We tested whether adding meditation-based emotional training to a 5-component lifestyle program improves cognition in high-risk community elders and explored mediating pathways. Ten Beijing communities were cluster-randomised (1:1); 182 eligible elders (MoCA <26 plus ≥2 vascular/psychosocial risks) received weekly 60-90 min group sessions plus daily homework (meditation, cognitive training, exercise, diet, vascular care) or usual lifestyle for 9 months.
89 % satisfaction and 81 % attendance indicated high feasibility. Relative to controls (n=90), the intervention (n=92) improved global cognition (21 %), memory (73 %) and subjective complaints (42 %), gains sustained 12 months. Positive affect ↑, negative affect ↓, social network and physical activity improved (all p<.01).
Structural-equation and group-based trajectory models showed: (1) lifestyle change enhanced psychological well-being (β=.38), which fully mediated intervention effects on memory and complaints; (2) three cognitive trajectories emerged—low-stable, moderate-improving, high-improving—predicted by baseline age, leisure activity, physical activity and depression.
Integrating psychological training into multidomain lifestyle programs is feasible and effective; emotional change is a key mechanism and individual baseline profiles forecast differential benefit, supporting personalised dementia-prevention strategies.