Effects of creative expression therapy for older adults with mild cognitive impairment at risk of Alzheimer’s disease: a randomized controlled clinical trial

Zhuo X., Yan Y., Lin R., Lin S., Zheng X., Shao T., Zhang H., Chen L., Li H.

Benito M.Á., Quevedo C.R.

Demirel Ö., Orak O.S.

AbstractBackgroundCognitive decline seen in old age manifests itself as a decrease in reasoning ability that is not related to intelligence. This situation, together with many other problems, can affect the psychological well‐being of the elderly. Especially the elderly living in institutional care constitute a special group that needs to be protected. It is important that the psychotherapy interventions to be carried out with this group are determined according to the characteristics of the group. The aim of this study is to determine the effect of art therapy on cognitive status and psychological well‐being in the elderly living in institutional care.MethodsThis single‐blind randomised controlled study was conducted with 42 elderly individuals living in three nursing homes in Türkiye. In the study, the sample group was assigned to the experimental (n = 21) and control (n = 21) groups by simple randomisation. Art therapy intervention was applied to the elderly individuals in the experimental group, and no special intervention was applied to the control group. The sociodemographic information form, standardised mini mental test (MMT) and Psychological Well‐being Scale for the Elderly (PWBS) were used as data collection tools in the study.ResultsIt was found that there was a statistically significant difference between the pre‐test and post‐test total scores of the PWBS and MMT in favour of the post‐test (P < 0.001). In the study, the effect of the art therapy intervention applied to the elderly individuals in the experimental group was evaluated and it was determined that the difference between the PWBS ( = 0.75) and MMT ( = 0.52) scores had a medium effect level.ConclusionsThe results showed that art therapy has a positive effect on the psychological well‐being and cognitive status of the elderly in institutional care and can be used as a moderate developmental intervention.

Luo Y., Lin R., Yan Y., Li Y., Huang C., Chen M., Li H.

To assess the maintenance effectiveness of a short-period intensive creative expressive arts-based storytelling (SPI-CrEAS) program in older patients with mild cognitive impairment (MCI). This two-arm, single-blinded, pilot, randomized controlled trial was conducted at XXX and included 38 participants who had previously completed a 24-week CrEAS project. Eligible participants were randomly assigned to receive intensive CrEAS program twice weekly for an additional 12 weeks (short-period intensive [SPI]-CrEAS) or complete their daily activities (control group). Linear mixed-model regression was used to analyze baseline and intra-group and inter-group comparisons at different follow-up periods. At the 12-week follow-up, verbal function (Verbal Fluency Test, P=0.021) improved significantly in the SPI-CrEAS group compared with the control group. The cognitive benefits of SPI-CrEAS were sustained with twice-weekly training for 3 months, lasting for up to 9 months. The initial cognitive improvement following CrEAS was sustained at follow-up and boosted by SPI-CrEAS.

Liu Q., Wang F., Tan L., Liu L., Hu X.

IntroductionSubjective cognitive decline means a decline in the subjective perception of self-cognitive function, which is likely to evolve into mild cognitive impairment and dementia. The number of elderly with subjective cognitive decline has increased, bringing huge burdens and challenges to caregivers and society. With the increase in research on art therapies, some of them have gradually been proven to be effective for cognitive function. Therefore, this study aims to summarise the evidence and identify the best art therapy for elderly with subjective cognitive decline.Methods and analysisWe will include published randomised controlled trials written in English and Chinese if the intervention is one of the art therapies and applied in people aged 60 and above with subjective cognitive decline. Eight electronic databases, including the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Elsevier, China BioMedical Literature Database, China National Knowledge Infrastructure, VIP Database and Wanfang Database, will be searched from January 2013 to December 2023. Art therapies will mainly include music therapy, reminiscence therapy, painting therapy, dance therapy, reading therapy, horticultural therapy, museum therapy, calligraphy therapy and so on. The outcome will be cognitive function. Study selection, data extraction and quality assessment will be performed by two reviewers. The risk of bias will be evaluated according to the Cochrane Collaboration’s risk-of-bias tool, and the evidence quality will be assessed with the Grading of Recommendations Assessment, Development and Evaluation. Standard pairwise meta-analysis and Bayesian network meta-analysis will be conducted. The probabilities of each art therapy will be ranked based on the surface under the cumulative ranking curve.Ethics and disseminationEthical approval is not required for reviewing published studies. To provide important evidence for clinicians and guideline developers, the findings of this study will be submitted to a peer-reviewed journal.PROSPERO registration numberCRD42023443773.

Yao C.

Espinoza Jeraldo R.I., Zabihi S., Miranda-Castillo C., Marshall C.R., Cooper C.

AbstractBy 2050, two-thirds of people with dementia will live in Low- and Middle-Income Countries (LMICs). Efforts to adapt and test multi-modal prevention interventions focusing on lifestyle changes for people at risk of dementia are being developed predominantly in higher income countries, for people with and without cognitive symptoms. However, there is evidence that needs may differ between these groups. We systematically reviewed Randomized Controlled Trials (RCTs) evaluating non-pharmacological interventions in individuals with Mild Cognitive Impairment (MCI) and Subjective Cognitive Decline (SCC) in LMICs. We analysed study quality using the Mixed Methods Assessment Tool (MMAT), meta-analysed and synthesized evidence. We included 25 RCTs, from six countries (most in China, n=17), involving 1304 participants. Across the 15 studies for which there was sufficient data to meta-analyse, we found significant positive effects on cognitive outcomes favouring interventions [1.49 (standardised mean difference, 95% Confidence Interval= 1.06-1.93)]. There was significant publication bias. Using an a priori standard framework, we classified interventions into exercise, multidomain, and arts/creative expression. Group exercise [1.67, 1.24-2.11, n=8]. and multidomain [1.22, 0.22-2.21, n=5] had replicated evidence of effectiveness. There was insufficient data to meta-analyse the creative arts category. We identified one high quality, multi-modal intervention, which combined Chinese mind-body exercises and health education, reporting a positive outcome. The first robust dementia prevention trials are underway in LMICs, evaluating effectiveness of models developed in higher income countries. We propose greater consideration and investment in development of interventions that account for specific LMIC contexts from the outset, so they are acceptable and used by local services.HighlightsThere was evidence that group exercise and multimodal interventions were effective for people with memory concerns in LMICs.We identified publication bias in meta-analyses; the open science agenda is critical to improving care in LMICs and reducing global inequalities.Most included studies were conducted in China, reflecting a need for high-quality evidence from underrepresented regions, including Africa and Latin America.We propose greater investment in developing interventions that account for specific LMIC contexts from the outset, so they are acceptable and used by local services.

Davidson J.W.

Finding appropriate and innovative psychosocial structures to support increased longevity is a priority for all: individuals, families and communities, local, state, and federal government services, public and private sector employment, and national economies.

Röder S.

Die vorliegende Publikation widmet sich der immer relevanter werdenden Thematik der Prävention in der modernen Medizin, mit einem besonderen Augenmerk auf den Einsatz von kunst- und kreativitätsfördernden Interventionen. In einer Zeit, in der die Bedeutung von Prävention und Gesundheitsförderung stetig zunimmt, beleuchtet dieser Artikel die potenziellen positiven Auswirkungen kreativer Maßnahmen auf das psychische Wohlbefinden, insbesondere in sozioökonomisch benachteiligten Gruppen. Durch die Integration aktueller Forschungsergebnisse und praxisnaher Beispiele wird dargelegt, wie gezielte Kreativitätsinterventionen nicht nur als präventive Strategien dienen können, um das Auftreten psychischer Störungen zu minimieren, sondern auch dazu beitragen, die Resilienz und Lebensqualität der Individuen nachhaltig zu stärken. Dieser Artikel strebt danach, den Leser mit auf eine faszinierende Reise zu nehmen, um die transformative Kraft der Kreativität in der präventiven Medizin zu erkunden und neue Perspektiven für eine integrative Gesundheitsförderung zu eröffnen.

Zhu D., Al Mahmud A., Liu W.

IntroductionInterventions utilizing the principles of digital storytelling can improve cognitive ability by cultivating positive emotions and framing a new way to enhance social participation among people with mild cognitive impairment. However, existing research has understudied group-based storytelling, focusing instead on building individual stories and connections with family and friends. In response to this research gap, this paper proposes co-designing a digital storytelling intervention for people with Mild Cognitive Impairment (MCI) to enhance their social participation and build meaningful connections.MethodsWe will conduct two co-design workshops with people with MCI (n = 12), their caregivers (n = 4–12), and therapists (n = 5) in Beijing, China, to facilitate the co-development of the digital storytelling application. During the first workshop, we will utilize card sorting and voting to define potential facilitators of social participation, identifying the abilities people with MCI want to improve through storytelling. During the second workshop, we will build on these findings to facilitate people with MCI and their caregivers to visualize the interfaces. After reflexive thematic analysis of the co-design workshops, we will develop a digital storytelling application and test its usability and efficacy among people with MCI and therapists, respectively. A single-blinded field test will be conducted with 20 community-dwelling adults with MCI (Age: 65+). The testing will consist of an intervention group of 10 participants who use the co-designed digital storytelling intervention and a control group of 10 participants who will not use the co-designed intervention on the waiting list. The intervention period will extend over 7 weeks, with individual intervention sessions lasting 30 min. We will evaluate its efficacy in terms of social participation, social connectedness, self-efficacy, subjective sense of happiness, and user experience of people with MCI.DiscussionThis study will examine an innovative digital storytelling intervention to enhance social participation among people with MCI. This study is expected to advance the concept of community-centric social groups in social health service contexts by integrating technological solutions with the self-identified needs and lived experiences of people with MCI, increasing the motivation of people with MCI to cultivate social participation.Ethics and disseminationSwinburne University of Technology’s Human Research Ethics Committee gave ethics approval for this research (Approval Number: 20226525-11105; Date: 26/09/2022). Our findings shall be reported in peer-reviewed journal articles and at relevant conferences.

Romero Reyes Y.Y., Andrade Valbuena L.P.

Mild cognitive impairment produces slight cognitive and motor disturbances without affecting daily life during aging, however, if this symptomatology is not controlled, the speed of deterioration can increase, and even some cases of dementia can appear in the elderly population.To describe non-pharmacological therapies that seek to prevent, control and reduce the symptoms of mild cognitive impairment.An initial search was carried out in the databases of PubMed, Lilacs, EBSCO, ScienceDirect, Taylor & Francis and ProQuest. The results found were filtered through the PRISMA system and biases evaluated using the Cochrane Handbook for Systematic Reviews of Interventions.Four categories of non-pharmacological therapies were created, using 50 articles found in the search, which contribute to controlling and improving cognitive and motor areas, in order to reduce the symptoms presented by mild cognitive impairment. The treatments have different methods, instruments and objectives, so that no meta-analysis of the studies could be performed. In addition, limitations related to the sample, the effectiveness of the results and the methodological quality were found.It was found that non-pharmacological therapies prevent, improve and control the symptoms caused by mild cognitive impairment, however, it is necessary to carry out more studies with better methodologies to corroborate these results.

Romero Reyes Y.Y., Andrade Valbuena L.P.

Resumen Introduccion El deterioro cognitivo leve produce ligeras perturbaciones cognitivas y motoras que no afectan a la vida cotidiana durante el envejecimiento; sin embargo, de no controlarse este sintoma, puede aumentar la velocidad del deterioro e incluso pueden manifestarse algunos casos de demencia en los adultos mayores. Objetivo Describir los tratamientos no farmacologicos para prevenir, controlar y reducir los sintomas del deterioro cognitivo leve. Metodos Se realizo una busqueda inicial en las bases de datos PubMed, Lilacs, EBSCO, ScienceDirect, Taylor & Francis y ProQuest. Los resultados se filtraron a traves del sistema PRISMA y se evaluaron los sesgos mediante el Manual Cochrane de revisiones sistematicas de intervenciones. Resultados Se construyeron 4 categorias de tratamientos no farmacologicos con los 50 articulos encontrados en la busqueda, las cuales contribuyen a controlar y mejorar areas cognitivas y motoras con el fin de reducir los sintomas del deterioro cognitivo leve. Los tratamientos tienen metodos, instrumentos y objetivos diferentes, por lo que no se pudo realizar un metanalisis de los estudios. Asimismo se encontraron limitaciones relacionadas con la muestra, la efectividad de los resultados y la calidad metodologica. Conclusiones Se encontro que los tratamientos no farmacologicos previenen, mejoran y controlan los sintomas del deterioro cognitivo leve, pero es necesario realizar mas estudios con mejores metodologias que corroboren estos resultados.

Karim M.A., Venkatachalam J.

Abstract Background Mild Cognitive Impairment (MCI) is a transitional stage between normal aging and the onset of dementia. The early detection of MCI is essential to avoid certain irreversible brain damage at the end of life. While there have been a variety of preventive interventions used in the past three decades, need to know the current trends is necessary for developing updated preventive modules for MCI. Objectives This bibliometric study examines the current trends in interventional research for treating MCI. Methods Published records were obtained from the Web of Science Core Collection (WoSCC) for the period of 1989–2023. CiteSpace 6.2.R4 (64-bit) advanced version software was utilized for mapping and bibliometric analysis of this study. Overall, 400 records were retrieved and analyzed using document co-citation analysis (DCA), author co-citation analysis (ACA), institutional, country based, and keyword analysis. Results It was found that the publication records were steadily increased in the recent five years (2018–2022) and shows that more than half of the interventional studies (234) were conducted on the recent times. Although United States (US) published highest number of publications (115), Canada secured top position based on burst (3.89) in country wise analysis. In ACA, Petersen RC_2003 secured top position based on citation counts (237), Rapp S_2006 on Burst strength (10.69), Ball K_2006 on Centrality (0.19) and Sigma value (2.00). Through the DCA analysis, clusters such as computerized cognitive training, virtual reality, rhythm training, and dance intervention, were considered to be the indicators of emerging trends.

Wang Y., Wang X., Chen L., Liu Y., Li Y.

Non-pharmacological therapy appeared to alleviate Mild Cognitive Impairment (MCI) symptoms and signs, according to systematic studies. This network meta-analysis aimed to assess the impact of non-pharmacological therapies on improving cognition in individuals with MCI and identified the most effective intervention.We reviewed six databases in search of potentially relevant studies of non-pharmacological therapies such as Physical exercise (PE), Multidisciplinary intervention (MI), Musical therapy (MT), Cognitive training (CT), Cognitive stimulation (CS), Cognitive rehabilitation (CR)，Art therapy (AT), general psychotherapy or interpersonal therapy (IPT), and Traditional Chinese Medicine (TCM) (such as acupuncture therapy, massage, auricular-plaster and other related systems) and others. Excluded the literature such as missing full text, missing search results, or no reporting specific values and combined with the inclusion criteria and exclusion criteria in this article, the literature ultimately included in the analysis addressed the following seven non-drug therapies PE, MI, MT, CT, CS, CR, AT. Mini-mental state evaluation paired meta-analyses were undertaken by taking weighted average mean differences with confidence intervals (CI) of 95%. The network meta-analysis was conducted to compare various therapies.A total of 39 randomized controlled trials, including two three-arm studies, with 3157 participants were included. PE was most likely to be the most effective intervention to slow down the cognitive ability of patients (SMD = 1.34, 95%CI: 0.80, 1.89). CS and CR had no significant effect on cognitive ability.The non-pharmacological therapy had the potential to greatly promote the cognitive ability of the adult population with MCI. PE had the best chance of being the best non-pharmacological therapy. Due to the limited sample size, substantial variability among different study designs, and the potential for bias, the results should be regarded with caution. Our findings should be confirmed by future multi-center randomized controlled, high-quality large-scale studies.

Delfa-Lobato L., Feliu-Torruella M., Cañete-Massé C., Ruiz-Torras S., Guàrdia-Olmos J.

Background: Museums and cultural institutions are increasingly aware of both the interests and needs of society. Accordingly, these institutions are becoming allies in terms of health and well-being due to the importance of their social functions. Presently, many institutions create cultural activities aimed at cognitively impaired people, a group on the rise owing to the prevalence of dementia and the aging of society. Nevertheless, scientific evidence in this field remains scarce. As a result, the main objective of this research was to empirically evaluate and identify the benefits that cultural interventions can bring to cognitively impaired participants. Method: A meta-analysis (MA) was performed following PRISMA guidelines. When inclusion and eligibility criteria had been established, articles were subsequently selected through a strategic search of Web of Science, SCOPUS, PubMed, and Medline. Results: Twenty-six studies met the eligibility criteria, involving a total of 1201 participants with cognitive impairment. The results showed a statistically non-significant effect size when analyzing these cultural interventions for cognitively impaired people overall. However, when conducting partial meta-analyses (MA’), focusing on studies related to a specific disease, a particular type of treatment, or a specific type of evaluation, the results concurred with the conclusion of the previous systematic review (SR). Conclusion: Despite the high heterogeneity of the studies, benefits were identified in emotional well-being and social aspects but not in clinical ones such as the deterioration of cognitive or motor function, among others.