###### Abstract  
PreCODE is a multifaceted protocol that applies lifestyle modifications to improve cognitive decline. NeuroQ is a blend of ingredients that have been individually reported to benefit cognition. The objective of this open-label exploratory study was to evaluate the efficacy of PreCODE with NeuroQ on cognition in healthy adults with risk factors for cognitive decline. Thirty participants \(\geq\)45 years at-risk of cognitive decline underwent PreCODE with NeuroQ. Cognitive function was assessed by CNS-Vital Signs (CNS-VS) at 30, 60 and 90 days. Quality of life (QoL), sleepiness, depression, and healthy habits were assessed with the Medical Outcomes Survey, Epworth Sleepiness Scale, Patient Health Questionnaire, and Life Habits Checklist, respectively. There was a 10, 12, and 14% increase in the neurocognitive index percentile scores from screening at Day 30, 60, and 90, respectively (\(p\leq 0.01\)). The CNS-VS domains in psychomotor-, processing-, and motor-speed, complex- and sustained-attention, reaction time, cognitive flexibility, executive function, and working memory improved at Day 90 (\(p\leq 0.04\)). Executive function, cognitive flexibility, processing speed, and working memory, improved by 12, 11, 10, and 7%, respectively, at Day 90. There were improvements in QoL, daytime sleepiness, depression, and lifestyle habits (\(p\leq 0.014\)). NeuroQ was safe and well tolerated. PreCODE with NeuroQ improved cognitive function and QoL in adults at-risk of cognitive decline. Placebo- or comparator-controlled studies are warranted to confirm the effect on cognitive function. aging; cognition; CNS-vital signs; phosphatidylinositolserine; whole coffee fruit extract; brain training; fasting +
Footnote †: journal: Medical Outcomes  
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diabetes, obesity), poor diet, and high alcohol consumption [7; 10]. The World Health Organization (WHO) recommends the implementation of interventions that delay or are capable of slowing cognitive decline with a focus on modifiable risk factors [7]. The current treatment strategies to combat cognitive decline include pharmaceuticals, exercise therapies, and cognitive training [11; 12]. Pharmacological and exercise therapies have produced inconsistent and weak results [12; 13], while brain training did not improve overall cognition [14]. Due to the number of risk factors involved and the complex pathophysiology of cognitive decline and dementias [5; 12], multidimensional lifestyle interventions, such as lifestyle education, cognitive training, and physical activity, that focus on prevention may be beneficial [15; 16]. There has been interest in multifactorial preventative options to provide a multidimensional benefit [16; 17; 18]. Several long-term studies have utilized various multidimensional approaches in the prevention of cognitive impairment in populations at-risk for cognitive decline [19; 20; 21; 22]. Adults receiving a multidimensional lifestyle intervention improved or maintained their cognitive function more than the adults receiving general health advice [16]. Therefore, there is a need to understand whether shorter term interventions that may yield higher compliance could be beneficial. Further, given the need for preventative strategies for cognitive decline, and the lack of effective pharmaceutical options, natural products and supplements have also received attention for their role in lifestyle intervention programs. Phosphatidylserine, turmeric, Ginkgo Biloba, Gotu Kola, propolisolis, and whole coffee fruit extracts have been studied individually and reported to have neuroprotective effects [23; 24; 25; 26]. In older adults, phosphatidylinositol has been shown to improve memory, verbal learning, verbal fluency, and sociability and Gotu Kola supplementation has been found to improve cognition [23; 27; 28]. Coffee fruit extract has increased subjective alertness and decreased task-related fatigue in healthy adults [29].