Visual art therapy as a treatment option for cognitive decline among older adults. A systematic review and meta‐analysis

Maintenance effects of short-period intensive creative expressive arts-based program (SPI-CrEAS) on cognitive function older adults with mild cognitive impairment: A pilot study

OBJECTIVES

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).

METHODS

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.

RESULTS

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.

CONCLUSIONS

The initial cognitive improvement following CrEAS was sustained at follow-up and boosted by SPI-CrEAS.

Visual art- and music-based interventions as adjuvants in the treatment of eating disorders: a systematic review and a theoretical model

AIM

To assess the effect of visual art- and music-based interventions in the treatment of eating disorders.

METHODS

This study was registered in PROSPERO (CRD42020161503). Six databases (CINAHL, EMBASE, Lilacs, PsycINFO, PubMed and The Cochrane Library) were consulted. The searches were performed on 19 June 2019, and updated on 18 March 2022. No restriction on language, date, or publication status was applied. Methodological quality was assessed using Joanna Briggs Institute's instruments. All steps were performed by two independent reviewers and a third participated in the event of disagreement.

RESULTS

Eight studies were included. Few statistically significant results were found. Overall, both interventions might help to reduce negative emotional states.

CONCLUSION

Visual art- and music-based interventions present limited and inconclusive scientific evidence in patients with eating disorders and therefore their effectiveness is currently unknown. A theoretical model is proposed to guide future research. Further studies are needed to clarify their clinical relevance.

The effects of visual art therapy on adults with depressive symptoms: A systematic review and meta-analysis

Depression constitutes a pervasive global mental health concern and stands as a principal determinant of elevated suicide rates worldwide. Recent empirical investigations have showcased the significant potential of visual art therapy (VAT) in ameliorating symptoms among individuals with depression. Nevertheless, specific studies have yielded findings marked by inconclusiveness, underscoring the imperative need for further research to comprehensively establish its efficacy. This study is a systematic review and meta-analysis of extant research, to ascertain the efficacy and effect size of VAT as an intervention for adults with depressive symptoms. A comprehensive search was conducted across 10 databases. The search encompassed articles published from the inception of these databases up until October 18, 2023. Two researchers screened the literature in accordance with inclusion and exclusion criteria and performed a thorough quality assessment. The original data and the data obtained from the literature were extracted for further analysis. The statistical analysis of the data was performed using Stata 17.0 software. fifteen studies were included, encompassing a total of 932 participants. The outcomes of meta-analysis unveiled a statistically significant effect of VAT in diminishing depressive symptoms among adults (SMD = -0.73; 95% CI, -1.07 to -0.39; p < 0.001; 15 randomised controlled trials (RCTs); low-quality evidence). The subgroup analysis indicated that VAT exhibited heightened effectiveness among adults below 65 years of age, with interventions lasting ≤12 weeks demonstrating superior efficacy. Additionally, sensitivity analysis underscored the robustness and reliability of the findings. VAT appears to alleviate depressive symptoms among adults. Existing research indicates that the effectiveness of VAT is influenced by factors, such as intervention population characteristics and intervention duration. However, to comprehensively probe the efficacy of VAT, future studies should strive for larger sample sizes, multicentre collaborations, and long-term follow-ups.

The Effect of Art Therapy on Pain, Emesis, Anxiety, and Quality of Life in Operated Breast Cancer Patients: Randomized Control Trials

Background: Breast cancer symptoms related to the disease nature and treatments develop and the quality of life of patients is impacted. Art therapy improves the quality of life by increasing symptom control and treatment compliance. This study aimed to determine the effect of art therapy on pain, emesis, anxiety, and quality of life in operated breast cancer patients. Methods: This experimental research was carried out with a total of 60 patients, 30 in the intervention group (IG) and 30 in the control group (CG), who received treatment in the Oncology Center of Sivas Cumhuriyet University Practice and Research Hospital. A Personal Information Form, the Pain Intensity-Visual Analog Scale, the Rhodes Index of Nausea, Vomiting, and Retching, the Beck Anxiety Inventory, and the Functional Assessment of Cancer Therapy Scale-General (FACT-G) were used to collect research data. Within the scope of the research, IG received chemotherapy sessions for 10 weeks (five sessions) with 2-week intervals by an art specialist in marbling, accompanied by ney music. CG received no intervention. The obtained data were uploaded to the SPSS (22.0) program and statistical analysis was performed. Results: The decrease in the pain, nausea-vomiting, and anxiety levels of the patients in IG and the increase in their quality of life after the art therapy accompanied by ney music were statistically significant compared with the first follow-up (p < 0.05). There was no statistically significant change in the quality of life of the patients in the CG, whereas their pain, nausea-vomiting, and anxiety scores increased. According to the comparison between IG and CG, there was a significant difference in favor of IG in terms of pain severity, quality of life, emesis, and anxiety levels (p < 0.05). Conclusions: The art of marbling with ney was effective in operated breast cancer patients experiencing pain, emesis, and anxiety and improved their quality of life. Clinical Trial Registration: NCT05666583.

Visual art therapy and its effects in older people with mild cognitive impairment: A systematic review

INTRODUCTION

Mild cognitive impairment (MCI) is a known risk factor for the development of dementia. The potential benefits on cognition from non-pharmacological measures such as art-based interventions are of increasing interest. This systematic review examines the evidence for the impact of one form of art-based intervention, visual art therapy (VAT), on the cognition and psychological wellbeing of older people with MCI.

METHODS

Randomised controlled and quasi-experimental trials evaluating the efficacy of VAT in older persons aged over 60 years with MCI were included. A search was performed on electronic databases: MEDLINE, CINAHL, Embase and PsycINFO. Joanna Briggs Institute critical appraisal and extraction tools were utilised for risk of bias assessment and data extraction, respectively. A narrative descriptive approach was used to outline the findings.

RESULTS

Seven studies were identified from 4311 articles screened. Improvement in cognition was reported in five studies, with two of these reporting sustained improvement at 6-9 months, while the remaining three studies showed improvement only at the immediate post-intervention period. A positive impact was reported in four of six studies that examined the effect of VAT on participant psychological wellbeing. The overall methodological quality of the studies ranged from moderate in four of five RCTs, to high in the quasi-experimental studies and one RCT. However, the low study power in the context of small sample sizes limits the applicability of these studies to the population of interest.

CONCLUSIONS

VAT is potentially an effective non-pharmacological intervention that may enhance cognition and provide benefits for psychological wellbeing in older persons with MCI. Given the limited studies available, with the majority emerging over the last 5 years, further research is required to confirm these reported benefits, as well as to determine whether VAT impacts on the progression of cognitive decline in MCI.

Effects of participatory 'A'rt-Based Activity On 'Health' of Older Community-Dwellers: results from a randomized control trial of the Singapore A-Health Intervention

Introduction

The practice of participatory art has been found to support the promotion, prevention, and management of health across the lifespan. However, clinical trials investigating the benefits of creative activities curated with and conducted in museums among older adults in East Asia remains limited.

Methods

The current research utilized a single-site, open-label randomized control trial (RCT) to evaluate a standardized Participatory 'A'rt-Based Activity On 'Health' of Older Community-Dwellers - the Singapore A-Health Intervention. Outcome measures include frailty as assessed by the Centre of Excellence on Longevity Self-administered Questionnaire, wellbeing as assessed by the Warwick-Edinburgh Mental Wellbeing Scales, and quality of life as assessed by the EuroQol-5D. 112 participants aged 60 and above were randomized into the intervention group (n = 56) or an inactive control group (n = 56). Participants completed four standardized online self-administered assessments at baseline, 5-week, 9-week and 12-week follow-up during the intervention period.

Results

Linear mixed model analyses revealed no statistically significant differences between the intervention group and control group for all outcome measures. However, within the intervention group, a consistent significant reduction in frailty was observed across time from baseline to 9 weeks (MD -0.44, 95% CI -0.85 to -0.039, p = 0.032), 5-weeks to 9-weeks (MD -0.64, 95% CI -1.03 to -0.24, p = 0.002), and 5-weeks to 12-weeks (MD -0.51, 95% CI -0.91 to -0.10, p = 0.014). Moreover, the post-test mean wellbeing score in the intervention group significantly improved over time at 9-weeks (MD 1.65, 95% CI 0.09 to 3.22, p = 0.039) and 12-week (MD 2.42, 95% CI 0.67 to 4.16, p = 0.006) as compared to baseline scores.

Discussion

The findings demonstrate the potential of a structured art and museum-based intervention as a resource for promoting health among aging populations. Such benefits transcend social, cultural, and societal contexts.

Clinical trial registration

ClinicalTrial.gov, NCT05945589.

Art therapy in Alzheimer's disease. An opportunity of collaboration between intersectoral public and private organizations in the co-design of health and social care services

Introduction

The World Health Organization (WHO) has recognized art therapy as an effective supportive mechanism for the maintenance and restoration of mental health. In recent years, art therapy has been integrated in the assistance pathways of older people affected by neurocognitive disorders according to the demonstrated benefits, as no conflicts with pharmacologic treatments and the reduction of anxiety and stress. The shortage of organizational, economic, and professional resources in social-health public organizations does not allow for guaranteeing the provision of these services without the help of the private ones, not exclusively belonging to social-health sector. This research aims to investigate how the collaboration between public and private organizations of different sectors in the co-provision of non-pharmacological approaches guarantees the economic sustainability and the quality improvement of the provided services.

Methods

The Alzheimer Café of Prato was selected as a significant case study.

Results and Discussion

Art therapy programs intended for taking care of older people in the first stages of the Alzheimer's disease have been developed, planned, supplied, and managed over the years as a result of the integration of resources, ideas, and professionals provided both by public and private sectors, the social-health sector, and cultural organizations.

Conclusions

The peer-to-peer co-responsibility of all organizations (public and private, from the cultural sector as well as the social and health sector) involved in the co-design of art therapy programs, not limiting their actions to only co-financing and/or co-delivery of the service, enabled the achievement of the economic sustainability of the services and the improvement of their quality.

Combined exercise and cognitive interventions for adults with mild cognitive impairment and dementia: A systematic review and network meta-analysis

BACKGROUND

Exercise and cognitive interventions are beneficial for adults with preclinical and clinical dementia, but it is unclear whether the combination of these two components could generate synergistic benefits and what intervention designs would optimize this effect.

OBJECTIVES

This review aims to compare the effects of combined exercise and cognitive interventions on cognitive, psychological, functional outcomes, and health-related quality of life with the corresponding single approach and control groups in adults with mild cognitive impairment and dementia. It also aims to identify the optimal intervention design and factors affecting treatment effects.

METHODS

A comprehensive search was conducted in ten databases from inception to 23rd November 2022. The methodological quality of studies was evaluated by the Cochrane risk of bias tool. Pairwise meta-analyses were performed to assess the effects of combined interventions relative to the single type of intervention and control groups, with further subgroup analysis to explore the factors affecting treatment effects. Network meta-analyses were used to identify the optimal intervention components.

RESULTS

Twenty-nine randomized controlled trials involving 2910 participants were included. The results of pairwise meta-analyses indicated that combined interventions were superior to exercise in improving response inhibition, working memory, and delayed recall, but were not superior to cognitive interventions in all outcomes. Combined interventions were superior to active/passive controls in improving global cognition, response inhibition, immediate recall, delayed recall, category fluency, processing speed, and visuospatial ability. Influences of the clinical severity of dementia (mild cognitive impairment vs dementia), combination format (sequential vs simultaneous combination), mode of delivery (group-based vs individual-based vs mixed), training duration (short: ≤12 weeks vs medium: 13-24 weeks vs long: >24 weeks), and types of control (active vs passive control) were not detected. The network meta-analysis results indicated that the optimal intervention components varied across different outcomes, with multimodal exercise combining cognitive training demonstrated the greatest effects among all other combined or single component interventions in improving global cognition.

CONCLUSIONS

This review suggests the advantage of combined interventions over exercise with comparable effects when compared with cognitive interventions in the population with mild cognitive impairment and dementia. Full scale multi-arm randomized controlled trials to compare the effects of combined interventions with cognitive interventions are warranted.

Evaluating an intergenerational art and storytelling program with older adults and medical students

Older adults in residential communities face loneliness and isolation, challenges exacerbated by COVID-19, leading to adverse physical and mental health outcomes. Intergenerational arts and humanities programs have been successful in addressing these challenges while also enabling medical learners to better understand aging populations. Draw YOUR Story, a program at a Houston residential senior living community, connects premedical and medical student volunteers with older adults through an art and storytelling activity. To evaluate the program, we conducted a focus group with older adults and pre and post-volunteering student surveys with questions about attitudes towards older adults and an Interpersonal Reactivity Index. Student surveys (n = 18) showed increased comfort working with older adults after volunteering (p = 0.02). Students who spent less time volunteering reported a decline in their perceptions of older adult quality of life, when compared to more frequent volunteers (p = 0.02). Older adults shared that the program encouraged learning new skills, offered time for reflection, connected them to medicine, and furthered desire for community. Draw YOUR Story benefitted students and older adults, increasing student comfort with older adults, providing aging adults opportunities to learn new skills and reflect, and building intergenerational connections.

The deficiency of 5-methylcytosine (5mC) and its ramification in the occurrence and prognosis of colon cancer

The incidence and mortality of colon cancer are increasing, and effective biomarkers for its diagnosis are limited. 5-methylcytosine (5mC), a vital DNA methylation marker, plays important roles in gene expression, genomic imprinting, and transposon inhibition. This study aimed to identify the predictors of colon cancer prognosis and lay the foundation for research on therapeutic targets by detecting the levels of 5mC, 5-hydroxymethylcytosine (5hmC), 5-formyl cytosine (5fC), and 5-carboxylcytosine (5caC) in colon cancer and adjacent non-tumor tissues. A tissue microarray including 100 colon cancer tissue samples and 60 adjacent non-tumor tissue samples was used. The expression levels of 5mC and its ramifications were assessed by immunohistochemistry. According to the expression levels, patients were divided into moderately positive and strongly positive groups, and the correlation between clinicopathological characteristics and methylation marks was assessed using 2-sided chi-square tests. The prognostic values of 5mC, 5hmC, 5fC, and 5caC were tested using Kaplan-Meier analyses. Compared with adjacent non-tumor tissues, the overall levels of DNA methylation were lower in colon carcinoma lesions. However, the clinical parameters were not significantly associated with these methylation markers, except for 5hmC, which was associated with the age of cancer patients (P value = .043). Kaplan-Meier analysis disclosed that moderate positive group had a significantly shorter disease specific survival than strong positive group for patients with different levels of 5mC (65.2 vs 95.2 months, P = .014) and 5hmC (71.2 vs 97.5 months, P = .045). 5mC and its ramifications (5hmC, 5fC, and 5caC) can serve as biomarkers for colon cancer. 5mC and 5hmC are stable predictors and therapeutic targets in colon cancer. However, further understanding of its function will help to reveal the complex tumorigenic process and identify new therapeutic strategies.

Effect of self-determination theory-based integrated creative art (SDTICA) program on older adults with mild cognitive impairment in nursing homes: Study protocol for a cluster randomised controlled trial

BACKGROUND

The cognitive benefits of early non-pharmacological approaches have been demonstrated in older adults with mild cognitive impairment (MCI). However, older adults living in nursing homes have more severe cognitive impairment problems and lower initiative and compliance to participate in complex interventions. Hence, it important to investigate more attractive and sustainable methods to prevent or delay cognitive decline. The present study adopts the self-determination theory (SDT) as a theoretical framework to innovatively develop an integrated art-based intervention for older adults with MCI in nursing homes in China and aims to evaluate its effects on cognitive function, mental health, and other health-related outcomes.

METHODS

The study is a nursing home-based, cluster randomised controlled trial (RCT) that targets older adults (aged ≥ 60 years) with MCI in Fuzhou City, China. All nursing homes in the area covered by Fuzhou City are invited to participate. Eligible nursing homes are randomised to one of two groups: intervention group (receive a 14-week, 27-session intervention) and waitlist control group (receive the usual care). The SDT-based integrated creative art (SDTICA) program reasonably adopts the SDT as a theoretical framework to innovatively develop an integrated art-based intervention for older adults with MCI in nursing homes. The primary (global cognitive function and psychological indicator) and secondary (daily activity function, social function, and specific domains of cognitive function) outcomes will be measured at baseline, after the intervention, and during follow-up.

DISCUSSION

This study aims to evaluate the effects of SDTICA program on neuropsychological outcomes in older adults with MCI and provide scientific evidence for art-based non-pharmacologic interventions in nursing homes, which may reduce dementia risk in older adults with MCI.

TRIAL REGISTRATION

The trial was prospectively registered at the Chinese Clinical Trials Registry with the registration number ChiCTR2200061681 on 30 June 2022.

A participatory arts programme – Shared experience for family caregivers and care recipients

AIM

This study aimed to describe family caregivers of older people's experiences of participatory art interventions, including music, dance and visual arts.

DESIGN

A descriptive qualitative study.

METHODS

Thematic interviews were conducted with 12 family caregivers. Qualitative data were analysed with thematic analysis.

RESULTS

The results illustrated the meaning of art groups, which included a shared feeling of togetherness, empowering and activating peer support and a sense of communality. Art groups also represented a hobby, enhancing caregivers' social and mental well-being. The art groups could be described as an art-driven, participatory shared experience. Participatory arts are noteworthy contributors to the well-being of family caregivers and care recipients, especially from peer support and communality. Further research is needed to find out about participants' preferred art-based activities and their impact on their well-being. No patient or public contribution because of inflexibility in the timing of engagement.

Evaluation of Expressive Arts Therapy on the Resilience of University Students in COVID-19: A Network Analysis Approach

As an alternative to traditional verbal counselling, expressive arts therapy has been shown to be an effective method of mental health care, particularly when dealing with stressful public interactions, such as those associated with COVID-19. However, few studies have been conducted to determine the efficacy of expressive arts therapy on the resilience of psychologically exposed university students during COVID-19. Furthermore, since network analysis appears to be a popular approach in psychological research, it has not been used in recent intervention studies for resilience. As a result, the current study utilized a network analysis approach to determine the efficacy of expressive arts therapy on the resilience of university students during the COVID-19 pandemic. A total of 263 students in a comprehensive university in China were selected for the therapy group between March and November 2021. In a pre-post design, students’ resilience was assessed using the Resiliency Scale for University Students (RSUS). The extended Bayesian information criteria (EBIC) and graphical LASSO were used to estimate and define paired resilience networks, and the strength, betweenness, and closeness indices were utilized to determine the centrality of the six facets of resilience. Additionally, we verified the stability and accuracy. It was discovered that significant differences appeared between the paired networks before and after expressive arts therapy. Facets of self-efficacy, self-acceptance and problem-solving in resilience were notably improved after the therapy, with the variable of emotional stability sustained at the mean level. Meanwhile, the network analysis has highlighted the central variable of self-efficacy in the pre-intervention and support from friends in the post-intervention. The connectivity among the components of problem solving, support from friends, and support from family was enhanced, with support from friends playing the role of hub nod in the following network. By utilizing a network analytic approach, expressive arts therapy can be more targeted in intervening in resilience mechanisms. As a proxy for efficacious problem-solving, intervention should be calibrated to the cultivation of social support networks, especially in the support from friends.

Non-Pharmacological Treatments of Neuropsychiatric Symptoms in Mild Cognitive Impairment (MCI)

Mild cognitive impairment (MCI) is a syndrome defined by objective cognitive deficits that do not impact functional independence. Individuals with MCI develop dementia at an annual rate of 10 to 15%. Neuropsychiatric symptoms (NPS) are common non-cognitive features of neurocognitive disorders and have a major impact on the wellbeing and quality of life of affected individuals and their families. Non-pharmacological interventions for NPS are considered the first-line treatment because of the limited efficacy and side-effect potential of current pharmacological agents. This article summarizes the literature on non-pharmacological treatments for NPS in MCI. The limited number of studies specific to individuals with MCI and its various etiologies, as well as the overall heterogeneity of research design and methodologies, make the evidence base inconclusive. Nevertheless, some studies support psychosocial interventions aimed at individuals with MCI and their caregivers.

Crafting Life Stories in Photocollage: An Online Creative Art-Based Intervention for Older Adults

Creative arts therapies (CAT) provide a safe and creative environment for older adults to process life experiences and maintain personal growth while aging. There is a growing need to make creative arts therapies more accessible to the aging population, as many have limited access to these services. This need has been catalyzed by the advent of the COVID-19 pandemic. Tele-CAT offers a possible solution. This study explored the experiences of older adults who participated in an online creative process of digital photocollage based on CAT. Twenty-four Italian and Israeli community-dwelling older adults aged 78 to 92 participated in this research through Zoom teleconferencing software. Transcriptions of the sessions and the art produced through the photocollage were qualitatively analyzed through Thematic Analysis. The findings show that the projective stimuli of digital photographs supported older adults' narratives and engaged them in a more embodied emotional experience. Participant experiences involved artistic enjoyment within a positive and safe interaction with therapists. The creation of digital photocollages allowed the participants to process their life experiences and create an integrative view of their life, a vital developmental task in late life. These results point to the advantages and challenges of tele-CAT for older adults.

Benefits of Cultural Activities on People With Cognitive Impairment: A Systematic Review

Museums and cultural institutions are increasingly striving to respond to the interests and needs of the society that hosts them. This means, apart from other actions, that these institutions must be involved in the health and wellbeing of society, and the creation of cultural activities aimed at people with cognitive impairment, a group of individuals that is growing worldwide due to the aging of society and the increasing prevalence of dementia. The involved sectors are aware of the potential and benefits of activities for this population, even though there is much research to be conducted. To date, no systematic review has focused on the benefits of cultural activities for cognitively impaired people. This study aimed to explore the benefits of different modalities of cultural activities with evidence from 145 studies from various databases, which met the inclusion criteria. Significant improvements in general cognition, quality of life (QoL), emotional wellbeing, socialization, and communication were generally reported after interventions, with a reduction in depression symptoms. There was not enough evidence to prove memory, language, or daily functioning improvements attributable to cultural interventions. There were no significant reductions reported in apathy, sadness, agitation, or anxiety.

Visual art therapy and cognition: Effects on people with mild cognitive impairment and low education level

OBJECTIVES

The aim of this study was to examine the effects of visual art therapy (VAT) on cognition, psychological and functional ability of people with mild cognitive impairment (MCI) and low education.

METHOD

A single-blinded randomized controlled trial was conducted among 127 older adults with MCI, mean age 73.6 years and level of education in years, (median (range)) = 0 (0 - 9). The intervention group received 12 VAT sessions over six weeks. The control group received six health education sessions. The outcomes measures at baseline, immediately after intervention, at three-months and six-month follow up included global cognitive functions, depression, mental wellbeing and instrumental activities of daily living functions.

RESULTS

The intervention group demonstrated greater improvement than the control group in global cognition (β =2.56, (95% CI =1.16, 3.97), p< .001, standardized mean difference (SMD) = 0.75), and depression (β =-2.01, (95% CI =-3.09, -0.93), p< .001, SMD = -0.93) immediately post intervention. The effects on cognitive functions were sustained at three and six-months follow ups. The differential effect of VAT on mental wellbeing and functional ability compared to health education were undetectable.

DISCUSSION

Visual art therapy can improve cognitive functions and mood status of older adults with MCI who have no or low education.

Personalized treatment interventions: nonpharmacological and natural treatment strategies in Alzheimer's disease

Introduction: Alzheimer's disease (AD) is a slow, irreversible, progressive, complex, and fatal neurodegenerative disorder. Available pharmacological treatment, known for almost two decades, does not cure the disease, but only alleviates the symptoms, with various efficacy and different side effects. Therefore, there is an unmet need to find other person-centered or personalized approaches to treat AD.Areas covered: This article describes the application of precision medicine-like approaches utilizing nonpharmacological treatment strategies and the use of natural products in personalized care for patients with AD.Expert opinion: Due to the heterogeneity of disease symptoms, somatic conditions, and patient preferences, there is definitely no "one size fits all" intervention. Therefore, individualized treatment choice is based on dementia stage, medical and psychiatric comorbidity, leading symptoms, patient preferences, and remaining capacity of the patient. In the absence of disease-modifying agents, a patient-centered, multidisciplinary team approach appears to be the best option to alleviate the heavy symptomatic burden in this unfortunate population. Hence, appropriate interventions can be offered along the AD continuum, while a better understanding of personal characteristics might help in establishing optimal individualized treatment, as well as its duration and intensity, to deliver interventions in the most effective ways.

Effects of Creative Expressive Arts-based Storytelling (CrEAS) programme on older adults with mild cognitive impairment: protocol for a randomised, controlled three-arm trial

INTRODUCTION

Early non-pharmacological interventions can prevent cognitive decline in older adults with mild cognitive impairment (MCI). Creative expression (CrExp) can potentially mitigate cognitive decline and enhance the physical and mental health of older people. However, it is unclear whether activities involving CrExp can improve cognitive function and other health-related outcomes in older adults with MCI. The aim of the present study is to develop a Creative Expressive Arts-based Storytelling (CrEAS) programme that integrates verbal and non-verbal expressive activities and evaluate its effectiveness in improving cognitive function and other outcome indicators so as to explore its possible mechanism from the perspective of neuroimaging.

METHODS AND ANALYSIS

This parallel randomised controlled trial with three arms (one intervention and two control arms) will be conducted over a 24-week period. A total of 111 participants will be enrolled and randomised to the CrEAS, recreation and usual activity groups. The CrEAS programme combines visual arts therapy and storytelling (TimeSlips) under the Expressive Therapy Continuum theoretical framework and provides an opportunity for people with MCI to actively engage in activities to improve cognitive function through verbal and nonverbal CrExp. Global cognitive function, specific domains of cognition (memory, executive function, language and attention) and other health-related outcomes (anxiety, depression and quality of life) will be measured at baseline, at the end of the intervention, and at the 24-week follow-up. Structural/functional brain MRI data will be collected at baseline and immediately after the intervention.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of Fujian Provincial Hospital (K2018-03-061). The study results will be disseminated through peer-reviewed journals and at academic conferences.

TRIAL REGISTRATION NUMBER

ChiCTR1900021526.