Effects of Remote Expressive Arts Program in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial

Abstract

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.

Effects of computerized cognitive training on biomarker responses in older adults with mild cognitive impairment: A scoping review

“…A rsfMRI study on computerized crossword training for four 30‐min per week sessions for 12 weeks and subsequent booster training until 72 weeks showed significantly enhanced FC within the default mode network (DMN) and FC between the DMN and salience network (SLN) with improvement in the 11‐item Alzheimer's Disease Assessment Scale‐Cognitive total score 29,34 . Another rsfMRI study using the Remote Expressive Arts Program for 60 min, twice weekly for 12 weeks, found significantly increased activation in the right ACC and left dorsolateral superior frontal gyrus related to improved attention, memory, and global cognitive function 33 …”

“…CCT enhances regional activity in areas of the hippocampus related to improvement in verbal memory 41 and in the temporal poles and insular cortices, which are related to improvement in global cognitive function, attention, memory, visuospatial configuration, and executive function 39 . It also enhances regional activity in the ACC and superior frontal cortex, leading to improved attention, memory, and global cognitive function 33 . Regarding the FC between brain regions, CCT enhanced the FC between the hippocampus and superior frontal cortex related to improvement in memory, 12 between the hippocampus and PCC, 37 between the frontal and occipital regions related to improvements in the RCFT copy task, 9 and between the DMN and SLN with improvement in overall cognitive function 29 .…”

“…41 Resting-state fMRI (rsfMRI) had shown significantly enhanced FC between the hippocampus and superior frontal cortex, with attenuation of memory decline in the CCT group after intervention with the COGPACK program. 12 In a study involving an online CCT program at the patient's home for 120-160 min/week with 3-4 sessions per week for 6 months, rsfMRI showed significantly increased regional activity at the bilateral temporal poles, insula 33…”

“…50 One possible reason for the efficacy of CCT in older patients with MCI is the enhanced regional activity in the insula and ACC. 29,33,39 However, some studies have reported contradictory results in these contexts. For example, studies have reported no structural change after WM training 35 or enhanced FC in the neural network after CCT involving non-crossword puzzles.…”

Opportunities for Joy: A Mindful Path to Self-Compassion and Compassion for the Neurodiverse

“…The expressive arts “include drawing, crafts, sewing, knitting, music, movement, dress-up, masks, dollhouse play, storytelling, going for nature walks, creating a garden, or playing in the outdoor sandbox…[with] objects [found] on nature outings, such as seashells, feathers, stones, acorns, chestnuts, and pine cones, [that] found their way into the sandbox” (Dhaese, 2011, p. 76). The expressive arts provide individuals with safe, nonpharmacological avenues of expression where they can drop their false self, transcend their lived experiences and circumstances, and choose who they are and who they want to be through their personal selection and interaction with objects in their environment (Dhaese, 2022; Luo et al, 2023). This therapeutic process, involving play using expressive arts, relies on counselors to see the abilities and potential of the individuals we serve while respectfully acknowledging the differentials in neurocognitive functioning across neurocognitive domains.…”