Early, long-term multimodal interventions are required to halt the progression of mild cognitive impairment (MCI) and Alzheimer’s disease, according to Professor Timothy Kwok of the Division of Geriatrics,
Chinese University of Hong Kong (CUHK), who spoke at AIM 2026.
MCI is common in Hong Kong, with a prevalence of 30–40 percent among adults aged ≥65 years. By the age of ≥85 years, the prevalence of dementia reaches 47.5 percent. [Lam CW, 2022] “Alzheimer’s disease is one of the causes of MCI and dementia, and a major driver of cognitive decline in old age,” noted Kwok.
Why isn’t mAb alone enough?
Recently, three anti-amyloid monoclonal antibodies (mAbs) have been approved for treatment of Alzheimer’s disease. [J Pers Med 2025;15:437] “Although patients receiving these mAbs experience a slower decline in cognitive function, they still worsen over time; the results are unsatisfactory,” commented Kwok.
“No single therapy is going to work on its own because Alzheimer’s disease is a complicated multifactorial condition,” he continued.
Multimodal combinations work better
As outlined in the World Alzheimer Report 2014, some risk factors of Alzheimer’s disease are preventable.
“Physical exercise is the most important. A randomized controlled trial showed that aerobic exercise can increase the size of the anterior hippocampus in older adults,” said Kwok. [Proc Natl Acad Sci U S A 2021;108:3017-3022] “These results suggest that hippocampal atrophy may be at least partially reversible with aerobic exercise. However, if amyloid has already accumulated, I doubt whether hippocampal volume could increase. Therefore, combination [of mAbs and physical activity] works best.”
An anti-inflammatory, antioxidant-rich diet is crucial as Alzheimer's disease is driven by chronic neuroinflammation and oxidative stress. [Oxid Med Cell Longev 2019;2019:9874159] The LipiDiDiet trial showed that a multinutrient combination slowed declines in cognition, function and brain atrophy, as well as disease progression, but these benefits were only evident after 3 years. [Alzheimers Dement 2021;17:29-40]
“Supplements do not work quickly. It does take time and perseverance,” commented Kwok. “They can help people with poor diets, but offer little benefit if you already eat healthily.”
A CUHK research team developed a dual task cycling exercise training system to enhance cognitive function of elderly individuals with MCI. [NCT05384639] “Results showed that combining cycling with cognitive training simultaneously improved cognitive function more than either intervention alone,” reported Kwok.
In the randomized controlled FINGER trial, a multidomain intervention with diet, exercise, cognitive training, and vascular risk monitoring significantly improved overall cognition (p=0.03), executive function (p=0.04) and processing speed (p=0.03) at 2 years in at-risk elderly people from the general population vs control intervention (general health advice). [Lancet 2015;385:2255-2263]
“Interestingly, even the control group improved, suggesting that merely providing general health advice can prompt people to adopt healthier lifestyles,” highlighted Kwok. “The more we talk about and publicize it, the greater the public health impact will be.”
“Long-term multimodal approaches with healthy diet, cognitive training, social activity, physical exercise, and vascular and metabolic monitoring are necessary to halt the progression of MCI and Alzheimer's disease. The earlier the interventions, the better,” concluded Kwok.