Non-pharmacological Approaches to Preserving Cognitive Functions in Normative Aging: A Narrative Review

BACKGROUND:Despite a significant body of research on non-pharmacological interventions, evidence regarding their effectiveness in normative aging remains heterogeneous. Existing reviews have primarily focused on individual interventions or combined normative aging with symptomatic cognitive impairment, making it difficult to compare the results specifically for older adults without cognitive impairment. AIM:To summarize and critically compare the evidence on non-pharmacological approaches to maintaining cognitive functioning in normative aging and to identify the mechanisms, structural characteristics, and conditions of implementation associated with their effectiveness. METHODS:A narrative review of randomized controlled trials, systematic reviews, and meta-analyses published between 2006 and 2026 was conducted. The literature search was performed in PubMed, Google Scholar, and eLIBRARY.RU. We analyzed cognitive training, physical activity, and state-regulation practices. The final qualitative analysis included 50 papers. The interventions were compared based on the nature of cognitive effects, near and far transfer effects, the sustainability of changes, suggested mechanisms, and effectiveness factors. RESULTS:Cognitive training demonstrates primarily domain-specific effects and near transfer, with the sustainability of results increasing with adaptive increases in difficulty and the use of maintenance sessions. Physical activity is characterized by a broader profile of cognitive effects, the magnitude of which depends on the type, intensity, and duration of the activity. Mindfulness and breathing practices primarily impact stress and psychological well-being, while evidence for direct and sustained cognitive effects is limited. The interventions generally have a favorable safety profile, but adverse events are inconsistently reported. The most promising interventions are multicomponent programs that combine cognitive activation, physical activity, and social interaction. CONCLUSION:The effectiveness of non-pharmacological interventions in normative aging is determined not only by their type, but also by their duration, regularity, participant engagement, baseline cognitive status, and conditions that ensure adherence to interventions.