Enhancing cognitive reserve: Evidence-based strategies for healthy aging

Introduction: The concept of cognitive reserve (CR) emerges as a key explanatory framework by demonstrating that modifiable factors such as education, physical activity, and social participation can compensate for age-related cognitive decline. However, significant gaps persist in its practical implementation, especially in diverse community and political contexts. Objective: This study aimed to analyze the most effective strategies to strengthen CR, integrating recent evidence and proposing a multilevel model that articulates individual, community, and structural interventions. Methodology: A mixed-methods approach was adopted, combining systematic reviews with bibliometric analyses using VOSviewer, examining a total of 1,060 studies organized into three axes: protective factors (693 studies), structured interventions (71 studies), and social determinants (296 studies). Results: The results revealed that physical activity and education are the best-documented factors, showing robust associations with improved cognitive function. In contrast, bilingualism emerged as an under-researched area despite its neuroprotective potential. Conclusions: The most effective interventions were multimodal approaches, such as the combination of cognitive training with physical exercise, while at the social level, community participation emerged as a key predictor of cognitive resilience, although marked disparities were observed between urban and rural areas.