## 4 Discussion  
This exploratory intervention combined PreCODE with NeuroQ to determine the effects on cognitive function in adults at-risk of cognitive decline. Both the multidimensional lifestyle modifications and the ingredients in NeuroQ have previously shown beneficial and protective effects on cognitive function in adults at-risk of cognitive decline or with MCI or AD [15; 16; 17; 18; 24; 25]. Following this 90-day intervention, adults at-risk of cognitive decline demonstrated significant improvements in their cognitive function, quality of life, daytime sleepiness, mood, and healthy lifestyle habits. There are several potential mechanisms whereby the lifestyle modifications used in the current study and the ingredients that comprise NeuroQ may elicit their positive effects on cognitive function. Pre-clinical and clinical studies have shown that exercise induces neurogenesis in the hippocampal region of the brain, preserves white and gray matter, modulates neurotransmission systems, and increases neurotrophic factors [45]. Further, a fasting state promotes the production of ketones from the neuronal cells, which upregulate the expression of the brain-derived neurotrophic factor (BDNF), which in turn promotes mitochondrial biogenesis, synaptic plasticity, and cellular stress resistance [46]. Previous evidence showed that engagement in complex mental activity enhances resting neural activity, structural connectivity, and increases cerebral blood flow [47], while sleep restores the brain synaptic plasticity, which facilitates learning processes [48]. NeuroQ is comprised of turmeric, Gotu Kola, gingko biloba, propolisolis, and coffee fruit, which are all independently known to have antioxidant properties [24; 26; 49]. Accumulating evidence suggests that sources rich in antioxidants increase the expression of mitochondrial and antioxidant response genes, contributing to cognitive improvement [50]. Moreover, supplementation with polyphenic compounds enhances neuronal communication, neuroprotective adaptations, and reduces stress signals [51; 52]. Further, phosphatidylinositolserine supplementation is reported to slow biochemical alterations and structural deterioration in nerve cells, and the incorporation of phosphatidylinositolserine into the cell membrane influences the metabolism of neurotransmitters [23]. The potential for practice effects using the CNS-VS is certainly a consideration due to the repeated administration of the CNS-VS. Practice effects refer to the improvement in performance with repeated testing due to the recognition or familiarity with the assessment materials or procedures. The test-retest reliability is the variability that can occur in the same person, using the same instrument, under the same testing conditions. Certainly, both practice effects and test-retest reliability need to be considered when interpreting repeated neuropsychological assessments as this may erroneously overestimate the efficacy of the intervention. As previously reported, there is the potential for practice effects in cognitive testing [53]. Thus, to address this limitation, the tool CNS-VS selected to assess cognitive decline was based on its demonstrated suitability for repeated administration [37; 54; 55]. Practice effects within the CNS-VS have been shown to be present between the first and second assessments, whether those are one week or three months apart, but diminish after the second assessment, whether those are one week or twelve months apart [55; 56]. Therefore, in the context of the current study, it is possible to conclude that practice effects would not have had an influence beyond the second assessment at Day 30. Based on the latter, it is possible to surmise that the results of this study remain true to the intent and purpose of the hypothesis. There were significant improvements in neurocognitive performance at Days 30, 60, and 90,.