Real-World Cognitive Stabilization via CDSS-Guided MultidomainInterventions in MCI and Older Adults with Cognitive Concerns

Introduction: Randomized multidomain trials have established that cognitive decline requires coordinated action across modifiable contributors, but routine care lacks delivery infrastructure. We evaluated real-world cognitive trajectories in older adults receiving uMETHOD Health clinical decision support system (CDSS)-guided care plans and assessed whether this multidomain approach could be operationalized in routine care. Methods: This retrospective, nonrandomized implementation-and-outcomes study analyzed the complete eligible paired cohort: individuals with CDSS-guided care plans and two valid sameinstrument cognitive assessments ≥6 months apart. No additional selection was made by outcome, adherence, or trajectory. The CDSS integrates EHR-derived diagnoses, medications, biomarkers, vital signs, genomics, and lifestyle factors through expert clinical rules with constrained AI support to generate individualized clinician-, patient-, and caregiver-facing plans. Results: Favorable cognitive trajectories were observed in 294 of 345 matched assessment pairs (85.2%) over a mean follow-up of 14.1 months. Assessments used seven validated instruments; mean age was 74.6 years, and baseline medication use was 11.7 medications/patient. Favorable trajectories included 83.5% stable, improved, or minor decline without diagnostic progression and 1.7% slower-than-expected decline on benchmarked instruments (MoCA, MMSE, or SAGE). Discussion: The CDSS served as an implementation layer, translating multidomain evidence into prioritized, patient-specific next-best actions within ordinary clinical workflows. This positions multidomain cognitive management as a scalable, routine-care activity rather than a researchonly protocol. Conclusion: Multidomain cognitive management was made executable in routine practice, with favorable trajectories observed in 85.2% of paired assessments. The practical implication is immediate: evidence-based cognitive management can be operationalized now at the point of care.