Comparative analysis of traditional and modern epigenetic therapies for diabetes associated cognitive decline

Diabetes-Associated Cognitive Decline (DACD) is increasingly recognized as a neurodegenerative complication driven by chronic metabolic stress, neuroinflammation, and epigenetic dysregulation. This review critically evaluates two therapeutic paradigms: traditional approaches-defined here as herbal remedies, dietary and nutritional interventions, lifestyle modifications, and traditional medical systems such as Ayurveda and Traditional Chinese Medicine-and modern epigenetic strategies, including pharmaceutical modulators, CRISPR-based epigenome editing, RNA-based therapies, and stem cell interventions. Traditional approaches act broadly on multiple epigenetic pathways and are generally safe, affordable, and accessible, though limited by issues of bioavailability, standardization, and clinical validation. Modern therapies provide targeted, gene-specific modulation with transformative potential, but face challenges of safety, delivery, cost, and ethical oversight. A comparative analysis of these approaches highlights complementary strengths, suggesting opportunities for integrative models. Overall, this review synthesizes recent evidence (2022-2025) and provides insights that may guide, rather than prescribe, the development of individualized and integrative therapeutic strategies for DACD. Future directions include the application of AI-based tools for epigenomic profiling and careful consideration of ethical frameworks, both of which extend the comparative discussion presented here.