Development And Evaluation Of A Remote Creative Expressive Programe For Patient With Mild Cognitive Impairment

Objective: To develop a web-based program of creative expressive cognitive intervention for patients with mild cognitive impairment,evaluate the effects of remote creative expression program on cognitive function and psychological state of patients with mild cognitive impairment and explore the central mechanism of brain function changeable by using the web-based creative expression program.Methods: Remote creative expression program was developed based on our preliminary study and revised the program through experts meeting;A sample of 73 participants were recruited from a general hospital and a community health service center in Fujian,China.The eligible participants were randomly assigned to the remote creative expression group(r CE,n=38)and the health education group(HE,n=35)for 24 sessions in 12 weeks.All outcomes measure were undertaken at baseline,post-intervention using Montreal cognitive assessment scale(Mo CA),Mini-Mental State Examination(MMSE),Chinese version of Auditory Verbal Learning Test(AVLT),Verbal Fluency Tests(VFT),Boston Naming Test(BNT),Shape Trails Test(STT),Symbol Digital Modalities test(SDMT),Quality of Life-Alzheimer’s Disease(QOL-AD),Activity of Daily Living(ADL),Self-Rating Anxiety Scale(SAS),Geriatric Depression Scale(GDS),Self-esteem Scale(SES),General Perceived Self-Efficacy Scale(GSES),Memorial University of Newfoundland scale of happiness(MUNSH).A semi-structured interviews were used to elicit the MCI patients’ perceptions of the web-based creative expression cognitive intervention program;The MCI patients who completed the 12 weeks intervention from r CE group and the HE group were scanned using 3TMRI to compare the brain functional changes in the resting state.The Re Ho value and ROI-based functional connectivity magnetic resonance imaging analysis approach was performed to compare the inter-group differences.Result: The study constructed a remote creative expressive program which was feasible and applicable in MCI patients.Compared with HE group,the r CE group had a significant improvement in the total scores of Mo CA,AVLT,VFT,BNT,STT,SDMT,SES,QOL(P<0.05).For r CE group,there were significant improvement in the scores of Mo CA、MMSE、AVLT、BNT、STT_B、SDMT、GDS、SAS、MUNSH、GSES、SES(P < 0.05).For HE group,a significant improvement in Mo CA、AVLT、GSES(P < 0.05).The Re Ho of the two groups had interactive effects after intervention in right anterior cingulate gyrus / paraccingulate gyrus(F = 16.49,GRF correction)and left dorsolateral superior frontal gyrus(F = 17.49,GRF correction).Post test showed that compared with the HE group,the Re Ho value of the right anterior cingulate and paraccingulate gyrus(P < 0.05)and the left dorsolateral superior frontal gyrus(P < 0.05)in the r CE group increased after the intervention.Functional connectivity with bilateral posterior cingulate gyrus(PCC)as ROI showed that there was interaction effect between two groups after intervention in the right middle temporal gyrus(F = 18.20,GRF correction).After the intervention,the functional connectivity between PCC and right middle temporal gyrus in the experimental group was weakened,while that in the control group was enhanced;functional connectivity with bilateral ventral medial prefrontal cortex(vm PFC)as ROI showed that there was interaction effect between the two groups after the intervention in the left angular gyrus(F = 15.80,GRF correction)After the intervention,the functional connection between vm PFC and left angular gyrus was enhanced in the experimental group and decreased in the control group.Conclusion: The remote creative expression cognitive intervention is feasible,and applicable for MCI patients.Remote creative expression program can effectively improve the cognitive function and psychological state of MCI patients and alter the brain functional connection of MCI patients.