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Background Art-based interventions may delay cognitive decline and improve health-related outcomes in older adults with mild cognitive impairment (MCI). Objective To examine the effects of the Creative Expressive Arts-based Storytelling (CrEAS) program compared to active and waitlist controls on neurocognitive and other health-related outcomes in older people with MCI. Design Three-arm parallel-group, randomised controlled design. Participants One-hundred and thirty-five adults with MCI (mean age: 70.93 ± 6.91 years). Methods Participants were randomly assigned to intervention (CrEAS, n = 45), active control (n = 45) or waitlist control (n = 45) groups. Interventions were applied once per week for 24 weeks. The primary outcome was global cognitive function; secondary outcomes were specific cognition domains (memory, executive function, language and attention) and other health-related outcomes (anxiety, depression and quality of life [QoL]). All variables were measured at baseline (T0), 24-week follow-up (T1) and 48-week follow-up (T2). Results Participants in the CrEAS group showed significantly higher global cognitive function (adjusted mean difference [MD] = −0.905, 95% confidence interval [CI] −1.748 to −0.062; P = 0.038) and QoL (adjusted MD = −4.150, 95% CI -6.447 to −1.853; P = 0.001) and lower depression symptoms (adjusted MD = 2.902, 95% CI 0.699–5.104; P = 0.011) post-intervention at the 24-week follow-up compared with the active control group. At 48-week follow-up, only the Auditory Verbal Learning Test Immediate recall score was significantly improved compared with the active control group (adjusted MD = −2.941, 95% CI −5.262 to −0.620; P = 0.014). Conclusions Older adults with MCI who participated in the CrEAS program improved their neuropsychological outcomes and QoL and reduced their rate of cognitive deterioration.

IntroductionEarly 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 analysisThis 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 disseminationEthics 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 numberChiCTR1900021526.

Background: Mild cognitive impairment (MCI) is a stage of cognitive ability loss with intact activities of daily living and an increased risk for the development of dementia. Objective: This study evaluated the intervention effect of remote expressive arts program (rEAP) on cognitive function in older adults with MCI and investigated the underlying neurobiological mechanisms. Methods: We assigned 73 older MCI patients to receive rEAP or health education (HE), who underwent neuropsychological evaluation and resting-state functional magnetic resonance imaging before and after treatment. Neuropsychological scores were analyzed using SPSS software, and regional homogeneity (ReHo) values and seed-based functional connectivity (FC) were analyzed using Matlab software. Results: The rEAP group showed more significant improvements in cognitive function than the HE group. rEAP affected spontaneous brain activity and brain networks. The ReHo values in the right anterior cingulate/paracingulate cortex and the left dorsolateral superior frontal gyrus significantly increased and decreased, respectively, in the rEAP and HE groups. Further, ReHo value changes were significantly associated with the corresponding neuropsychological test score changes in the rEAP group. Moreover, the rEAP group showed decreased FC between the posterior cingulate cortex and the right middle temporal gyrus and increased FC between the ventromedial prefrontal cortex and left angular gyrus. Conclusion: The 12-week rEAP improved cognitive function in MCI patients. Additionally, the alterations of spontaneous brain network connections and activity helped improve and maintain cognitive function in MCI patients.

Background: Due to the heterogeneity of MCI, the key points of non-drug therapies cannot be determined. Exploring the characteristics among different MCI subgroups would therefore be beneficial in guiding the development of non-drug therapies. In the present study, weexplored subgrouping of older Chinese adults with MCI based on cognitive function and analyzed the characteristics of the resulting subgroups. Methods: A cross-sectional study was conducted between October 2018 and January 2022. The study enrolled a total of 1017 participants with MCI in Fujian, East China. Participants underwent a comprehensive neuropsychological test assessing memory, language, attention, and executive function and completed a questionnaire examining socioeconomic and clinical variables.Neuropsychological test scores were transformed to z-scores, which were then examined using latent class analysis. Correlations of socioeconomic and clinical variables with MCI subgroups were assessed using multinomial logistic regression analysis. Results: Three MCI subgroups were identified: (1) false-positive MCI (56.64%); (2) early MCI (36.28%); and (3) late MCI (7.08%). Age, data sources, marriage status, living status, and participation in intellectual activities differed significantly across the three MCI subgroups (P<0.05). Compared with the false-positive MCI group, participants with late MCI were less likely to participate in intellectual activity and more likely to live in a nursing home. Conclusions: Older Chinese adults with MCI can be classified into subgroups based on cognitive function. A large proportion of participants were classified in the false-positive MCI group, suggesting that conventional diagnostic criteria are susceptible to false-positive errors, resulting in patients being misdiagnosed as MCI in China. And further research to define the characteristics of different MCI subgroups could facilitate the development of non-drug therapies for MCI.