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Multidomain lifestyle interventions for the risk reduction of cognitive impairment and dementia: A systematic review and meta-analysis
Barbera M, Stephen R, Levälahti E, Lehtisalo J, Rosenberg A, Asher S, De Jager Loots CA, Kekkonen E et al.. medRxiv, 2026-07-15
Topic: Brain imaging, connectivity and assessment
Background Multidomain lifestyle interventions targeting multiple risk factors have been proposed to reduce cognitive impairment and dementia risk. However, mixed findings hamper their application. More evidence is needed to optimise approaches in different settings. The increasing number of clinical trials being conducted warrants an up-to-date synthesis. Methods We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) testing multidomain interventions (three or more components) on cognition or dementia incidence. Maximum-likelihood random-effect models were applied. Sensitivity analyses were conducted to explore source of heterogeneity. Meta-regression analyses were conducted, including by intervention duration and intensity. Risk of bias on cognition was assessed using the revised Cochrane risk-of-bias tool for RCTs (RoB-2). Heterogeneity was estimated using Chi² test, I² statistics, and 95% prediction intervals. GRADE was used for evidence certainty assessment. Results After screening 4,759 and full-text reading 128 publications, 43 RCTs were eligible and 41 included in the meta-analysis (N=23,209). Risk of bias was generally “low”, with most concerns in older studies. Small but statistically significant intervention benefits were found for global cognition (composite score of validated neuropsychological tests; SMD=0·28; 95% CI: 0·10 to 0·45), and most of the other cognitive measures. High heterogeneity was observed for global cognition composite scores and could be only partially explained by three smaller RCTs. Intervention effect-size was significantly associated with shorter duration (P-value=0.009) and higher observed intensity (P-value=0.008). Interpretation Multidomain interventions have small but consistent beneficial effects on cognitive measures, suggesting the potential to reduce cognitive impairment and dementia risk. High heterogeneity across RCTs can hinder data pooling. More evidence on longer-term effect is needed. Future research should prioritise harmonisation of methodologies and reporting, long-term extended follow-up data, clinically relevant dementia-risk surrogate outcomes, and evidence from more diverse cultural, geographical, and socio-economic contexts.
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APA 7th
Barbera, M., Stephen, R., Levälahti, E., Lehtisalo, J., Rosenberg, A., Asher, S., et al. (2026). Multidomain lifestyle interventions for the risk reduction of cognitive impairment and dementia: A systematic review and meta-analysis. medRxiv. https://doi.org/10.64898/2026.07.12.26357861
Vancouver
Barbera M, Stephen R, Levälahti E, Lehtisalo J, Rosenberg A, Asher S, et al. Multidomain lifestyle interventions for the risk reduction of cognitive impairment and dementia: A systematic review and meta-analysis. medRxiv. 2026. doi:10.64898/2026.07.12.26357861.
BibTeX
@article{barbera2026-d985936c,
author = {Barbera, M. and Stephen, R. and Levälahti, E. and Lehtisalo, J. and Rosenberg, A. and Asher, S. and De Jager Loots, C. A. and Kekkonen, E. and others},
title = {{Multidomain lifestyle interventions for the risk reduction of cognitive impairment and dementia: A systematic review and meta-analysis}},
journal = {medRxiv},
year = {2026},
doi = {10.64898/2026.07.12.26357861},
url = {https://doi.org/10.64898/2026.07.12.26357861}
}
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Key findings
- Results After screening 4,759 and full-text reading 128 publications, 43 RCTs were eligible and 41 included in the meta-analysis (N=23,209).
- Small but statistically significant intervention benefits were found for global cognition (composite score of validated neuropsychological tests; SMD=0·28; 95% CI: 0·10 to 0·45), and most of the other cognitive measures.
- Intervention effect-size was significantly associated with shorter duration (P-value=0.009) and higher observed intensity (P-value=0.008).
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Study details
- Study designsystematic review
- Participants23,209
- Evidence strengthHigh
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 58 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for effect reported because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 36 of the 62 points we could judge it on, which is 58 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 4 / 4 | 23,209 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 36 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 36 of the 62 points we could judge it on is 58 out of 100. |
| Total | 58 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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