Healthy Brain Ageing in Older Adults: An Umbrella Review of Modifiable Determinants and Interventions

Background: Healthy brain ageing depends on interacting vascular, metabolic, behavioural, social and environmental determinants and on the preservation of cognitive, functional and psychological health. Evidence is distributed across intervention-specific systematic reviews and meta-analyses, making an umbrella approach useful for clinical and public-health synthesis.
Objective: To synthesise contemporary systematic-review evidence on modifiable determinants and interventions relevant to cognitive, functional and broader brain health in adults aged 60 years and older.
Methods: An umbrella review of systematic reviews and meta-analyses was undertaken using PRISMA 2020 principles. The evidence base was updated to 25 September 2026 through structured searches centred on PubMed, with targeted searches of Cochrane and WHO resources and citation chasing. Eligible evidence addressed exercise, multidomain interventions, diet, sleep, social connection, comprehensive geriatric assessment (CGA), vascular and environmental risk factors, frailty and emerging biomarkers.
Results: Long-term exercise alone showed little or no effect on global cognition (SMD 0.05, 95% CI −0.04 to 0.13), whereas multidomain interventions improved global cognition (SMD 0.09, 0.04 to 0.15), MoCA performance (SMD 0.23, 0.06 to 0.40), depressive symptoms (SMD −0.35, −0.57 to −0.12) and physical performance (SMD 0.40, 0.14 to 0.66). Higher Mediterranean-diet adherence was associated with lower risks of cognitive impairment (HR 0.82, 0.75 to 0.89), dementia (HR 0.89, 0.83 to 0.95) and Alzheimer disease (HR 0.70, 0.60 to 0.82). Strong social engagement was associated with lower dementia risk (RR 0.81, 0.74 to 0.89), while loneliness was associated with higher risk. CGA was associated with improved functional status in home-based programmes and favourable hospital outcomes in umbrella-review evidence. Sleep disturbance, hearing impairment, air pollution and other vascular and behavioural factors remain clinically relevant modifiable exposures. Plasma p-tau217 showed promising diagnostic accuracy for amyloid pathology, but it is a biomarker of detection rather than a preventive intervention.
Conclusions: Healthy brain ageing is best understood as a multidomain, life-course process. The most consistent evidence supports integrated approaches that combine physical activity with cognitive, nutritional, psychological and social components, alongside risk-factor management and age-attuned care. Evidence remains heterogeneous across settings, and causal inference is weaker for several observational risk-factor associations. Future research should prioritise implementation, equity, standardised outcomes and better integration of biological, functional and social measures.

healthy brain ageing; older adults; dementia prevention; multidomain intervention

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