Long-Term Experience of Chinese Calligraphic Handwriting Is Associated with Better Executive Functions and Stronger Resting-State Functional Connectivity in Related Brain Regions

Effect of increasing cognitive activity participation on default mode network in older adults with subjective cognitive decline: a randomised controlled trial

BACKGROUND

Having more cognitive activities may prevent dementia, but its evidence of modulating the functional brain network is limited. This randomised controlled trial (RCT) investigated the effect of increased cognitive activity participation on the default mode network (DMN) in older adults who had already been having regular cognitive activity participation and experiencing subjective cognitive decline (SCD).

METHODS

Community-living Chinese individuals aged 55-75 years with regular practice of Chinese calligraphy and screened positive for SCD (but negative for mild cognitive impairment or dementia) were randomly allocated to either the intervention or control group. Over 6 months, the intervention group doubled their weekly calligraphy practice time, while the control group maintained their usual amount of practice. The primary outcome was functional connectivities (FCs) of DMN, with pre-specified regions of interest including medial prefrontal cortex (mPFC), inferior parietal lobe (IPL), hippocampal formation (HF), posterior cingulate cortex (PCC), and lateral temporal cortex (LTC). FC changes were compared using repeated measures multivariate analysis of variance (MANOVA). This study is registered at the Chinese Clinical Trial Registry, ChiCTR1900024433.

FINDINGS

Between 15 January 2020 and 31 December 2021, 112 individuals consented and completed the baseline assessment. The participants, who had a mean age of 66.3 (SD 4.3) years, with 83 (74%) being women, had been practising calligraphy for an average duration of 9.7 years before enrolment and, in the preceding six months, for an average of 3.1 hours per week. 96 (86%) completed the post-intervention fMRI scan. Significant between-group differences were observed in the FCs between mPFC and right LTC (group difference = 0.25 [95% CI = 0.06-0.44], p = 0.009), mPFC and right IPL (0.23 [0.06-0.39]; p = 0.007), left HF and right LTC (0.28 [0.002-0.57]; p = 0.04), and left HF and right IPL (0.34 [0.09-0.60]; p = 0.009).

INTERPRETATION

Our findings, which reveal positive neuromodulatory effects with increased calligraphy practice, highlight the importance of engaging more in cognitive activities in late life for better brain health.

FUNDING

Research Grants Council, Hong Kong (grant number 24114519).

Chinese calligraphic handwriting practice promotes positive affect in adolescents: Converging evidence from correlational and experimental designs

Chinese calligraphic handwriting (CCH) practice has proven to be beneficial to several aspects of psychological health and has been considered a complementary therapy for mental disorders. However, less is known about whether CCH practice benefits an individual's positive affect, a core component of affective well-being. Therefore, we examined this question in Chinese adolescents by combining correlational and experimental methods. In Study 1 (N = 1460), we found that high school students who practiced CCH had higher positive affect in their daily lives than those who did not practice CCH. In Study 2, a training experiment was conducted with college students, who were randomly assigned to receive either CCH training or no treatment. A six-day short-term CCH training led to a significant benefit in positive affect in the training group (N = 23) relative to the control group (N = 27). Together, our study provides converging evidence that CCH practice can promote positive affect in adolescents, further supporting the promotion of CCH in mental health practice.

Self-Reported Beneficial Effects of Chinese Calligraphy Handwriting Training for Individuals with Mild Cognitive Impairment: An Exploratory Study

BACKGROUND

Dementia is a common disease in aging populations. The treatment has mainly focused on memory decline prevention and behavior control. Nonpharmacological treatments, such as cognition training, physical exercise, and music therapy have been effective in slowing memory decline. Chinese calligraphy handwriting (CCH) through breath regulation and fine hand control involves high concentration levels, emotion regulation, and self-awareness. CCH is a mind and body activity that is culturally relevant to older Chinese adults. This study evaluated the beneficial effects of CCH on mild cognitive impairment.

METHODS

In 2018, we conducted 8 weeks of CCH training at the Tri-Service General Hospital. The participants were asked to copy a regular script. At the end of the course, they gave oral presentations and showed their work. Self-report questionnaires on emotion, memory, upper limb coordination, attention, and language were collected before and after training.

RESULTS

The five questionnaires showed significantly positive feelings after CCH training. The conditions of emotional stability, concentration, hand movement, memory, and speech improved.

CONCLUSIONS

CCH training stimulated the brain and improved cognition, psychological symptoms, and hand stability. It is inexpensive and worthwhile for elderly Chinese individuals with mild cognitive impairment to take time daily to practice calligraphy.

The Impact of Motor Imageries on Aesthetic Judgment of Chinese Calligraphy: An fMRI Study

Previous behavioral studies on aesthetics demonstrated that there was a close association between perceived action and aesthetic appreciation. However, few studies explored whether motor imagery would influence aesthetic experience and its neural substrates. In the current study, Chinese calligraphy was used as the stimuli to explore the relationship between the motor imagery and the aesthetic judgments of a participant using functional magnetic resonance imaging. The imaging results showed that, compared with the baseline, the activation of the brain regions [e.g., anterior cingulate cortex (ACC), putamen, and insula] involved in perceptual processing, cognitive judgments, aesthetic emotional, and reward processing was observed after the participants performed motor imagery tasks. The contrast analyses within aesthetic judgments showed that the kinesthetic imagery significantly activated the middle frontal gyrus, postcentral gyrus, ACC, and thalamus. Generally, these areas were considered to be closely related to positive aesthetic experience and suggested that motor imagery, especially kinesthetic imagery, might be specifically associated with the aesthetic appreciation of Chinese calligraphy.

The effect of action observation on aesthetic preference of Chinese calligraphy: An fMRI study

INTRODUCTION

There is some evidence suggesting that movement perception has an effect on aesthetic experience. However, the neural mechanisms underlying the observation of creators' creative action (the process that calligraphers create calligraphy) remain unclear.

METHODS

In this study, participants were scanned with fMRI while performing aesthetic judgments on Chinese calligraphy images with/without action observation.

RESULTS

Behavioral results showed that both the work by the expert and novice with action observation were rated significantly higher on aesthetic preference than those without action observation. Imaging results showed that brain regions associated with perceptual, cognitive, and emotional processing were commonly activated by calligraphy images with/without action observation. However, compared with no action observation, aesthetic judgments of calligraphy images with action observation elicited stronger activation in the anterior cingulate cortex and the bilateral insula. Meanwhile, the superior parietal lobe which is associated with relevant inner action imitation, was also activated when observing the creator's action.

CONCLUSIONS

Brain activation in the superior parietal lobe, anterior cingulate cortex, and the bilateral insula indicated that observing the creative action of the creators contributed to the aesthetic experience of the observer.

Long-term Chinese calligraphic handwriting reshapes the posterior cingulate cortex: A VBM study

As a special kind of handwriting with a brush, Chinese calligraphic handwriting (CCH) requires a large amount of practice with high levels of concentration and emotion regulation. Previous studies have showed that long-term CCH training has positive effects physically (induced by handwriting activities) and psychologically (induced by the state of relaxation and concentration), the latter of which is similar to the effects of meditation. The aim of this study was to investigate the long-term CCH training effect on anxiety and attention, as well as brain structure. Participants were 32 individuals who had at least five years of CCH experience and 44 controls. Results showed that CCH training benefited individuals' selective and divided attention but did not decrease their anxiety level. Moreover, the VBM analysis showed that long-term CCH training was mainly associated with smaller grey matter volumes (GMV) in the right precuneus/posterior cingulate cortex (PCC). No brain areas showed larger GMV in the CCH group than the control group. Using two sets of regions of interest (ROIs), one related to meditation and the other to handwriting, ROI analysis showed significant differences between the CCH and the control group only at the meditation-related ROIs, not at the handwriting-related ROIs. Finally, for the whole sample, the GMV of both the whole brain and the PCC were negatively correlated with selective attention and divided attention. The present study was cross-sectional and had a relatively small sample size, but its results suggested that CCH training might benefit attention and influence particular brain structure through mental processes such as meditation.

Long-term Chinese calligraphic handwriting training has a positive effect on brain network efficiency

As a visual art form, Chinese calligraphic handwriting (CCH) has been found to correlate with certain brain activity and to induce functional connectivity reorganization of the brain. This study investigated the effect of long-term CCH training on brain functional plasticity as assessed with network measures. With the resting-state fMRI data from 31 participants with at least five years of CCH training and 40 controls, we constructed brain functional networks, examined group differences at both the whole brain and modular levels, and correlated the topological characteristics with calligraphy skills. We found that, compared to the control group, the CCH group showed shorter characteristic path lengths and higher local efficiency in certain brain areas in the frontal and parietal cortices, limbic system, basal ganglia, and thalamus. Moreover, these network measures in the cingulate cortex, caudate nucleus, and thalamus were associated with CCH performance (i.e., copying and creating skills). These results suggest that long-term CCH training has a positive effect on the topological characteristics of brain networks.

Chinese calligraphy handwriting (CCH): a case of rehabilitative awakening of a coma patient after stroke

INTRODUCTION

This study investigated the efficacy of Chinese calligraphy handwriting (CCH) for the awakening of patients under a vegetative state after stroke. The theories, the instrument, and the treatment protocols were reported. A single case of a severe stroke patient who was in a coma state for 2 years is presented in this study. The objectives were to apply finger writing as a new method to awaken a stroke patient in a coma state and to test the effect of this method in improving the patient's vegetative states over time.

CASE PRESENTATION

A 55-year-old man suffered a severe stroke in 2004 which left him in a coma for 2 years without any systematic rehabilitation. A culture-based finger-writing method of visual-spatial intervention was then applied to improve his condition. The writing tasks involved aided viewing and finger tracing of sets of innovative characters with enriched visual-spatial and movement characteristics. Following regular treatment protocols involving diverse movement and sensory feedback, the patient was awakened after 12 months. As a consequence, the patient showed significant behavioral changes favoring enhanced focusing, alertness, visual scan, visual span, and quickened visual and motor responses. The treatment continued for another 12 months. As the treatment progressed, we gradually observed improvements in his attention span and mental concentration. His eye ball movements - the left eye in particular - were quickened and showed wider visual angularity in his focal vision. Currently, the patient can now watch television, engage in improved visual sighting, and focus on visual-spatial and cognitive-linguistic materials.

CONCLUSION

This CCH method of training by finger tracking has shown its effectiveness in awakening the patient from his coma state and in producing long-term, clinical outcomes that were similar from those that took place 10 years ago. This finding supports the efficacy of the system for clinical improvement of the patient's conditions.