Abstract
Background
This study aimed to evaluate whether a multi-modal training that combined Baduanjin, computerized cognitive training, and reminiscence therapy is associated with improved cognitive function in older adults with mild cognitive impairment (MCI) in a pilot randomized controlled trial.
Material/Methods
Sixty-five patients with MCI were randomly assigned into an intervention group (a 24-week multi-modal training) and a control group (health education). Cognitive function was assessed at baseline, week 12, and week 24 using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). A repeated-measures ANOVA was conducted across 3 time points to examine the group effects, time effects, and interactions.
Results
Significant group × time interactions were observed for MMSE and MoCA (both P < 0.001). At 24 weeks, the intervention group showed greater improvement than the control group in MMSE score, with a between-group difference of 1.88 points (P < 0.001), and in MoCA score, with a between-group difference of 1.62 points (P < 0.001). Exploratory MoCA subdomain analyses suggested possible domain-specific benefits in the intervention group, with nominal declines in naming, memory, and attention in controls.
Conclusions
This pilot randomized controlled trial provides preliminary evidence that a 24-week multi-modal program combining Baduanjin, computerized cognitive training, and reminiscence therapy was associated with improved global cognitive performance in community-dwelling older adults with MCI compared with health education alone. Given the pilot nature of the study and the modest between-group differences, these findings should be interpreted with caution and confirmed in larger, adequately powered trials.
Registration
https://www.chictr.org.cn; Unique Identifier: ChiCTR2500104935.
Keywords: Cognition, Rehabilitation, Aged
Introduction
Mild cognitive impairment (MCI), a transitional stage between normal cognition and dementia, is characterized by measurable cognitive decline that does not substantially interfere with independence in activities of daily living [1]. Globally, the prevalence of MCI among adults aged 60 years and older ranges from 6.7% to 25.2% [2], and estimates in China suggest a prevalence of 14.7% to 20.8% among older adults [3,4]. Approximately 50% of individuals with MCI may progress to Alzheimer dementia within 5 years [5]. Given its high prevalence and risk of progression, MCI is a major public health challenge, and effective strategies to delay or prevent conversion to dementia are needed.
At present, no effective pharmacological therapies have been established to reliably reverse MCI or prevent progression to dementia [6]. Accordingly, interest in non-pharmacological interventions for MCI has increased. Previous evidence from multidomain intervention studies, such as the FINGER trial, supports the potential of combined lifestyle modification, cognitive training, physical activity, and vascular risk management strategies for maintaining cognitive function in at-risk older adults [7]. Computerized cognitive training is a safe and cost-effective approach that improves cognitive performance through repeated, guided practice on standardized tasks designed to engaged cognitive domains [8]. Baduanjin, a traditional Chinese mind-body exercise, may improve cognition by modulating brain structure and neural activity and by enhancing cerebral perfusion [9–11]. Reminiscence therapy is a group-based psychosocial intervention in which participants share autobiographical experiences to evoke memories, stimulate cognitive activity, and enhance well-being, and several studies suggest cognitive benefits in older adults with MCI [12,13].
However, previous studies have generally evaluated these interventions separately or as part of broader multi-domain programs, and evidence remains limited regarding a structured intervention that deliberately integrates cognitive stimulation, mind-body exercise, and psychosocial engagement. In addition, the optimal sequencing, frequency, and duration of these components remain unclear [14–18]. Therefore, we designed a tri-modal intervention that combined domain-specific computerized cognitive training, standardized Baduanjin, and structured reminiscence therapy delivered in a prespecified sequence and frequency. We hypothesized that this 24-week multi-modal intervention would lead to greater improvements in global cognitive function than health education alone among community-dwelling older adults with MCI. Accordingly, this pilot randomized controlled trial aimed to evaluate the preliminary cognitive effects of this intervention in this population.
Material and Methods
Study Participants
A total of 800 older adults from 7 neighborhoods in Wuxing District of Huzhou were selected for cognitive function screening. The inclusion criteria were as following: (1) age 60 years or older; (2) community residency of 1 year or longer; (3) ability to communicate and complete assessments; and (4) meeting the criteria of MCI as defined in the 2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment. The exclusion criteria were as following: (1) severe sensory impairments; (2) major psychiatric disorders; (3) acute physical illnesses, such as stroke; (4) use of cholinesterase inhibitors or medications affecting motor function; and (5) inability to complete follow-up.
Finally, 65 eligible patients with MCI were enrolled in this single-blind, randomized controlled pilot trial. The study was conducted within the scope of a broader ethics-approved project entitled “Cross sectional study on MCI in the older adults of urban Huzhou and the efficacy of non-pharmacological comprehensive intervention”, which aimed to investigate MCI among older adults in urban Huzhou and to evaluate non-pharmacological interventions in this population. The project was approved by the Ethics Committee of Huzhou Third Municipal Hospital in China on January 20, 2022 (approval number: 2021-162). The present manuscript reports the randomized pilot intervention component of this broader project. The trial was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR; registration number: ChiCTR2500104935) on April 18, 2025, after enrollment of the first participant on March 1, 2022. The participant population, intervention, control, and outcomes reported in the present manuscript were within the scope of the ethics committee–approved project and the registered trial record. Written informed consent was obtained from all participants prior to their enrollment or, when applicable, from their immediate family members.
Institutional Review Board Statement
The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the institutional review boards at Huzhou Third Municipal Hospital in China (approval number: 2021-162).
Informed Consent Statement
Written consent was obtained from all study participants or their immediate family members.
Sample Size Calculation
The sample size was calculated a priori using PASS 2021 software with the module for testing 2 means in a repeated-measures design. This randomized controlled pilot trial included 2 groups and 3 repeated measurements. The significance level was set at α = 0.05, 2-sided, and the statistical power was set at 1−β = 0.90. Based on preliminary data, the expected between-group difference in Montreal Cognitive Assessment (MoCA) score was set at 3.0, with a common standard deviation of 4.3. The correlation coefficient among repeated measurements was conservatively assumed to be 0.5, and a compound symmetry covariance structure was used.
The calculation indicated that 29 participants were required in each group, for a total of 58 participants. Considering an anticipated attrition rate of 10%, the minimum required sample size was increased to 32 participants per group, resulting in a total required sample size of 64 participants. The final sample size of 65 participants met this requirement.
Randomization
Participants were randomly assigned (1: 1) to the intervention or control group using a computer-generated sequence via SPSS, with allocation concealed in sequentially numbered, opaque, sealed envelopes (Figure 1). Given the nature of the intervention, participants were not blinded to group assignment. However, outcome assessors (trained neurologists) were blinded throughout the study to minimize assessment bias.
Figure 1.
Flowchart of the study.
Intervention
The intervention group received a 24-week multi-modal program consisting of Baduanjin, computerized cognitive training, and reminiscence therapy. Baduanjin consisted of 60-minute sessions (15-min warm-up, 40-min exercise, 5-min cool-down) conducted 5 times weekly, following the national “Fitness Qigong·Baduanjin” standard. For computerized cognitive training, 30-minute sessions were conducted 5 times weekly using the “Cognitive Impairment Rehabilitation Software V1.0” (Hunan Aizer Medical Technology Co, Ltd), targeting memory, attention, executive function, language, and other domains. Training plans were personalized and adjusted under psychiatrist supervision. In reminiscence therapy, 60-minute group sessions were conducted once weekly, focusing on themes such as childhood memories, festivals, and personal milestones, which were aided by photos, music, and objects.
The control group received general health education sessions without structured cognitive, physical, or psychosocial training.
Outcome Measures
The primary outcome was cognitive function and were assessed by trained neurologists using the Mini-Mental State Examination (MMSE) and the MoCA at baseline and at the 12-week and 24-week follow-up. The MMSE consists of 20 items designed to assess cognitive performance across several domains, including orientation, registration, attention and calculation, recall, language, and visual construction [19]. The MoCA is a 30-item assessment that tests 7 cognitive domains: visuospatial and executive functions, naming, memory, attention, language, abstraction, and orientation [20].
Statistical Analysis
Baseline continuous variables with normal distribution were expressed as mean ± standard deviation. The independent samples t test was used to compare the differences between the 2 groups. Categorical variables were presented as frequencies and percentages, and the chi-square test was performed to assess for differences between the 2 groups. A repeated-measures ANOVA was conducted across 3 time points (baseline, 12 weeks, 24 weeks) to examine group effects, time effects, and the interaction (group × time) on the cognitive outcomes, including MMSE and total MoCA scores. Mauchly’s test indicated that the sphericity assumption was violated. Therefore, Greenhouse-Geisser corrections were applied. Effect sizes for repeated-measures ANOVA were reported as partial eta squared (ηp2). Pairwise comparisons were performed to explore between-group differences and within-group changes across time points. These post hoc comparisons were exploratory. Therefore, no formal adjustment for multiple testing was applied. In addition, MoCA subdomain scores were analyzed as exploratory outcomes using simple-effects analyses to describe domain-specific within-group changes and between-group differences across time points. The P values from these subdomain analyses were considered nominal because no adjustment for multiple comparisons was applied. All randomized participants completed the follow-up assessments and had complete outcome data. Therefore, no imputation procedure was required, and all randomized participants were included in the final analysis according to their originally assigned groups. All statistical analyses were performed using SPSS software, with 2-sided tests and a significance level set at 0.05.
Results
Study Participants
Figure 1 (CONSORT flowchart) illustrates participant flow. A total of 65 eligible participants with MCI were randomized, including 33 participants in the intervention group and 32 participants in the control group. Participant adherence to the intervention was monitored throughout the study period. All enrolled participants completed the assigned intervention and the scheduled repeated assessments according to the study protocol. No participants withdrew from the intervention, and no participants were lost to follow-up. Therefore, all 65 randomized participants were included in the final analysis. Baseline characteristics were balanced between groups (Table 1). Both groups had comparable MMSE and MoCA scores at baseline (all P > 0.05).
Table 1.
Baseline characteristics of study participants.
| Intervention (n = 33) | Control (n = 32) | P value | |
|---|---|---|---|
| Age, years | 72.30 ± 5.02 | 71.38 ± 5.25 | 0.47 |
| Sex, n (%) | |||
| Male | 13 (39.39) | 12 (40.63) | 0.88 |
| Female | 20 (60.61) | 20 (59.37) | |
| Educational level, n (%) | |||
| Illiterate | 4 (12.12) | 13 (40.63) | 0.07 |
| Primary school | 18 (54.55) | 12 (37.5) | |
| Middle school | 9 (27.27) | 5 (15.62) | |
| High school and above | 2 (6.06) | 2 (6.25) |
Effect of Multi-Modal Training on Cognitive Function
As shown in Table 2, the intervention group showed improvements in both MMSE and MoCA scores over 24 weeks, whereas the control group showed slight declines. At week 24, the unadjusted between-group difference in change was +1.88 points for MMSE and +1.62 points for MoCA. Repeated-measures ANOVA demonstrated significant group-by-time interactions for both MMSE (F = 31.933, P < 0.001, ηp2 = 0.336) and MoCA (F = 99.906, P < 0.001, ηp2 = 0.613), indicating different trajectories of cognitive change between the 2 groups. Changes in MMSE and MoCA scores over time are further illustrated in Figure 2.
Table 2.
Longitudinal changes in Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores.
| Outcome | Time | Intervention (mean ± SD) | Control (mean ± SD) | Effect | F | P value | ηp2 |
|---|---|---|---|---|---|---|---|
| MMSE | Baseline | 19.82 ± 3.07 | 19.31 ± 3.56 | Group | 4.133 | 0.046 | 0.062 |
| Week 12 | 20.61 ± 3.22 | 19.28 ± 3.55 | Time | 6.027 | 0.007 | 0.087 | |
| Week 24 | 21.27 ± 3.38 | 18.88 ± 3.64 | Group × time | 31.933 | < 0.001 | 0.336 | |
| MoCA | Baseline | 17.30 ± 4.36 | 16.75 ± 3.82 | Group | 3.605 | 0.062 | 0.054 |
| Week 12 | 17.67 ± 4.24 | 16.63 ± 3.70 | Time | 16.199 | < 0.001 | 0.205 | |
| Week 24 | 18.36 ± 4.49 | 16.19 ± 3.69 | Group × time | 99.906 | < 0.001 | 0.613 |
Abbreviations: SD, standard deviation; ηp2, partial eta squared.
Figure 2.
Trajectories of global cognitive scores over time. (A) Mini-Mental State Examination (MMSE) scores and (B) Montreal Cognitive Assessment (MoCA) scores at baseline, week 12, and week 24 in the intervention and control groups. Data are shown as mean ± standard deviation.
Pairwise Comparisons and Exploratory MoCA Subdomain Analyses
As shown in Table 3, the intervention group had significantly higher MMSE and MoCA scores than the control group at week 24 (both P < 0.001), whereas no significant between-group differences were observed at week 12. Within-group analyses showed significant increases in MMSE and MoCA from baseline to week 24 in the intervention group (both P < 0.001), while significant decreases were observed in the control group over the same period (both P < 0.001) (Table 4).
Table 3.
Exploratory between-group comparisons of Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores.
| Outcome | Time point | Comparison | F | P value |
|---|---|---|---|---|
| MMSE | Baseline | Intervention vs control | 0.232 | 0.632 |
| Week 12 | Intervention vs control | 2.842 | 0.097 | |
| Week 24 | Intervention vs control | 13.728 | < 0.001 | |
| MoCA | Baseline | Intervention vs control | 0.052 | 0.821 |
| Week 12 | Intervention vs control | 0.886 | 0.350 | |
| Week 24 | Intervention vs control | 19.608 | < 0.001 |
Table 4.
Exploratory within-group comparisons of Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores.
| Outcome | Group | Comparison | F | P value |
|---|---|---|---|---|
| MMSE | Intervention | Week 12 vs baseline | 16.589 | < 0.001 |
| Week 24 vs baseline | 24.347 | < 0.001 | ||
| Control | Week 12 vs baseline | 1.000 | 0.325 | |
| Week 24 vs baseline | 32.319 | < 0.001 | ||
| MoCA | Intervention | Week 12 vs baseline | 7.918 | 0.008 |
| Week 24 vs baseline | 82.355 | < 0.001 | ||
| Control | Week 12 vs baseline | 5.013 | 0.032 | |
| Week 24 vs baseline | 39.118 | < 0.001 |
MoCA subdomains, exploratory simple-effects analyses using nominal P values suggested improvements in memory, attention, and language at both week 12 and week 24 in the intervention group, while visuospatial/executive function and naming improved only at week 24. In the control group, nominal declines from baseline to week 24 were observed in naming, memory, and attention (Tables 5, 6). These subdomain findings should be interpreted cautiously because the analyses were exploratory and were not adjusted for multiple comparisons. Therefore, they should be regarded as hypothesis-generating rather than confirmatory.
Table 5.
Exploratory simple-effect analyses of Montreal Cognitive Assessment (MoCA) subdomain scores.
| MoCA subdomain | Type of comparison | Comparison | F | P value |
|---|---|---|---|---|
| Visuospatial/executive | Between-group | Intervention vs control at baseline | 0.299 | 0.586 |
| Intervention vs control at week 12 | 0.033 | 0.856 | ||
| Intervention vs control at week 24 | 13.834 | < 0.001 | ||
| Within intervention group | Week 12 vs baseline | 2.065 | 0.160 | |
| Week 24 vs baseline | 43.230 | < 0.001 | ||
| Within control group | Week 12 vs baseline | 0.195 | 0.662 | |
| Week 24 vs baseline | 0.139 | 0.712 | ||
| Naming | Between-group | Intervention vs control at baseline | 1.440 | 0.235 |
| Intervention vs control at week 12 | 0.141 | 0.708 | ||
| Intervention vs control at week 24 | 12.065 | 0.001 | ||
| Within intervention group | Week 12 vs baseline | 1.000 | 0.325 | |
| Week 24 vs baseline | 9.191 | 0.005 | ||
| Within control group | Week 12 vs baseline | 2.067 | 0.161 | |
| Week 24 vs baseline | 10.448 | 0.003 | ||
| Memory | Between-group | Intervention vs control at baseline | 6.839 | 0.011 |
| Intervention vs control at week 12 | 0.129 | 0.721 | ||
| Intervention vs control at week 24 | 35.414 | < 0.001 | ||
| Within intervention group | Week 12 vs baseline | 23.579 | < 0.001 | |
| Week 24 vs baseline | 67.107 | < 0.001 | ||
| Within control group | Week 12 vs baseline | 5.741 | 0.023 | |
| Week 24 vs baseline | 17.714 | < 0.001 | ||
| Attention | Between-group | Intervention vs control at baseline | 0.033 | 0.856 |
| Intervention vs control at week 12 | 1.268 | 0.264 | ||
| Intervention vs control at week 24 | 6.403 | 0.014 | ||
| Within intervention group | Week 12 vs baseline | 4.414 | 0.044 | |
| Week 24 vs baseline | 5.485 | 0.026 | ||
| Within control group | Week 12 vs baseline | 3.894 | 0.057 | |
| Week 24 vs baseline | 12.130 | 0.002 | ||
| Language | Between-group | Intervention vs control at baseline | 0.000 | 1.000 |
| Intervention vs control at week 12 | 1.161 | 0.285 | ||
| Intervention vs control at week 24 | 1.287 | 0.261 | ||
| Within intervention group | Week 12 vs baseline | 4.414 | 0.044 | |
| Week 24 vs baseline | 4.414 | 0.044 | ||
| Within control group | Week 12 vs baseline | 1.000 | 0.325 | |
| Week 24 vs baseline | 1.000 | 0.325 | ||
| Abstraction | Between-group | Intervention vs control at baseline | 8.771 | 0.004 |
| Intervention vs control at week 12 | 4.401 | 0.040 | ||
| Intervention vs control at week 24 | 2.874 | 0.095 | ||
| Within intervention group | Week 12 vs baseline | 3.200 | 0.083 | |
| Week 24 vs baseline | 3.883 | 0.057 | ||
| Within control group | Week 12 vs baseline | 1.000 | 0.325 | |
| Week 24 vs baseline | 1.000 | 0.325 |
Table 6.
Mean (SD) of Montreal Cognitive Assessment (MoCA) subdomain scores at baseline, week 12, and week 24 by group.
| Subdomain | Intervention | Control | ||||
|---|---|---|---|---|---|---|
| Baseline | Week 12 | Week 24 | Baseline | Week 12 | Week 24 | |
| Visuospatial/executive | 1.36 ± 0.99 | 1.48 ± 1.03 | 2.33 ± 0.96 | 1.50 ± 1.06 | 1.53 ± 1.02 | 1.47 ± 0.92 |
| Naming | 2.52 ± 0.67 | 2.58 ± 0.56 | 2.79 ± 0.42 | 2.69 ± 0.47 | 2.63 ± 0.49 | 2.34 ± 0.60 |
| Memory | 1.36 ± 0.74 | 1.79 ± 0.78 | 2.45 ± 0.75 | 1.88 ± 0.83 | 1.72 ± 0.77 | 1.38 ± 0.71 |
| Attention | 3.33 ± 1.24 | 3.45 ± 1.28 | 3.73 ± 1.26 | 3.28 ± 1.05 | 3.13 ± 1.07 | 3.00 ± 1.05 |
| Language | 2.00 ± 0.50 | 1.88 ± 0.70 | 1.88 ± 0.65 | 2.00 ± 0.36 | 2.03 ± 0.40 | 2.03 ± 0.40 |
| Abstraction | 0.94 ± 0.70 | 0.85 ± 0.76 | 0.79 ± 0.78 | 0.47 ± 0.57 | 0.50 ± 0.57 | 0.50 ± 0.57 |
| Orientation | 5.64 ± 0.65 | 5.48 ± 0.76 | 5.55 ± 0.75 | 5.16 ± 0.88 | 5.22 ± 0.83 | 5.22 ± 0.79 |
Discussion
This pilot RCT demonstrated that a 24-week multi-modal training program combining computerized cognitive training, Baduanjin, and reminiscence therapy significantly improved global cognitive function (MMSE) and specific cognitive domains (MoCA) in older adults with MCI. Importantly, the intervention group showed progressive improvement over time, whereas the control group exhibited decline. These results provide preliminary evidence that an intensive and structured multi-component program may support cognitive maintenance, although confirmation in adequately powered trials is required.
Our results are consistent with current evidence suggesting that non-pharmacological interventions, particularly multidomain interventions combining physical exercise and cognitive training, may improve cognitive outcomes in older adults with MCI [21,22]. Evidence for the individual components of our intervention is also supportive. Baduanjin has been reported to improve global cognition and attention in community-dwelling older adults with MCI as a mild mind-body exercise [15]. computerized cognitive training has shown benefits for several memory domains in individuals with MCI, and real-world cohort data suggest a dose-dependent association between computerized cognitive training exposure and cognitive improvement [23,24]. Reminiscence therapy has also received renewed support from recent meta-analyses reporting improvements in cognition and related outcomes among older adults with cognitive impairment [12,13,25]. Previous randomized trials have also evaluated multi-modal interventions in MCI. For example, Fan et al reported that a 12-week multimodal program consisting of cognitive training, physical exercise, healthy lifestyle education, and computerized interaction training improved cognitive outcomes in community-dwelling individuals with MCI [26]. Although this prior trial provides important evidence supporting multi-modal intervention, its intervention structure differed from that of the present study. Specifically, our program integrated standardized high-frequency Baduanjin, individualized computerized cognitive training, and reminiscence therapy as a distinct psychosocial component over a 24-week period. Therefore, the present study provides complementary evidence by evaluating a longer, structured 3-component intervention format. Given the pilot nature of the study and partial conceptual overlap with previous multi-modal intervention trials, these findings should be interpreted as preliminary and hypothesis-generating, and require confirmation in larger, adequately powered studies.
A key observation was the absence of between-group differences at week 12 that emerged clearly by week 24. One interpretation is that cumulative dose and sustained engagement are important for detectable benefits, particularly given the high frequency schedule in this protocol, with Baduanjin and computerized cognitive training delivered 5 times weekly plus weekly group reminiscence therapy. This view is consistent with prior evidence suggesting dose-response patterns for computerized cognitive training in real-world settings [24]. However, alternative explanations should be considered. The pilot sample size may have limited statistical power at earlier time points, and modest effects may only become detectable as cumulative change accrues. Brief screening measures can be less responsive over short intervals, and repeated testing may introduce practice-related shifts that blur time-specific separation. Participants may also require an initial familiarization period, especially for digital tasks, before training reaches an effective intensity. Future trials should prespecify time window hypotheses, capture detailed adherence and learning metrics, and model trajectories to distinguish early learning from longer-term cognitive change.
The mechanisms underlying cognitive improvement after multi-modal training in MCI remain elusive. The 3 components of our intervention may act through partially distinct but potentially complementary pathways. Baduanjin may promote overall cognitive resilience by enhancing brain hemodynamics, reducing stress, improving cardiometabolic health, and strengthening attentional networks [27,28]. computerized cognitive training may promote cognition through adaptive practice and feedback that stimulate neuroplastic changes and functional reorganization of cognitive networks [29,30]. Reminiscence therapy may engage autobiographical memory, semantic processing, and social-cognitive interaction, thereby supporting cognitive networks and adaptive functioning. However, these mechanistic explanations remain speculative because the present study did not include neuroimaging, biomarker, cerebral perfusion, or other mechanistic assessments. In addition, potential performance bias should be considered. Because of the behavioral nature of the intervention, participants and intervention providers could not be fully blinded, and the intervention group received more structured training, social interaction, and regular engagement than the control group. Therefore, nonspecific factors such as attention, expectation, motivation, and social contact may have contributed to the observed benefits. Future studies should include active control conditions with comparable contact intensity and objective mechanistic outcomes to better distinguish intervention-specific effects from nonspecific effects.
However, several limitations should be noted. First, as a pilot randomized controlled trial with a modest sample size, this study was not powered to isolate the independent contribution of each intervention component or to formally test potential synergy across modalities. Although baseline educational level did not differ significantly between groups, a relative imbalance in educational attainment was observed, and residual confounding related to education cannot be fully excluded. Moreover, although statistically significant group-by-time interactions were observed, the absolute between-group differences were modest, and the clinical significance of these changes remains uncertain. Therefore, these findings should be interpreted as preliminary evidence of feasibility and potential cognitive benefit rather than definitive evidence of clinical effectiveness. Second, potential performance bias should be considered. Because of the behavioral nature of the intervention, participants and intervention providers could not be fully blinded. The intervention group also received more structured training, regular contact, and social interaction than the control group. Therefore, nonspecific factors such as attention, expectation, motivation, and social engagement may have contributed to the observed effects. Third, MoCA subdomain analyses were exploratory and involved multiple comparisons without correction. Therefore, the subdomain-level findings should be interpreted cautiously and should not be considered confirmatory. In addition, baseline imbalance in some subdomains further limited causal inference at the domain level. Finally, this study did not include neuroimaging, biomarker, cerebral perfusion, or other mechanistic assessments. Therefore, the proposed mechanisms remain speculative. Larger studies with active control conditions, longer follow-up, and objective mechanistic measures are needed to confirm the efficacy, durability, and mechanisms of this intervention
Conclusions
This pilot randomized controlled trial provides preliminary evidence that a 24-week multi-modal intervention combining Baduanjin, computerized cognitive training, and reminiscence therapy may improve global cognitive function in older adults with MCI. Given the modest sample size and pilot nature of the study, these findings should be interpreted with caution and require confirmation in larger, adequately powered trials.
Data Availability Statement
The datasets used and analyzed in the present study are available from the corresponding author upon reasonable request.
Acknowledgement
We appreciate all the study participants for their participation and the research team who contributed to data collection.
Footnotes
Financial support: The study is supported by grants from the Huzhou City Science and Technology Plan Public Welfare Application Research Project Population Health (Medical and Health Key Points; 2021GZB04)
Conflict of interest: None declared
Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher
Declaration of Figures’ Authenticity: All figures submitted have been created by the authors who confirm that the images are original with no duplication and have not been previously published in whole or in part.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and analyzed in the present study are available from the corresponding author upon reasonable request.