Non-Pharmacological Interventions for Preventing or Managing Cognitive Decline

Abstract

Mild cognitive impairment (MCI) and early Alzheimer's disease (AD) present significant challenges in aging populations, as cognitive decline impacts daily life and overall well-being. There has been a growing interest in non-pharmacological interventions that can mitigate the progression of these conditions. This review explores the impact of various interventions, including physical activity, nutrition, cognitive training, and multidomain approaches, on cognitive function in individuals with MCI or early AD. Studies have demonstrated the potential of exercise, particularly aerobic and strength training, to improve cognitive health by preserving brain structure and function. Nutritional interventions, particularly those focusing on Mediterranean-style diets, offer promising cognitive benefits due to their anti-inflammatory properties. Cognitive training programs have shown improvements in specific cognitive domains, but results regarding their long-term effectiveness are still inconclusive. Multidomain interventions that combine exercise, nutrition, and cognitive training show potential for optimizing cognitive function and reducing the risk of further cognitive decline. However, while these studies offer promising results, more large-scale, long-term trials are needed to confirm the sustained impact of these interventions and identify the most effective strategies for preventing dementia.

Introduction 

Mild cognitive impairment (MCI) is characterized by noticeable cognitive decline that exceeds normal age-related changes but does not significantly interfere with daily life. Alzheimer’s disease (AD) is a progressive neurodegenerative disorder, most common in older adults, that is believed to be caused by the accumulation of amyloid-beta plaques and tau tangles in the brain. Early-stage AD involves more pronounced cognitive deficits that begin to disrupt daily functioning. Both MCI and AD are often seen as part of a continuum, with MCI potentially progressing to AD.¹ The aging global population has led to a rise in cognitive disorders such as MCI and AD, which present significant social, emotional, and economic challenges. Pharmacological treatments are limited and often have side effects, prompting interest in non-pharmacological interventions that could promote cognitive health and delay more severe impairment. Identifying interventions that improve or maintain cognitive function in early AD is crucial for improving quality of life and reducing healthcare burdens.² 

This review examines the effects of physical activity, nutrition, cognitive training, and multidomain approaches on cognitive function in individuals with MCI or early AD. By synthesizing recent clinical trial findings, the paper aims to highlight promising strategies for cognitive preservation and disease prevention. Research indicates that lifestyle interventions, including exercise, nutrition, and cognitive training, may enhance cognitive function and delay cognitive decline in MCI or early AD, but their effectiveness remains inconclusive.³ Multidomain interventions that combine physical activity, nutrition, and cognitive training show the most promise, though further studies are needed to confirm their long-term efficacy and generalizability.⁴ 

While studies have shown that lifestyle interventions such as aerobic exercise, strength training, the Mediterranean Diet, and cognitive training programs have positive effects on memory and executive functioning, most studies are limited by sample size, duration, and methodological differences. These shortcomings make it challenging to draw definitive conclusions about their long-term impact. Additionally, the mechanisms by which these interventions influence brain health are not well understood. This review focuses on three key non-pharmacological interventions—physical activity and nutrition, cognitive training, and memory-driven occupational therapy—to provide a clearer understanding of the current research and identify areas for further exploration. 

Lifestyle Changes 

Numerous studies have explored the role of lifestyle interventions in slowing the progression of MCI and early AD. These interventions, including physical activity and dietary changes, have shown promise in enhancing cognitive function and preventing further decline. In addition to physical and dietary factors, comprehensive lifestyle changes that incorporate stress management, social support, and adequate sleep may also play a critical role in supporting cognitive health.³ Yoga, a form of exercise that integrates physical movement, breathing techniques, and mindfulness, has also shown potential in reducing cognitive decline and promoting emotional well-being in individuals at risk for AD.⁵ 

Physical activity stands out as a key factor in cognitive enhancement and has proven to be particularly effective in improving cognitive function in older adults with MCI and early AD. Various forms of exercise, such as aerobic activities, strength training, and dual-task exercises, have been associated with improvements in memory, executive function, and processing speed.^{4, 5, 6} For example, the J-MINT PRIME Tamba trial demonstrated that a multifaceted program combining physical exercise, nutrition counseling, and cognitive training resulted in significant improvements in executive function and memory.⁴ In addition to enhancing brain blood flow and promoting neuroplasticity, regular physical exercise may also reduce inflammation and support overall brain health.⁶ Moreover, practices like yoga, which promote relaxation and reduce stress, may further support brain health by improving neuroplasticity, emotional regulation, and reducing anxiety, which are all linked to cognitive preservation.⁵ 

Alongside physical activity, dietary modifications, particularly adherence to the Mediterranean Diet (MeDi), play an essential role in cognitive health and may help mitigate the effects of MCI.⁶ The MeDi, which emphasizes fruits, vegetables, whole grains, lean proteins, and healthy fats, has been shown to improve cognitive function, especially in memory, processing speed, and executive function. Following this diet may help reduce the progression of cognitive decline by providing essential nutrients that support brain health and reduce inflammation. Furthermore, a plant-based diet, when combined with other lifestyle factors like regular exercise and stress management, can provide comprehensive support for maintaining cognitive function.⁶ Additionally, combining the MeDi with specific supplements, such as pomegranate seed oil, can further enhance cognitive function in patients with MCI and represents a promising component of holistic strategies for dementia prevention. This oil is rich in antioxidants and anti-inflammatory compounds, particularly punicic acid, which can help reduce oxidative stress, inhibit inflammation, and support neuronal function. Research suggests that this combination has a more significant impact on cognitive improvement than the diet alone, underlining the potential benefits of integrating dietary changes into a healthy lifestyle to slow cognitive decline.⁷

Cognitive Training 

Cognitive training has emerged as a promising non-pharmacological approach to improving cognitive function in individuals with MCI and early AD.⁸ This training typically targets specific cognitive abilities. Such as memory, attention, or executive function, through structured exercises. This includes task-switching activities (e.g., alternating between different rules), visual and spatial working memory tasks (e.g., recalling information over progressively longer intervals), and spatial memory recall exercises (e.g., studying a set of unfamiliar faces and later identifying them among distractors). Research indicates that cognitive training (CT) can help reduce the effects of MCI by improving cognitive functions and potentially slowing the neurodegenerative process. One of the key ways CT benefits MCI patients is by enhancing fluid cognition, which includes memory, attention, and processing speed. Studies find that exercises involving memory and executive function stimulate brain areas, such as the dorsolateral prefrontal cortex, that are critical for healthy cognitive control. By engaging these areas, CT strengthens neural connections and helps mitigate cognitive decline. Additionally, CT may support the integrity of white matter, which is essential for efficient brain communication. For individuals with MCI, where brain atrophy and connectivity issues are common, cognitive training can potentially slow neurodegeneration and improve both cognitive function and quality of life.⁸ 

In addition to its direct cognitive benefits, cognitive training can be further enhanced by incorporating innovative approaches that engage multiple cognitive domains. Most cognitive training programs for older adults on the AD spectrum focus primarily on memory and visuospatial skills. However, incorporating additional domains—such as perceptual processing, decision-making, and associative thinking—may further enhance cognitive function. By targeting multiple cognitive domains simultaneously, these approaches leverage synergistic interactions between skills, potentially providing benefits beyond those achieved with traditional memory-focused training. One such approach involves art-based activities, which have shown promise in improving cognitive function in individuals on the AD spectrum. These programs target specific cognitive domains—including perception and sensory processing, attention, executive function, memory, language, social cognition, and creativity—by engaging participants in creative and cognitively stimulating activities. When combined with interventions like the MeDi, these programs can also improve psychological well-being, leading to better quality of life and sleep quality. These programs underscore the potential of non-pharmacological interventions to help reduce cognitive decline in individuals with Alzheimer’s disease or those at risk.⁹ 

Recollection-Based Occupational Therapy 

Recollection-based occupational therapy is an innovative non-pharmacological intervention that combines cognitive stimulation with physical, social, and creative activities to help improve both cognitive and emotional well-being in individuals with AD. This type of therapy often focuses on evoking nostalgic memories through activities such as horticultural tasks (e.g., planting and caring for herbs), music (e.g., listening to familiar songs), art (e.g. engaging in past creative hobbies), and daily living exercises (e.g., cooking simple recipes); which aim to stimulate memory recall and foster engagement. The approach not only targets memory but also encourages physical activity and social interaction, which is beneficial for overall cognitive health. Research suggests that recollection-based occupational therapy can lead to significant improvements in cognitive function and emotional health, especially in individuals with mild AD. For example, interventions that integrate physical, horticultural, and artistic activities have been shown to reduce symptoms of depression and enhance quality of life, demonstrating the potential of this therapy to improve both cognitive and emotional outcomes. This approach offers a promising avenue for improving cognitive function and well-being in those with mild AD, and may be particularly valuable as a non-pharmacological alternative to traditional treatments.¹⁰ 

Discussion and Future Directions 

The studies reviewed suggest that multidomain interventions, combining cognitive training, physical activity, nutrition, and lifestyle modifications, hold promise for improving cognitive function and preventing dementia. These interventions aim to preserve or enhance cognitive function in individuals with MCI or early AD by addressing various aspects of health—brain stimulation, physical well-being, and nutritional support. However, limitations such as small sample sizes, short intervention durations, and challenges with participant engagement need to be addressed. 

One key challenge in current research is the inconsistency in study findings, which may stem from variations in intervention duration, intensity, and participant characteristics. For example, while some trials show significant cognitive benefits from aerobic exercise, others report minimal or no improvement, suggesting that factors such as frequency, type, and baseline cognitive status may influence outcomes.^4,6 Similarly, while adherence to the Mediterranean Diet (MeDi) is associated with better cognitive function, some studies indicate that dietary changes alone may not be sufficient to produce long-term benefits without additional lifestyle modifications.^6,7,9 These discrepancies highlight the need for more standardized methodologies to assess the effectiveness of interventions across different populations. 

Additionally, while cognitive training programs have demonstrated improvements in specific cognitive domains, their long-term effects remain uncertain. Some research suggests that the benefits of cognitive training may be temporary or domain-specific, rather than contributing to overall cognitive resilience. Further investigation is required to determine whether these improvements translate to everyday cognitive function and whether cognitive training alone is sufficient or most effective when combined with other interventions.^4,5,8,9 

Future research should address these limitations by improving engagement with each component of multidomain interventions. For example, low participation rates in cognitive training suggest that increased involvement could lead to more significant cognitive improvements. Additionally, gaining a deeper understanding of the mechanisms driving cognitive and emotional benefits will be crucial for optimizing these interventions. Examining how physical activity, nutrition, and cognitive training interact can help develop more effective treatments and potentially improve long-term outcomes. Large-scale, longitudinal studies with diverse populations are necessary to assess the sustainability, generalizability, and clinical applicability of these interventions.^4,10 

Conclusion 

Multidomain interventions that combine cognitive training, physical activity, and lifestyle modifications hold significant promise for improving cognitive function and preventing dementia. These comprehensive approaches address the multifactorial nature of cognitive decline, targeting both the brain's structural integrity and the broader factors that contribute to cognitive health, such as physical fitness, nutrition, and mental stimulation. The studies reviewed here provide strong evidence that such interventions can slow the progression of conditions like MCI and early AD. However, despite promising findings, several challenges remain. The variability in intervention outcomes, the difficulty in maintaining long-term commitment to treatment, and the need for larger, more diverse study populations must be addressed to strengthen the evidence base. As the global aging population continues to grow, the urgency of finding effective strategies to prevent cognitive decline increases. Continued research should focus on refining multidomain interventions, improving accessibility and adherence, and identifying the most effective combination of lifestyle factors for optimizing brain health. By addressing these challenges, non-pharmacological interventions may become a cornerstone in dementia prevention and cognitive health maintenance in aging populations.

About the Author: Layla C Semaan

Layla Semaan is a Biomedical Engineering major with a minor in Computational Biology, (Class of 2026). She wrote this paper because Alzheimer’s disease holds deep personal significance and she is motivated to explore ways to prevent or mitigate its progression. She hopes to raise awareness about small, actionable lifestyle changes that may help reduce the risk of cognitive decline. After graduating, Layla plans to pursue a Ph.D. in neuroscience with a focus on neurodegenerative diseases. She currently conducts cancer research in a cellular and tissue engineering lab and spent the summer at the University of Rochester studying Batten disease, a rare neurodegenerative condition affecting children. In addition to her research, Layla serves as the Service Vice President of the UC Davis Prytanean Women’s Honor Society, where she coordinates and actively participates in volunteer events for more than 80 active members.

References

1. Alzheimer’s Association. Mild Cognitive Impairment (MCI). Accessed February 24, 2025. Available from: https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/mild-cognitive-impairment

2. Livingston G et al. 2020. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet [Internet]. 396(10248):413–446. doi: 10.1016/S0140-6736(20)30367-6.

3. Jones A, Ali MU, Kenny M, Mayhew A, Mokashi V, He H, Lin S, Yavari E, Paik K, Subramanian D, et al. 2024. Potentially Modifiable Risk Factors for Dementia and Mild Cognitive Impairment: An Umbrella Review and Meta-Analysis [Internet]. Dement Geriatr Cogn Disord. 53(2):91–106. doi: 10.1159/000536643.

4. Sandison H, Callan NGL, Rao RV, Phipps J, Bradley R. 2023. Observed Improvement in Cognition During a Personalized Lifestyle Intervention in People with Cognitive Decline. J Alzheimers Dis. 94(3):993–1004. doi: 10.3233/JAD-230004.

5. Krause-Sorio B, Siddarth P, Kilpatrick L, Milillo MM, Aguilar-Faustino Y, Ercoli L, Narr KL, Khalsa DS, Lavretsky H. 2022. Yoga Prevents Gray Matter Atrophy in Women at Risk for Alzheimer’s Disease: A Randomized Controlled Trial. J Alzheimers Dis. 87(2):569–581. doi: 10.3233/JAD-215563.

6. Ornish D, Madison C, Kivipelto M, Kemp C, McCulloch CE, Galasko D, Artz J, Rentz D, Lin J, Norman K, 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. Alzheimers Res Ther. 16(1):122. doi: 10.1186/s13195-024-01482-z.

7. Chatzikostopoulos T, Gialaouzidis M, Koutoupa A, Tsolaki M. 2024. The Effects of Pomegranate Seed Oil on Mild Cognitive Impairment. J Alzheimers Dis. 97(4):1961–1970. doi: 10.3233/JAD-231100.

8. Gozdas E, Avelar-Pereira B, Fingerhut H, Dacorro L, Jo B, Williams L, O’Hara R, Hosseini SMH. 2024. Long-term cognitive training enhances fluid cognition and brain connectivity in individuals with MCI. Transl Psychiatry. 14(1):1–9. doi: 10.1038/s41398-024-03153-x.

9. Yan Y, Huang C, Lin R, Chen M, Wang Y, Xu Y, Chao Y, Zhang C, Sun W, Wang N, et al. 2024. Effects of a nurse-led staged integral art-based cognitive intervention for older adults on the Alzheimer’s disease spectrum: A randomized controlled trial. Int J Nurs Stud. 160:104902. doi: 10.1016/j.ijnurstu.2024.104902.

10. Kim D. 2020. The Effects of a Recollection-Based Occupational Therapy Program of Alzheimer’s Disease: A Randomized Controlled Trial. Occup Ther Int. 2020(1):6305727. doi: 10.1155/2020/6305727.