The effect of the Mediterranean diet combined with physical activity on cognitive function in older adults: a scoping review

BACKGROUND: Cognitive impairment and dementia are rapidly increasing among older adults, with limited pharmacological treatments available. Modifiable lifestyle factors, particularly diet and physical activity, are promising preventive targets. Although the Mediterranean diet and regular exercise individually benefit cognition, their combined effects and underlying mechanisms remain poorly synthesised. METHODS: The systematic review followed PRISMA-ScR guidelines and involved database searches on PubMed, Embase, Web of Science, Cochrane, and CNKI. Study inclusion criteria were defined using the PICO framework. RESULTS: The Mediterranean diet supplies polyphenols and fatty acids that reduce oxidative stress and inflammation, and support neurotrophic and neuroendocrine functions, thus protecting the brain. Meanwhile, physical activity boosts cerebral blood flow, improving antioxidant delivery and stimulating neurotrophic factors like BDNF, IGF-1, and VEGF to enhance brain plasticity. Together, these approaches act synergistically to balance energy metabolism, lower inflammation, and activate antioxidant defenses, thereby preserving brain homeostasis and boosting cognitive function. CONCLUSIONS: Evidence suggests a synergistic effect of the Mediterranean diet and physical activity in preserving cognitive function in older adults. The diet directly supports cognitive health and provides essential nutrients for exercise-induced neuroregeneration. Physical activity, in turn, increases cerebral blood flow, improving nutrient delivery and stimulating neurotransmitter release. This interaction enhances brain plasticity, establishing a virtuous cycle between nutrition, exercise, and cognitive health.