies have been proposed to preserve cognitive function, yet their comparative effectiveness remains uncertain. This study conducted a systematic review and network meta-analysis of randomized controlled trials evaluating lifestyle interventions in older adults at risk of dementia. Searches of PubMed, PubMed Central, Clinicaltrials.gov, and Cochrane Library (collection to February 2026) identified 18 trials (n = 10,405). Interventions included aerobic exercise, resistance/multicomponent exercise, cognitive training, dietary, and multidomain lifestyle approaches. Risk of bias was assessed using RoB 2. Random effects network meta-analysis was used to estimate pooled standardized mean differences (SMDs) in global cognitive performance. Cognitive training and multidomain lifestyle interventions were associated with statistically significant improvements in global cognitive performance compared with controls. Cognitive training produced the largest estimated effect (SMD = 0.61, 95% CI: 0.31 to 0.91. Multidomain lifestyle intervention demonstrated modest, but consistent effects (SMD = 0.19, 95% CI: 0.05 to 0.33). Dietary and aerobic exercise interventions did not demonstrate statistically significant differences compared to control, but evidence was limited by the scarcity and heterogeneity of trials. The network consisted of six intervention nodes, allowing indirect comparisons across lifestyle strategies. No significant global inconsistency was observed. Overall, risk of bias was mixed across studies. However, sensitivity analyses excluding high-risk-of-bias trials yielded similar findings. These findings suggest that cognitive training and multidomain lifestyle interventions may offer modest benefits, though conclusions are constrained by sparse head-to-head comparisons and limited network size. In conclusion, these findings provide a synthesis of the literature on non-pharmacological interventions and highlight areas of priority for further methodologically robust research.

Name thesis:degree_name

M.S. (Master of Science)

Level thesis:degree_level

Masters

Discipline thesis:degree_discipline

Bioinformatics (UMKC)

Grantor

University of Missouri--Kansas City

Year dc:date.issued

2026

Author dc:creator

• Linhardt, Lauren Elizabeth

Advisor dc:contributor.advisor

• Bhattacharyya, Sudeepa

Language dc:language.iso

en_US

Handle dc:identifier.uri

https://hdl.handle.net/10355/112343

OAI identifier oai:identifier

oai:mospace.umsystem.edu:10355/112343