Is creatine (creatine monohydrate) supplementation effective for cognitive improvement?

Creatine Supplementation for Cognitive Improvement

Creatine supplementation may provide a small beneficial effect on cognitive function, but current evidence does not strongly support its routine use as a primary intervention for cognitive improvement.

Evidence Overview

The evidence regarding creatine supplementation for cognitive enhancement shows mixed results with limited support from guidelines:

• The UEFA expert group statement (2021) acknowledges that creatine "may also support brain function" alongside its well-established effects on muscle performance 1.
• ESPEN guidelines (2015) do not include creatine among recommended supplements for cognitive impairment 1.
• Praxis Medical Insights (2025) notes that creatine is not included in major clinical guidelines for cognitive function 2.

Potential Benefits and Target Populations

Certain populations may experience greater cognitive benefits from creatine supplementation:

• Individuals with brain creatine deficits, including those experiencing:
  • Acute stressors (exercise, sleep deprivation)
  • Chronic conditions (aging, Alzheimer's disease, depression) 2, 3
• Vegetarians may show better responses in memory tasks compared to meat-eaters 2, 4
• Young, healthy individuals without cognitive impairment typically show minimal or no improvement 5

Efficacy by Cognitive Domain

Research suggests variable effects across different cognitive domains:

• Short-term memory: Possible small improvements 4
• Intelligence/reasoning: Some evidence of benefit 4
• Other domains (long-term memory, spatial memory, attention, executive function): Conflicting results 4

Recent Research Findings

The largest and most recent randomized controlled trial on creatine for cognitive performance (2023) found:

• Small beneficial effects that bordered on statistical significance for backward digit span (p=0.064)
• No significant improvement on Raven's Advanced Progressive Matrices (p=0.327)
• No improvements on exploratory cognitive tasks
• Side effects were reported significantly more often with creatine than placebo (RR=4.25) 6

Dosing Considerations

If considering creatine supplementation:

• Standard dosing: 5g daily (maintenance phase) 2
• Loading phase option: ~20g/day (divided into four equal doses) for 5-7 days 1
• Maintenance phase: 3-5g/day as a single dose 1
• Side effects may be more common than with placebo 6

Clinical Implications and Caveats

• Creatine has a well-established safety profile when used appropriately 1, 7
• Benefits for cognitive function appear modest at best and primarily in specific populations
• Creatine should be considered an experimental adjunctive approach rather than a primary treatment for cognitive concerns 2
• More research is needed with larger sample sizes and longer follow-up periods 2, 6
• Studies should simultaneously assess brain creatine levels and cognitive function 3

Bottom Line

While creatine supplementation is generally safe and may offer small cognitive benefits for specific populations (those with brain creatine deficits, vegetarians, or individuals under cognitive stress), the current evidence does not strongly support its routine use as a primary intervention for cognitive enhancement. Those interested in cognitive health should prioritize established approaches like regular physical activity, cognitive stimulation, heart-healthy diet patterns, and management of vascular risk factors.