Comparative efficacy of various non-pharmacological therapies on cognitive function in patients with mild cognitive impairment or dementia

Background: Evidence directly comparing the cognitive improvement effects of non-pharmacological therapies in patients with mild cognitive impairment or dementia is limited. Our objective was to evaluate the efficacy of various non-pharmacological therapies on cognitive function through a network meta-analysis. Methods: PubMed, Embase, Cochrane Library, China Biology Medicine Database, China National Knowledge Infrastructure, Wanfang Database, and Web of Science were searched from database inception until October 2025. Two researchers independently screened studies, extracted data, and assessed bias risk. Results: Twenty-four randomized controlled trials (2082 patients) compared multidomain intervention (MI), music therapy (MT), cognitive rehabilitation (CR), physical exercise (PE), cognitive training (CT), and health education (HE). For Mini-Mental State Examination scores, CT (standardized mean difference [SMD] = 1.43, 95% confidence interval [CI] = 0.20–2.65) and HE (SMD = 2.02, 95% CI = 0.05–4.00) showed statistically significant improvements versus control ( P < .05). Exploratory P-score ranking yielded values of 0.26 (MI), 0.39 (MT), 0.49 (CR), 0.59 (PE), 0.73 (CT), and 0.86 (HE), suggesting HE and CT may carry higher efficacy probability within this network. Regarding the Montreal Cognitive Assessment scores, PE (SMD = 2.26, 95% CI = 0.95–3.57), HE (SMD = 2.43, 95% CI = 0.43–4.43), and CT (SMD = 2.96, 95% CI = 1.57–4.35) showed statistically significant improvements compared to the control group ( P < .05). Exploratory P-score ranking gave values of 0.07 (MI), 0.46 (MT), 0.69 (PE), 0.73 (HE), and 0.89 (CT), indicating CT had the highest preliminary ranking probability. Conclusion: The results of this study indicate that PE, CT, and HE show good potential for improving cognitive function, but the screening results of different assessment tools show a certain degree of variability. MT, CR, and MI did not show significant efficacy. More randomized controlled trials may need to be included in the future.