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Given the expected increase in the prevalence of MCI and dementia and the significant personal and societal costs of this spectrum of disorders, there is ongoing interest in identifying effective interventions for these conditions. Currently available interventions can be divided into pharmacologic and non‐pharmacologic categories. A thorough review of pharmacologic interventions is beyond the scope of this chapter, but commonly used agents include acetylcholinesterase inhibitors (e.g. donepezil) and NMDA receptor antagonists (e.g. memantine). Regardless, even when pharmacologic intervention is used, there is usually still a need for non‐pharmacologic approaches in the treatment and management of cognitive and functional decline. A past literature review suggested that non‐pharmacologic interventions for MCI and dementia can essentially be divided into four categories: (i) restorative cognitive training, (ii) compensatory cognitive training, (iii) lifestyle interventions, and (iv) psychotherapeutic interventions (Huckans, et al., 2013). The primary difference between these intervention categories is the identified target of intervention (e.g. specific symptoms versus underlying brain pathology).

Restorative cognitive training refers to interventions involving structured and repeated practice of specific cognitive tasks and mental exercises to improve specific cognitive abilities and underlying neural connections. Examples of restorative cognitive training include repetitive auditory processing training exercises or use of commercially available ‘brain training’ products. The purported target of such interventions is the neural systems underlying the cognitive domain of interest. Two assumptions underlie restorative cognitive training. The first is that practice in the given task/exercise will improve or at least maintain function in the targeted cognitive domain by way of strengthening or maintaining connectivity of underlying neural circuits. Second, it is assumed that benefits obtained from the task/exercise will generalize to behaviour outside of the training context.

Compensatory cognitive training refers to interventions that teach patients and caregivers to use specific techniques and strategies to compensate for the functional impact of cognitive deficits in daily life. The target of these interventions is improving the individual's functional ability but not necessarily underlying neural function. The primary assumption underlying this approach is that the patient, despite having cognitive deficit, can still use residual cognitive ability in impaired and unimpaired domains to learn and implement compensatory techniques. A wide variety of compensatory cognitive techniques have been described and can be subdivided into internal strategies (e.g. spaced retrieval, method of loci), external strategies (e.g. day planners, pill boxes, smartphone applications), and environmental strategies (e.g. quiet workspace, eliminating unnecessary distractions).

Lifestyle interventions refer to efforts designed to educate and promote healthy lifestyle habits that have been shown to benefit cognitive function in older adults. These interventions often target cerebrovascular health but can also target mood symptoms. Examples include education about the neuroprotective effects of regular aerobic exercise, a healthy diet, and participation in cognitively stimulating activities. Education can also focus on the detrimental effects of specific lifestyle habits, such as smoking and heavy alcohol consumption. Lifestyle interventions sometimes go beyond education and enrol individuals in exercise programs and use motivational interviewing techniques to facilitate behaviour change.

Finally, psychotherapeutic interventions refer to traditional psychotherapy approaches to target neuropsychiatric symptoms that can occur with or independent of cognitive dysfunction in older adults (e.g. depression, anxiety, sleep problems). Individuals with depression often have a greater subjective experience of cognitive symptoms than non‐depressed individuals. Treatment of mood symptoms with psychotherapy can result in improved self‐perception of cognitive and daily function. Common examples of psychotherapeutic interventions include cognitive behavioural therapy, mindfulness training, and relaxation techniques.

There is now a broad literature on the efficacy of non‐pharmacologic interventions for cognitive and functional decline in late life, and recent reviews and meta‐analytic studies have outlined the main findings of this work to date. These summaries have generally concluded that restorative cognitive training, compensatory cognitive training, and lifestyle interventions (e.g. regular aerobic exercise, dietary changes) are effective for improving cognitive function on objective neuropsychological testing as well as for improving subjective cognitive appraisal and daily function (Chandler, Parks, Marsiske, Rotblatt, & Smith, 2016); (Huckans, et al., 2013); (Sherman, Mauser, Nuno, & Sherzai, 2017). Given the broad support for these interventions, some clinics have combined these non‐pharmacologic methods with traditional pharmacologic approaches in comprehensive multidisciplinary treatment programs. One such example is the Healthy Action to Benefit Independence & Thinking (HABIT) program hosted at the Mayo Clinic.