## 4 Discussion
Based on 1069 age-matched scores, the six-point increase in the NCI corresponded to an improvement from the 56 th to 74 th percentile, or from \"average\" to \"above average\" [44]. The improvement in cognition is consistent with the findings from the FINGER study, a two-year double-blind randomized controlled trial examining lifestyle interventions compared with general health advice in participants at-risk of cognitive decline [16], as well as a one year intervention that investigated the impact of lifestyle interventions through goal setting in community dwelling adults [15]. While these previous interventions observed increases in cognition in one-to-two years, the current intervention of PreCODEwith NeuroQ elicited increases in cognitive function in 30 days. In forgetful Japanese older adults with low BDNF, dietary supplementation with curcumin, propolisis extract, gingko biloba extract, and phosphatidylinositolserine for 12 weeks improved the NCI [32]. These findings, in addition to the previous research, indicate that supplementation and lifestyle modifications are an effective way to improve cognitive function in at-risk adults in as little as 30 days. The improvements to the NCI were associated with increases in nine of the thirteen domains assessed by the CNS-VS. There were significant improvements in: working memory; reaction time; complex- and sustained-attention; processing-, psychomotor- and motor-speed; cognitive flexibility; and executive function scores at Day 90. The greatest improvements at Day 90 were seen in executive function, cognitive flexibility, processing speed, and working memory. Improvements to reaction time, cognitive flexibility, executive function, psychomotor speed, and processing speed were observed 30 days after beginning PreCODE with NeuroQ, indicating that this intervention can rapidly improve cognitive function in adults at-risk of cognitive decline, faster than what has been shown previously with lifestyle interventions alone [15; 16]. In natural aging, processing speed, working memory, attention, and executive function are susceptible to age-related declines [1]; thus, an intervention that can improve these cognitive domains is of high value. In forgetful Japanese older adults with low BDNF concentrations, 12 weeks of supplementation with an herbal blend of ingredients improved the NCI, as well as cognitive flexibility, executive function, and shifting attention [32]. Interestingly, participants with BDNF concentrations that were greater than the first quartile did not experience the same benefit to their cognitive function as those with BDNF concentrations less than the first quartile [32]. While BDNF was not assessed in this study, PreCODE with NeuroQ improved cognitive function in a broader range of cognitive domains in the entire cohort of participants. Therefore, it is possible that PreCODE with NeuroQ acted synergistically, providing more benefit than supplementation or lifestyle alone. However, further research is needed to better understand the effects of the combination of PreCODE with NeuroQ, compared to either intervention alone. Memory is one of the most common cognitive complaints associated with aging [1], and poor memory has been associated with poorer QoL [57]. Working memory, a measure of how well a participant can hold information in their consciousness using short-term memory processes [58], was improved by 15% at Day 90 by the current study intervention. Recent studies examining curcumin, an ingredient in NeuroQ, reported significant improvements in working memory among healthy older adults [59], and all participants in a Japanese population taking a supplement with the same formulation of ingredients to NeuroQ saw improvements in immediate and delayed memory tasks [32]. Interestingly, a two-year multidimensional lifestyle intervention did not observe greater improvements to memory compared with generic health advice [16].