Comparative efficacy of non-pharmacological interventions for amnestic mild cognitive impairment: a network meta-analysis.

Background: Amnestic mild cognitive impairment (aMCI) represents a critical prodromal stage of Alzheimer's disease, with a prevalence of approximately 10.03% and an annual conversion rate to dementia of 5%-10%. Non-pharmacological interventions, including acupuncture, moxibustion, cognitive therapies, repetitive transcranial magnetic stimulation, and Tai Chi, are considered potentially effective therapeutic approaches. However, comparative efficacy among these interventions remains elusive. Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were systematically searched from inception to March 2026. Randomized controlled trials comparing two or more non-pharmacological interventions for aMCI were included. The RoB2 was used to assess methodological quality. A frequentist network meta-analysis was conducted with changes in cognitive function scores as the primary outcome, measured by the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Statistical analyses were performed using R software (version 4.4.3) with the netmeta package. Mean differences (MD) and 95% confidence intervals (CI) were calculated. The surface under the cumulative ranking curve (SUCRA) was used to rank interventions. Consistency was evaluated using the node-splitting method, publication bias was assessed with funnel plots, and robustness was examined through sensitivity analysis. Results: A total of 32 randomized controlled trials were included, of which 22 reported MMSE scores and 21 reported MoCA scores. Network meta-analysis demonstrated that manual acupuncture combined with moxibustion ranked first for improving MMSE scores (SUCRA = 87.9%), showing significant superiority over usual care (MD = 1.65, 95% CI: 0.01 to 3.29), followed by Tai Chi (SUCRA = 76.7%) and electroacupuncture (SUCRA = 71.7%). For MoCA score improvement, manual acupuncture combined with moxibustion also ranked first (SUCRA = 95.3%), with manual acupuncture (SUCRA = 71.5%) and moxibustion (SUCRA = 65.9%) ranking second and third, respectively. Both outcome measures yielded consistent results, indicating that traditional Chinese medicine-based non-pharmacological interventions demonstrated favorable efficacy with higher rankings. However, absolute effect sizes were modest, and the top ranking of the combined intervention was tentative given local inconsistency and the small number of informing trials. Conclusions: Non-pharmacological interventions confer modest beneficial effects on cognitive function in patients with amnestic mild cognitive impairment, and traditional Chinese medicine-based modalities consistently occupied the top ranks for both outcomes. Manual acupuncture combined with moxibustion ranked highest; however, this ranking is tentative given local inconsistency and the small number of informing trials, and the certainty of evidence was limited by the methodological quality of the included studies. Given their favorable safety profiles, these interventions are best positioned as adjunctive therapies. Large-scale, rigorously designed randomized controlled trials, including head-to-head comparisons of combined vs. single-modality interventions, are warranted to substantiate these findings. Systematic review registration: PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251007806, identifier: CRD420251007806.