Neuriva Is Not Recommended for Mild Cognitive Impairment or Cognitive Health Concerns
Neuriva should not be used for treating mild cognitive impairment (MCI) or age-related cognitive concerns, as it lacks evidence-based support and contains ingredients that have failed to demonstrate meaningful cognitive benefits in rigorous clinical trials.
Evidence Against Neuriva's Key Ingredients
Phosphatidylserine Shows No Benefit in Controlled Trials
A well-designed randomized controlled trial of 120 elderly subjects with age-associated memory impairment found that soy-derived phosphatidylserine (a key Neuriva ingredient) at both 300mg and 600mg daily doses produced no significant differences in memory, learning, reaction time, planning, or attentional functions compared to placebo after 12 weeks 1
The only positive study on Neuriva itself was industry-sponsored and showed minimal improvements on selected computerized tasks in healthy adults with self-reported memory problems—a population that does not meet clinical criteria for MCI 2
Earlier reviews concluded that phosphatidylserine produced only "consistently modest increases in recall of word lists" in older adults with moderate cognitive impairment, with inconsistent effects on other memory tests 3
Coffee Cherry Extract Lacks Clinical Validation
While one industry-funded study claimed Neuriva improved "numeric working memory" and "picture recognition" tasks 2, these computerized outcomes do not translate to clinically meaningful improvements in real-world cognitive function or quality of life
In vitro studies comparing memory supplements found that Neuriva (both Original and Plus formulations) showed only 27% reduction in beta-amyloid fibrils—far less than other tested supplements and unlikely to produce clinical benefit 4
What Actually Works: Evidence-Based Alternatives
For Established Dementia (Not MCI)
Cholinesterase inhibitors like donepezil are recommended for mild to moderate dementia with established Alzheimer's disease, showing statistically significant improvements in cognition, global function, and activities of daily living 5
However, cholinesterase inhibitors should be deprescribed for individuals with mild cognitive impairment, as they merely delay diagnosis temporarily without altering disease trajectory while causing significant adverse effects (nausea, diarrhea, vomiting, leg cramps) 6, 5
Memantine may be reasonable for moderate to severe dementia after intracerebral hemorrhage 6
For MCI: Focus on Risk Factor Management
The appropriate management strategy for MCI is to reassess patients in 6-12 months to determine if cognitive decline progresses to dementia (MMSE ≤24 with functional impairment) 5
During this observation period, focus on modifiable risk factors including hypertension, diabetes, and cardiovascular disease 5
Only initiate prescription cognitive enhancers if and when the patient meets diagnostic criteria for dementia 5
Dietary Interventions With Some Evidence
Omega-3 fatty acids (DHA/EPA) have weak support for cognitive benefits in MCI populations, though results are mixed 6
B vitamins (folic acid, B6, B12) showed some benefit in specific MCI populations, particularly those with elevated homocysteine 6
Vitamin E showed no clear benefit and may even be detrimental in "non-responders" 6
Critical Pitfalls to Avoid
The Supplement Industry Trap
Herbal supplements are not regulated by the FDA to provide evidence of claims and have actual drug interaction concerns, add to medication burden and expense, with poor to no evidence of pharmacological benefit 6
Multiple vitamin/mineral supplements contribute to medication burden and occasionally anorexia without substantiated benefit 6
Premature Treatment of MCI
Initiating cognitive enhancers for MCI causes significant harm (nausea with relative risk 2.54-2.92, diarrhea with relative risk 2.57, leg cramps with relative risk 7.73-9.62) without meaningful benefit 5
Meta-analyses demonstrate that donepezil produces nonsignificant treatment effects in MCI populations (P = 0.31) with substantial heterogeneity between studies 5
Bottom Line Clinical Approach
For patients presenting with cognitive concerns:
Determine if they meet criteria for dementia (MMSE ≤24 with functional impairment) or only MCI 5
If MCI: Do NOT prescribe Neuriva or other unproven supplements; instead, aggressively manage vascular risk factors and reassess in 6-12 months 5
If established dementia: Consider prescription cholinesterase inhibitors (donepezil, rivastigmine, galantamine) which have proven efficacy 5, 6
Avoid the temptation to prescribe "something" for worried patients with MCI—the evidence clearly shows more harm than benefit from premature pharmacological intervention 6, 5