The global demographic shift toward an aging population has heightened the focus on age-related health challenges, particularly cognitive decline which affects essential daily functions such as memory, attention and emotional well-being that can affect the quality of life of seniors ^[1]. Aging is defined as natural and gradual process of biological, psychological, and social changes that occur in living organisms over time. Biologically, aging involves changes at the cellular and molecular levels, including DNA damage, decreased cell division, and the buildup of cellular waste products ^[2]. These alterations lead to the gradual deterioration of tissues and organs, resulting in a decline in overall health and vitality. Psychologically, aging may bring about changes in cognitive functions, including memory, attention, and problem-solving skills, along with alterations in emotional states ^[3]. On the basis of anatomical changes at neurological levels in elderly it involves the alterations in the brain, spinal cord. In brain it is seen that brain atrophy occurs which includes cortical thinning. The cerebral cortex, which governs higher cognitive functions like reasoning, memory, and language, gradually thins with age. This thinning is especially noticeable in the prefrontal cortex, a region crucial for executive functions, and the hippocampus, which is vital for memory formation ^[4]. Another major changes in being noticed as the person ages is the number of neurons starts decreasing Aging-related structural changes to neurons include a decrease in the number and length of dendrites, loss of dendritic spines, a decrease in the number of axons, an increase in axons with segmental demyelination, and a significant loss of synapses. Synaptic loss is a key structural marker of aging in the nervous system ^[5]. Neuron loss is not uniform across the brain, certain regions of the brain experience significant reductions in the number of neurons. For example, the hippocampus and the frontal lobes show notable neuron loss, contributing to memory decline and changes in decision-making abilities which is majorly seen in elderly population ^[6]. On neuro-chemical levels the neurotransmitter system shows significant decrease of the neuro-chemicals like dopamine and serotonin & acetylcholine ^[7]. Dopamine is a neurotransmitter for movement motivation and reward processing, the reduction of the same results in decreased motivation to perform any activities of daily living ^[8]. Another neurotransmitter which is serotonin & acetylcholine which contributes mood regulation and memory also starts to decline with age which ultimately leads to mood disorders and cognitive decline ^[9,10]. However, few approaches which is being constantly in use i.e. pharmacological treatment. Evidence of pharmacological interventions for cognitive impairment in older adults the available medications Donepezil, Galantamine, Rivastigmine, Intranasal Insulin, Cerebrolysin and Acetylsalicylic Acid, Metformin and Memantine ^[11].

Non-Pharmacological Approach -
Many of the pharmacological drugs are available but for the non-pharmacological treatment or intervention the physiotherapy is the cornerstone of the non- Pharmacological treatment which mainly focuses on improving physical function, mobility, cognition and overall health. It constitutes the exercises related to the balance, co-ordination, mobility ^[12]. Conventional therapy is the major non pharmacological treatment but sometimes it shows that the only physiotherapy is stressful to the patients and many a times patients refuses to complete the physiotherapy sessions. Thus, to make it more interactive and playful there’s another approach which is being used along with conventional physiotherapy is recreational games which are quite interactive to the patients and the population does enjoy the treatment process. Recreational activities are gaining increasing recognition for their significant role in enhancing cognitive function and emotional well-being among the elderly ^[13]. These activities, which include a variety of mentally stimulating and socially engaging exercises like music therapy, art therapy, and group games like puzzle games ^[14], are not only enjoyable but also crucial for promoting mental health and cognitive resilience in older adults. Studies have shown that such activities can help delay the onset of cognitive decline, improve memory, and reduce symptoms of depression and anxiety. These activities play a vital role in combating loneliness and social isolation, which are common contributors to emotional distress in the elderly.