A summary of the evidence and evaluation of the effectiveness of nonpharmacological interventions for mild cognitive impairment

Objective: To summarize and evaluate the evidence of guidelines and systematic reviews（SRs） of nonpharmacological interventions for mild cognitive impairment（MCI） to support the development of future guidelines and clinical decisions for MCI patients.Methods: Scottish Intercollegiate Guideline Network（SIGN）, National Institute for Health and Clinical Excellence（NICE）, American Academy of Neurology（AAN）, Registered Nurses Association of Ontario（RNAO）, Web of Science, PubMed, Cochrane Library, CNAHL, VIP, China National Knowledge Infrastructure（CNKI）, and Wanfang Database were searched for relevant publications, including guidelines and SRs, from January 2014 to March 2019. Two authors independently screened articles, extracted data, and assessed the publications for adherence to the inclusion criteria. Appraisal of Guidelines for Research and Evaluation（AGREE II） was used to assess the quality of the guidelines, and Assessment of Multiple Systematic Reviews（AMSTAR 2） was used to assess the quality of SRs. In addition, the Grading of Recommendations Assessment, Development and Evaluation（GRADE） approach was used to evaluate the quality of outcomes.Results: Thirty-two articles were retrieved, including 1 guideline and 31 SRs. Fourteen SRs of physical exercise for MCI, six articles describing cognitive interventions, four articles describing acupuncture, and seven articles assessing dietary interventions（including four articles employing a Mediterranean diet, one article using vitamin B supplementation, and two articles assessing the effects of tea, coffee, and caffeine） were included. The quality of the articles was very low for 4（13%）, low for 10（32%）, and moderate for 17（55%）.Conclusions: Based on the evidence available to date, nonpharmacological interventions may improve the current cognitive function of persons with MCI. In particular, physical exercise, cognitive interventions, and acupuncture exerted promising effects. However, due to the limited number and quality of the included publications, additional high-quality reviews are needed to further confirm.