Association of nonpharmacological interventions for cognitive function in older adults with mild cognitive impairment: a systematic review and network meta-analysis

Background Understanding the effectiveness of nonpharmacological interventions to improve cognitive function in older adults with MCI and identifying the best intervention may help inform ideas for future RCT studies and clinical decision-making.Aim The main focus of this study was to assess the comparative effectiveness of nonpharmacological interventions on cognitive function in older adults with MCI and to rank the interventions.Methods RCT studies until September 2022 were searched from six databases, including PubMed, the Cochrane Library, Embase, Web of Science, PsycINFO and CINAHL. The risk of bias in eligible trials was evaluated using the Cochrane Risk of Bias tool. Both pairwise and network meta-analyses were used, and pooled effect sizes were reported using SMD and the corresponding 95% confidence intervals.Results A total of 28 RCT studies were included in this study, pooling 18 categories of nonpharmacological interventions. MBE (mind-body exercise) (SMD (standard mean difference): 0.24, 95% CI: 0.08-0.41, P= 0.004), DTE (dual-task exer-cise) (SMD: 0.61, 95% CI: 0.09-1.13, P= 0.02), PE (physical exercise) (SMD: 0.58, 95% CI: 0.04-1.12, P = 0.03) may be effective in improving cognitive function in older adults with MCI. Acupressure + CT (cognitive training) was the top-ranked intervention among all interventions. No greater benefits of MA (mindful awareness) on cognitive function were found.Conclusions Overall, nonpharmacological interventions significantly improved cognitive function in older adults with MCI. Acupressure + CT(cognitive training) was the most effective intervention for managing cognitive impairment. Future studies with high quality and large sample size RCT studies are needed to confirm our results.