Effects of 12-week 24-form Tai Chi on cognitive function, cerebral perfusion, and vascular function in postmenopausal women with mild cognitive impairment: an exploratory randomized controlled trial

Background Postmenopausal women are at increased risk of mild cognitive impairment (MCI). Vascular and cerebrovascular dysfunction may contribute to this increased vulnerability. Tai Chi has been shown to benefit cognitive function, but its effects on cerebrovascular health in this high-risk population remain poorly defined. This study aimed to evaluate the impact of a 12-week Tai Chi intervention on cognitive performance, cerebral perfusion, and circulating vasomotor and Alzheimer’s disease (AD)-related biomarkers in postmenopausal women with MCI. Methods This single-center, parallel-group, open-label exploratory randomized controlled trial was conducted from June 2023 to September 2024 in Fuzhou, China. Forty postmenopausal women with MCI were randomized in a 1:1 ratio using block randomization to either a 12-week supervised 24-form Tai Chi program or a health education control group. Primary and secondary outcomes included Montreal Cognitive Assessment (MoCA) total and domain-specific scores, cerebral blood flow in cognition-related brain regions, circulating vasomotor factors, and serum AD-related biomarkers. Results Compared with the health education control group, the Tai Chi group showed greater improvement in MoCA total score ( β = 4.95, p < 0.001) and in delayed recall ( β = 1.50), visuospatial/executive function ( β = 1.10), and attention ( β = 1.05) (all p < 0.001). Tai Chi was also associated with greater increases in global and regional CBF, including a significant group-by-time interaction for global CBF ( β = 15.29, p < 0.001), as well as increased plasma NO ( β = 10.41, p < 0.001), a lower ET-1/NO ratio ( β = −0.97, p = 0.004), and greater reductions in circulating T-tau ( β = −255.45, p < 0.001), P-tau ( β = −135.67, p < 0.001), and Aβ 1–42 ( β = −169.41, p < 0.001). No intervention-related adverse events occurred. Conclusion A 12-week program of standardized 24-form Tai Chi was associated with improvements in overall cognitive performance as assessed by the MoCA in postmenopausal women with MCI. These cognitive changes were accompanied by increased cerebral perfusion, a more favorable vasomotor profile, and reductions in circulating AD-related biomarkers. Tai Chi appears to be a feasible and well-tolerated non-pharmacological intervention for this vulnerable population. Clinical trial registration ChiCTR2300068871.