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Area All 382 Care, carers and services 140 Medicines 85 Genes (not modifiable) 35 All modifiable factors together 27 Diet and supplements 23 Exercise and activity 21 Sleep, mood and social life 19 Hearing and vision 8 Alcohol, tobacco and cannabis 6 Infection and vaccination 5 Heart and metabolic health 4 Injury, delirium and falls 4 Environment 3 Cognitive activity 2

Question Both Prevention 190 Treatment 192

Direction Any Benefit 144 Harm 105 No effect 38 Mixed 37 No direction reported 58

Design Any meta-analysis 57 randomised trial 44 phase 3 trial 15 systematic review 9 phase 2 trial 10 cohort study 136 phase 1 trial 2 cross-sectional study 31 case-control study 14 modelling study 20 regulatory decision 7 company announcement 1 coverage determination 1 None 35

Showing 19 of 382 rows. One row per study per exposure: a study that tested two different things appears twice, once for each.

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Research and outcomes, 19 rows. Every row links to its source.
Exposure	Question	Direction	Outcome measured	Design	People	Effect size, as the source reported it	Source
Cost-effectiveness of multidomain prevention programme Care, carers and services	Prevention	Mixed why Direction is for value for money: APPLE-Tree had a 96% probability of being cost-effective per cognition point at a £30 000 threshold but only 12% on QALYs, which were slightly lower in the intervention arm. Post hoc subgroups suggested better value in non-White and socioeconomically disadvantaged participants.	QALYs over 24 months (primary) and cost per 1-point NTB cognition gain	randomised trial	746	Mean adjusted QALYs were 1.511 (intervention) and 1.520 (control), an adjusted difference of -0.010 (95%CI -0.04 to -0.022). Mean adjusted (SD) costs were £2966 (3629) and £2551 (4439), respectively. Cost per 1-point NTB change z-score was £6809. At a £30 000 threshold, the probability of cost-effective was 12% and 96% based on QALYs and cognition, respectively	Age and ageing 2026 ✓ Peer-reviewed PMID 42328805
Cognitive training Cognitive activity	Prevention	No effect why Neither the combined package nor risk-factor modification beat health advice.	ADAS-Cog z-score at 15 months	randomised trial	456	ADAS-Cog z-score difference vs health advice: -0.04 (95% CI -0.34 to 0.26) for combined package	The Lancet Healthy Longevity 2025 ✓ Peer-reviewed PMID 40294622
Dietary pattern (general) Diet and supplements	Prevention	No effect why The control arm also received diet counselling and mild caloric restriction, so this is MIND against another active diet, not against usual eating. It is the only randomised test of the MIND diet here and it disagrees with the cohort evidence.	Global cognition at 3 years	randomised trial	604	Global cognition mean difference 0.035 standardised units (95% CI -0.022 to 0.092; P=0.23)	New England Journal of Medicine 2023 ✓ Peer-reviewed PMID 37466280
Dietary pattern (general) Diet and supplements	Prevention	Benefit why Controls declined while the olive-oil arm held steady; the nut arm fell between the two. Cognitive follow-up was available for 334 of 447 enrolled.	Global cognition composite at median 4.1 years	randomised trial	447	Global cognition composite: +0.05 (95% CI -0.11 to 0.21) olive-oil arm vs -0.38 (-0.57 to -0.18) control; P=0.005	JAMA Internal Medicine 2015 ✓ Peer-reviewed PMID 25961184
MIND diet Diet and supplements	Prevention	No effect why The control arm also received diet counselling and mild caloric restriction, so this is MIND against another active diet, not against usual eating. It is the only randomised test of the MIND diet here and it disagrees with the cohort evidence.	Global cognition at 3 years	randomised trial	604	Global cognition mean difference 0.035 standardised units (95% CI -0.022 to 0.092; P=0.23)	New England Journal of Medicine 2023 ✓ Peer-reviewed PMID 37466280
Mediterranean diet Diet and supplements	Prevention	Benefit why Controls declined while the olive-oil arm held steady; the nut arm fell between the two. Cognitive follow-up was available for 334 of 447 enrolled.	Global cognition composite at median 4.1 years	randomised trial	447	Global cognition composite: +0.05 (95% CI -0.11 to 0.21) olive-oil arm vs -0.38 (-0.57 to -0.18) control; P=0.005	JAMA Internal Medicine 2015 ✓ Peer-reviewed PMID 25961184
Multidomain lifestyle intervention Exercise and activity	Prevention	Benefit why Compared with flexible health advice, not with nothing; both groups improved.	Global cognitive composite (SD per year) over 2 years	randomised trial	1,065	Between-group difference in global cognitive composite 0.11 SD per year (95% CI 0.06-0.15)	The Lancet 2026 ✓ Peer-reviewed PMID 42442374
Multidomain lifestyle intervention Exercise and activity	Prevention	No effect why The intervention did not change any brain biomarker trajectory. Participants with lower baseline hippocampal volume did show a greater cognitive benefit.	Amyloid, tau, hippocampal volume and white matter trajectories	randomised trial	983	Cognitive benefit of structured vs self-guided: 0.077 SD (95% CI 0.022-0.132) with lower hippocampal volume vs 0.002 SD (95% CI -0.037 to 0.041) with higher	JAMA Neurology 2026 ✓ Peer-reviewed PMID 42008251
Multidomain lifestyle intervention Exercise and activity	Prevention	Benefit why Both groups improved; the structured programme improved more. The trial compares two active interventions, so there is no untreated comparison.	Global cognition (SD per year) over 2 years	randomised trial	2,111	Structured 0.243 SD/year vs. self-guided 0.213 SD/year; difference 0.029 SD/year	JAMA 2025 ✓ Peer-reviewed PMID 40720610
Multidomain lifestyle intervention Exercise and activity	Prevention	No effect why A small improvement that did not reach significance (adjusted difference 0.06, 95% CI -0.001 to 0.128, p=0.055).	Neuropsychological Test Battery at 24 months	randomised trial	746	Adjusted mean difference in NTB score at 24 months 0.06 (95% CI -0.001 to 0.128, p=0.055)	The Lancet Healthy Longevity 2025 ✓ Peer-reviewed PMID 41130254
Multidomain lifestyle intervention Exercise and activity	Prevention	Benefit	Neuropsychological test battery Z-score at 2 years	randomised trial	1,260	NTB Z-score change 0.20 (intervention) vs. 0.16 (control); annual between-group difference 0.022	The Lancet 2015 ✓ Peer-reviewed PMID 25771249
Physical activity (general / dose) Exercise and activity	Prevention	No effect why Neither the combined package nor risk-factor modification beat health advice.	ADAS-Cog z-score at 15 months	randomised trial	456	ADAS-Cog z-score difference vs health advice: -0.04 (95% CI -0.34 to 0.26) for combined package	The Lancet Healthy Longevity 2025 ✓ Peer-reviewed PMID 40294622
Resistance training Exercise and activity	Prevention	No effect why The primary outcome did not move between groups. Attention and inhibitory control did improve (SMD 0.43), as did muscular strength.	Executive function at 24 weeks (primary)	randomised trial	90	Between-group executive function SMD 0.13 (P=0.37); attention/inhibitory control SMD 0.43 (P<0.001)	Alzheimer's & Dementia 2026 ✓ Peer-reviewed PMID 41562376
Resistance training Exercise and activity	Prevention	Benefit why The authors call the effect small (-0.18 points). Significant in women, not in men, on 91 randomised and 76 completing.	ADAS-Cog-Plus at 12 months	randomised trial	91	ADAS-Cog-Plus mean difference -0.18 (95% CI -0.35 to -0.01; P=0.04)	Alzheimer's & Dementia 2026 ✓ Peer-reviewed PMID 41795685
Polygenic risk / GWAS loci Genes (not modifiable)	Prevention	Mixed why The intervention-control cognitive difference was statistically significant in the higher-genetic-risk halves and not in the lower halves, but neither genetic score significantly modified the intervention effect overall (P > 0.46); an exploratory sex difference emerged for the Alzheimer score.	Annual change in overall cognition (modified NTB) with a 2-year multidomain lifestyle intervention, by Alzheimer and coronary genetic risk score	randomised trial	1,177	The intervention-control difference in annual overall cognition change (95% confidence interval) for participants with AD-GRS above/below the median (i.e. higher/lower risk) was 0.032 (0.002-0.063) versus 0.017 (-0.011 to 0.045), and for CAD-GRS above/below the median was 0.031 (0.002 to 0.059) versus 0.016 (-0.012 to 0.044). AD-GRS or CAD-GRS were not significantly related to the intervention effect overall (P > 0.46), but for AD-GRS there were differences between females and males (P = 0.024)	Brain : a journal of neurology 2026 ✓ Peer-reviewed PMID 40747850
Hearing loss / hearing aids Hearing and vision	Prevention	No effect why Null in the primary analysis of the whole cohort. The prespecified analysis of the higher-risk ARIC subgroup found less decline, which the authors present as hypothesis-generating rather than as a result.	3-year global cognition (primary analysis)	randomised trial	977	Primary analysis: "3-year cognitive change (in SD units) was not significantly different between HI and SA control (HI: -0.200 [95% CI: -0.256, 0.144]; SA: -0.202 [95% CI: -0.258, -0.145]; Difference 0.002 [95% CI: -0.077, 0.081], p=0.96)." ARIC subgroup: "HI was associated with a 48% reduction in 3-year cognitive change compared to SA control (Difference 0.191 [95% CI: 0.022, 0.360], p=0.027)."	The Lancet 2023 ✓ Peer-reviewed PMID 37478886
Antihypertensives / BP lowering Medicines	Prevention	Benefit why Significant for MCI and for the MCI-or-dementia composite; not significant for probable dementia alone (HR 0.86, 95% CI 0.72-1.02).	MCI and probable dementia over median 7 years	randomised trial	9,361	Probable dementia: 8.5 vs. 10.2 per 1,000 person-years (HR 0.86, 95% CI 0.72-1.02); MCI: HR 0.87 (95% CI 0.76-1.00); composite MCI-or-dementia: HR 0.89 (95% CI 0.79-0.99)	Neurology 2025 ✓ Peer-reviewed PMID 39819096
Antihypertensives / BP lowering Medicines	Prevention	Benefit why A large drop in blood pressure (22/9 mmHg) and fewer serious adverse events in the intervention villages.	All-cause dementia over 48 months	randomised trial	33,995	All-cause dementia RR 0.85 (95% CI 0.76-0.95)	Nature Medicine 2025 ✓ Peer-reviewed PMID 40258956
Sleep Sleep, mood and social life	Prevention	Benefit why Direction is for normal sleep versus sleep deprivation, on a clearance measure — not on cognition, which this trial did not measure.	Overnight brain-to-plasma clearance of amyloid-beta and tau	randomised trial	39	Additional variance explained by the physiological predictor model in the sleep condition: "between 49.1% (Abeta40) to 56.0% (Abeta42)" in amyloid-positive participants and "between 71.3% (p-tau181) to 97.8% (Abeta40)" in amyloid-negative participants	Nature Communications 2026 ✓ Peer-reviewed PMID 41593094

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