Mountain societies in developing and low-income countries are highly vulnerable to the impacts of climate change, which can severely threaten their livelihoods. The situation of mountain communities in the Pamir and Tien Shan mountains in Central Asia is exacerbated by remote location, difficult access, and poorly maintained infrastructure as well as by a distinctly continental climate. Designing and implementing climate adaptation policies for mountainous Central Asia is hindered by the limited understanding of a wide range of environmental and socio-ecological parameters. In particular, there are major knowledge gaps on the temperature and precipitation trends in high altitudes of the Pamir and Tien Shan mountains which are the result of poor and frequently unreliable data. These knowledge and date constraints have a negative effect also on forecasting the occurrence and intensity of extreme weather events which constitute a major hazard for local communities residing in the mountain foothills. This study reviews the state of research on climate change and climate change adaptation in mountainous Central Asia, also considering temperature and precipitation projections for the region. This includes an outline of the geophysical and socio-economic conditions of mountainous Central Asia as well as a survey of climate adaptation initiatives and policies currently implemented in the Pamir and Tien Shan mountain region with special consideration of their limitations and challenges. Knowledge gaps and data constraints, especially on climate-glacier-water and hazard interactions, are identified, and research and policy measures are suggested based on the study findings for improving climate change adaptation in mountainous Central Asia.