Domain-specific effects of dual-task interventions on cognitive function in older adults: a systematic review and three-level meta-analysis

Cognitive decline in older adults can affect memory, attention, executive control, processing speed, and working memory, with consequences for everyday function and independence. Dual-task and cognitive-motor interventions combine motor activity with concurrent or integrated cognitive demands and may better reflect everyday motor-cognitive challenges than single-mode exercise. We evaluated their overall and domain-specific effects on cognitive function in older adults. PubMed, Web of Science, Embase, and the Cochrane Library were searched for randomized controlled trials of concurrent or integrated dual-task/cognitive-motor interventions in older adults. Eligible cognitive outcomes were harmonized across studies and synthesized using Hedges’ g. A three-level random-effects model accounted for multiple effect sizes nested within independent trials. Risk of bias was assessed with RoB 2, and certainty of evidence was rated using GRADE. Twenty-one publications representing 20 independent trials contributed 93 effect sizes from 1,402 analyzed participants; the weighted mean age was approximately 73.4 years. The pooled effect favored dual-task interventions (Hedges’ g = 0.548, 95% CI 0.242 to 0.853, P < 0.001; I² = 70.8%). Significant positive effects were observed for global cognition (g = 0.346), executive function (g = 0.521), memory (g = 0.405), and processing speed (g = 0.387), whereas working memory and attention estimates were imprecise and not statistically significant. No statistically significant subgroup differences were detected for population, intervention format, control type, cognitive domain, exploratory intervention subtype, or duration. Dual-task interventions were associated with a positive overall cognitive effect in older adults, with the clearest pooled evidence for global cognition, executive function, memory, and processing speed. Evidence for working memory and attention remains uncertain, and no intervention format, duration, or participant subgroup was clearly superior. These findings support dual-task training as a potentially useful cognitive-motor strategy while underscoring the need for more standardized outcome selection, explicit reporting of cognitive task content, and trials designed to clarify domain-specific effects.