Does creatine supplementation have benefits for early cognitive decline?

Creatine Supplementation for Early Cognitive Decline: Current Evidence

Based on the available evidence, creatine supplementation shows promising but limited benefit for early cognitive decline, with the most recent research suggesting potential small improvements in specific cognitive domains, but insufficient evidence to recommend it as a standard intervention.

Current Evidence on Creatine for Cognitive Function

Recent Research Findings

• The most recent study (2025) found that creatine monohydrate supplementation (20g/day for 8 weeks) in Alzheimer's disease patients:

  • Increased brain total creatine by 11%
  • Showed improvements in global and fluid cognitive composites
  • Demonstrated benefits in specific cognitive tasks including list sorting, oral reading, and attention 1

• A 2023 randomized controlled trial (the largest to date) found:

  • A small beneficial effect of creatine (5g daily for 6 weeks)
  • Effects that bordered significance for backward digit span tasks
  • No significant improvement in other cognitive domains
  • More reported side effects with creatine than placebo 2

Systematic Reviews

• A 2018 systematic review indicated that creatine may improve:

  • Short-term memory
  • Intelligence/reasoning
  • But showed conflicting results for other cognitive domains
  • Potentially greater benefits for aging and stressed individuals 3

• A 2024 systematic review found:

  • Equivocal results for effects on cognition
  • Confirmation that supplementation can increase brain creatine content
  • Need for better research design and supplementation protocols 4

Specific Populations That May Benefit

Research suggests certain groups may experience greater benefits:

• Vegetarians showed better response in memory tasks compared to meat-eaters 3
• Individuals with brain creatine deficits, including:
  • Those experiencing acute stressors (exercise, sleep deprivation)
  • People with chronic conditions (aging, Alzheimer's disease, depression) 5

Clinical Guidelines Perspective

Current clinical guidelines do not specifically recommend creatine supplementation for cognitive decline:

• The ESPEN guidelines on nutrition in dementia (2015) do not include creatine among recommended supplements for cognitive impairment 6

• The U.S. Preventive Services Task Force (2014) reviewed various supplements for cognitive impairment and did not find evidence supporting dietary supplements for cognitive function in persons with mild cognitive impairment 6

• Guidelines on dietary interventions in mild cognitive impairment (2019) note limitations in nutritional intervention studies, including insufficient sample sizes and follow-up periods 6

Dosing and Safety Considerations

If considering creatine supplementation:

• Dosing in cognitive studies ranged from 5g/day 2 to 20g/day 1
• Side effects were reported significantly more often with creatine than placebo in the largest study (relative risk = 4.25) 2
• Creatine is generally considered safe based on extensive research in sports performance

Practical Recommendations

For patients interested in creatine for cognitive health:

1. Consider creatine as an experimental adjunctive approach, not a primary treatment
2. Start with standard dosing of 5g daily, which has shown acceptable safety profile
3. Monitor for side effects, which may be more common than with placebo
4. Combine with evidence-based approaches to cognitive health:
   • Regular physical activity (both aerobic and resistance exercise)
   • Cognitive stimulation and mental challenges
   • Heart-healthy diet patterns
   • Management of vascular risk factors

Limitations and Future Directions

Important considerations when discussing creatine with patients:

• Optimal protocols for increasing brain creatine remain undetermined
• More research is needed with larger sample sizes and longer follow-up periods
• Studies should simultaneously assess brain creatine levels and cognitive function
• The small effect size may limit clinical significance for many patients

While creatine shows theoretical promise and some positive early results, particularly in the most recent Alzheimer's disease pilot study, the current body of evidence is insufficient to make it a standard recommendation for early cognitive decline.