Rewiring the Aging Brain: A Meta-Analytic Comparison of Mind–Body and Expressive Therapies for Cognitive Enhancement in Older Adults

BackgroundAge-related cognitive decline and mild cognitive impairment (MCI) are major public health concerns, while pharmacological treatments offer limited benefit. Mind-body and expressive therapies have emerged as scalable non-pharmacological alternatives, yet their comparative cognitive effects remain unclear.ObjectiveTo evaluate and compare the effects of mind-body and expressive interventions on global cognition and domain-specific outcomes in adults aged 60 years and older.MethodsFollowing PRISMA 2020 guidelines, randomized controlled trials were identified from seven databases from inception to April 2025. Random-effects meta-analyses were conducted across 71 trials (6,754 participants). Certainty of evidence was assessed using the GRADE framework.ResultsInterventions produced a moderate improvement in global cognition (d = 0.61), with strongest effects in individuals with MCI. Smaller benefits were observed for cognitive flexibility and processing speed, while language and working memory effects were inconsistent. Evidence certainty was moderate for global cognition and lower for domain-specific outcomes.PROSPERO registrationCRD420251110463.