Nonpharmacological interventions for cognitive decline and dementia-related outcomes in older Asian adults: a systematic review.

OBJECTIVE: Older Asian populations face a growing burden of cognitive decline, while Asian American populations remain markedly underrepresented in intervention research. This systematic review identified and evaluated nonpharmacological interventions for cognitive decline and dementia-related outcomes in older Asian populations, with implications for Asian American care. METHOD: Following PRISMA 2020 guidelines, four databases (PubMed, Embase, PsycINFO, and Web of Science) were searched for English-language studies published from 2000 through 2024; titles, abstracts, and full texts were screened independently by two reviewers, and risk of bias was assessed using RoB 2 and ROBINS-I. RESULTS: Four intervention studies met the prespecified population, age, and intervention criteria. Studies were conducted in mainland China, Hong Kong, South Korea, and Taiwan and included 246 participants. Interventions spanned three domains: multicomponent lifestyle interventions, arts-based interventions, and music interventions. Two studies assessed cognitive abilities using the Mini-Mental State Examination (MMSE) or Cognitive Abilities Screening Instrument (CASI); neither showed significant improvement in global cognition, but a pilot study reported improvements in the abstraction domain. A cluster-randomized trial showed that a music intervention reduced agitation, aberrant motor behavior, and dysphoria, while a nonrandomized study found that art therapy was associated with reduced depression and improved self-expression. Two studies described culturally responsive elements: one used traditional Korean art materials, while the other used familiar Cantonese popular music and Chinese opera repertoire, selected based on participants' preferences and cultural backgrounds. Neither study used a formal cultural-adaptation framework. Samples ranged from 28 to 104 participants; the randomized trials raised some risk-of-bias concerns, and the nonrandomized studies were at serious risk of bias. CONCLUSION: Findings are preliminary. Larger, rigorously designed trials in U.S.-based Asian American populations, alongside disaggregated subgroup data, are urgently needed.