Mild cognitive impairment (MCI) is characterized by a decline in cognition and is associated with a higher risk of progression to dementia and Alzheimer's disease (AD). Considering the complexity and multifactorial etiology of MCI, dementia, and AD, there is a growing understanding that optimal preventive strategies are likely to require targeting several risk factors and mechanisms simultaneously. Recent evidence shows that interventions such as exercise, in particular aerobic exercise (AE), exogenous sources of ketones (namely ketogenic medium-chain triglyceride [kMCT]), and supplementation with vitamins B12 , B6 and folic acid may positively impact cognitive performance in MCI and AD. Although further studies might be necessary to understand the exact pathways through which this occurs, there are reasons to suspect that, in combination, these interventions could have a synergetic effect. In this paper, we hypothesize that a multicomponent cognitive therapy with ketogenic oral nutritional supplementation with vitamins B12 , B6 , and folic acid, and AE could have a synergistic effect and help delay cognitive decline in patients with MCI. Further studies that include objective measurements of cognitive function are needed to confirm this hypothesis.
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