The Effectiveness And Central Mechanism Research Of Creative Expression Cognitive Intervention To Mild Cognitive Impairment Of The Elderly

Objectives: 1? To establish the programme of creative expression cognitive intervention for Chinese MCI older adults.2? To evaluate the influence of the cognitive ability,ability of daily life and brain electrical physiological signals by using creative expression cognitive intervention programme.3? To explore the central mechanism of brain function changeable by using the creative expression cognitive intervention programme.Methods:1? A total of 30 MCI older adults from Public Hospital or Elderly activity center who are meeting inclusion and exclusion criteria were allocated into “The Standard Pathway of Creative Storytelling Therapy for Chinese Elderly Patients with Dementia” for 12 session in 6weeks.Using 3 rounds action research(4 process included planning,action,observation,reflection)to established the creative expression cognitive intervention programme for Chinese MCI older adults after optimizing and improving the former standard pathway.Data were collected and analyzed in combination of qualitative research(observation,interviews)and quantitative(questionnaire,scale)to evaluate the feasible and effects.2? Atotal of 63 MCI older adults from Public Hospital or Elderly activity center who are meeting inclusion and exclusion criteria were randomized into either a creative expression(CE)group(n=30)or a general social activity(SA)group(n=33)for 25 sessions in 16 weeks.All outcomes measures were undertaken at baseline,post-intervention and 6-month follow-up using Montreal Cognitive Assessment,Chinese Auditory Verbal Learning Test,Chinese Verbal Fluency Test,Digit Span Test,Trail Making Test,Alzheimer's Disease Assessment Scale Cognitive Subscale,Activity of Daily Life Chinese Version,Quantitative EEG and Event Related Potential P300.3? The MCI older adults who were completed the 16 weeks intervention from the creative expression(CE)group(n=18)andthe general social activity(SA)group(n=18)were studied using 3TMRI scanner to compare the functional change of intrinsic connectivity networks in the resting brain and tasking state.The seed-based and voxel-basedmorphometric(VBM)intrinsic functional connectivity magnetic resonance imaging analysis approach was performed to compare the difference of inter-group and self-groupbefore intervention and 6-month follow-up.Results: 1? Although there were no statistical difference inthe score of Mo CA(t=1.27,P=0.37)and ADL(t=0.89,P=0.39)after proceeding creative expression cognitive intervention activities,the feasibility and effects still can be objectively estimated from the site observation?interpersonal interviewsand feedback.Preliminary established the “Creative Expression Cognitive Intervention Programme” for Chinese MCI older adults after optimizing and improving four parts of the standard pathway(evaluation,preparation,process,notes).2? The result of repeated-measures ANOVA revealed that the CE group showed significant within-group improvements in Mo CA?ADL?AVLT?VFT?DST?TMT?ADAS-cog,?band??band??/?value of QEEG andlatency?reaction time of ERP-P300 at post-intervention and at 6-month follow-up.The SA group showed no significant within-group improvements in Mo CA?ADL?AVLT?VFT?DST?TMT?ADAS-cog,but has significant improvements in?band of QEEG,also the latency andreaction time of ERP-P300 at post-intervention and at 6-month follow-up.At post-intervention,results of ANCOVA showed the CE group demonstrated significant between-group differences for Mo CA?ADL?AVLT?VFT?DST?TMT?ADAS-cog,?band??band??/?value??+?/?+?value in temporal lobe of QEEG,also the latency andreaction time of ERP-P300.During 6-month follow-up,significant between-group differences were still evident in the CE group for all the outcomes.3? The CE group showed deactivation significantly morethan the SA groupinright angular gyrus,cingulate gyrus,precuneus and activation in supplementary moto area using the hippocampus seed-based rs-f MRIanalysis,also showed activation in left-right angular gyrus usingthe VBMrs-f MRIanalysis.During creative expression task,the SA group showed positive connectivity in right frontal lobe and negative connectivity in bilateral frontal lobe,right temporal lobe,and precuneus.Among them,part of the brain regions showed positive activation included bilateral frontal lobes and precuneus,part of the brain regions showed negativeactivation included bilateral frontal and right temporal lobe.During creative expression task,the CE group showed positive connectivity in anterior cingulate gyrus,inferior-superior frontal gyrus,right lentiform nucleus/putamen,superioroccipital gyrus,cuneus and negative connectivity in right temporal lobe,bilateral occipital lobe,left parietal lobe,precuneus and posterior cingulate.Among them,part of the brain regions showed positive activation included anterior cingulate,inferior-superior frontal gyrus,right temporal lobe,precuneus and posterior cingulate,part of the brain regions showed negativeactivation included right lentiform nucleus/putamen,cuneus,bilateral occipital lobe and left parietal lobe.During creative expression task,the CE group had greater activation than the SA group in larger areas involving right frontal lobe,bilateral occipital lobe,precuneus and posterior cingulate gyrus.No obvious difference found in negative activation.Conclusion:1? The creative expression cognitive intervention programme can help MCI older adults to inspire their creative thinking ability and language expressive,restore confidence and hope themselves,enhance interpersonal communication.Itmay afford as a feasible and cost-effective social support method for Service Industry for Elderly.2? The creative expression cognitive intervention programme is feasible for improving cognitive functions and ability of daily life of older adults with mild cognitive impairment.The QEEG and ERP-P300 also can be served as effective and sensitive evaluation tools for the non-pharmacy intervention in cognitive research.3? The creative expression cognitive intervention programme can increased the ranges and strength of the brain connectivity networks.Brain regions included right frontal lobe,bilateral occipital lobe,precuneus and posterior cingulate gyrus maybe related to the its effects.