Abstract
Background/Objectives: This systematic review summarizes the evidence regarding potential mechanisms underlying the relationship between spiritual practices and cognitive health in adults. The review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Methods: An extensive search of six electronic databases (i.e., PubMed, PsycINFO, Embase, Sociological Abstracts, ATLA, CINAHL) was conducted using keywords related to spiritual practices, religious activities, and cognitive health from 1 January 2000 to December 2025. The quality of the included studies was assessed using the Mixed Methods Appraisal tool aligned with the study design. Results: A total of 34 studies were selected for final inclusion in this review, and a narrative synthesis is provided. The studies were conducted throughout the world, with most studies conducted in North America and Asia. Short- and medium-term effects of spiritual practices on cognitive health were identified across heterogeneous practices ranging from meditation, tai chi and yoga to general spiritual and religious activities. Across the strongest evidence, 73% of the randomized control trials examined reported better cognitive health among the more spiritually active; neurobiological factors of decreased inflammation and improved immune response helped to explain these effects. A total of 5 studies examined mediators, while 29 studies contained only secondary outcomes for determining potential mechanisms. Informed by findings across psychosocial, behavioral, and neurobiological pathways, a conceptual model was created and needs testing. Conclusions: Possible mechanisms for spiritual effects on cognition may be through mental health and neurobiological factors, although more rigorous and long-term studies are needed.