Development and Evaluation of a Psychomotor Rehabilitation Nursing Plan for the Older Adults With Mild Cognitive Impairment to Promote Cognitive Health
Phase: NA
Conditions: Mild Cognitive Impairment (MCI)
Sponsor: Jinzhou Medical University

Page 1 of 48
Development and Evaluation of a Psychomotor
Rehabilitation Nursing Plan for the Elderly with
Mild Cognitive Impairment to Promote Cognitive
Health
Research Proposal
February 2025
Protocol ID: JZMULL2025230
Ethics Approval Number: USM/JEPeM/PP/24090806

Page 2 of 48
Exclusive summary of research proposal (max 300)
(Include the problem statement, objectives, research methodology, expected output/
outcomes/ implication, significance of output from the research project)
With the aging of the population, the number of older adults with mild cognitive
impairment (MCI) has increased year by year, which has caused serious social and family
burdens. At present, the existing drug treatment effect is limited. Studies show the application
value of non-drug treatment in the older adults with mild cognitive impairment. Psychomotor
Therapy (PMT) is now widely used in European countries and has formed an independent
scientific system. Therefore, this topic pays attention to older adults with mild cognitive
impairment, intending to promote cognitive stimulation, using PMT methods to build a
rehabilitation nursing plan. Relying on older adults care institutions, older adults with mild
cognitive impairment in a certain period were divided into a control group (CG) and an
experimental group (EG). Older adults will be engaged in a 12-week PMT rehabilitation
nursing plan involving relaxation and breathing exercises, face exercises, hand exercises, and
mind exercises to promote cognitive health. SPSS 28.0 software was used to analyze data.
The comparison of scores of various scales are based on paired t-test statistical methods. The
P value <0.05 will be considered to indicate statistically significant with 95% confidence
interval (CI). The rehabilitation effect of the two groups was evaluated according to cognitive
assessments (Montreal Cognitive Assessment, MoCA), psychological assessment (Positive
and Negative Syndrome Scale, PANSS), and emotional assessment (Hamilton Depression
Rating Scale, HAMD-17; Hamilton Anxiety Rating Scale, HAMA-14) . The expected
findings of this study may be useful for cognitive rehabilitation plans for the elderly in care
institutions, rehabilitation hospitals, communities, and families.
Introduction
Research background
In the wake of demographic shifts, China is experiencing the profound effects of an
aging population. In 2022, China's population aged 65 and over was estimated to be 196
million, accounting for nearly 13.7% of the total population (Feng & Wu, 2023). With the
change in population structure, China faces unprecedented challenges in health care, social
welfare, and economic sustainability, which has a profound impact on the aging of the

Page 3 of 48
population, and cognitive impairment has become the most prominent problem in an aging
society. Studies have shown that the overall prevalence of cognitive impairment in people
aged 60 years and above in China is estimated to be 6% (95% CI: 5.8% ～6.3%)( Jia L et al.,
2020), which increases the pressure on families, caregivers, and the healthcare system, and
poses economic challenges to the country.
Similarly, population aging is a general trend around the world. According to the United
Nations, by 2050, 1/6 of people in the world will be over 65 years old, compared to 1/11 in
2019 (Bott N T et al., 2019). As the number of elderly people increases year by year, the
prevalence of cognitive impairment in older adults is also increasing. It is reported that about
5-10% of people over 60 years old in the world suffer from dementia (Liu Xuan & Xiao
Zemei, 2020). Dementia is a disease characterized by cognitive decline with memory loss and
impaired judgment. It not only affects the quality of life but also puts tremendous pressure on
the world’s healthcare systems and social support systems. Effective intervention measures
are urgently needed to address this public health problem.
Mild Cognitive Impairment (MCI) refers to the prodromal stage of dementia that
generally does not severely affect daily functioning, associated with an increased risk for
Alzheimer’s disease and other dementia. The clinical manifestations of MCI mainly include
the decline of memory, language function, attention, executive function, visual-spatial
structural function, and calculation ability, as well as sensory impairment and thinking
disorder. While not all individuals with MCI will develop dementia. Studies have shown that
MCI patients have a much higher risk of developing dementia than people with normal
cognition. Early identification and intervention of MCI patients can slow or prevent the
progression of dementia, thereby reducing the personal, social, and economic burden of
dementia (Alzheimer’s Disease International 2011).
In recent years, there has been a large amount of literature in China that explores various
aspects of dementia, including risk factors, biomarkers, diagnostic criteria, and intervention
strategies (Fu Yuxiang, 2021; Tian Huan et al., 2021). However, there are still some
limitations for MCI. The diagnostic criteria and assessment tools for MCI in the Chinese
population are still not unified, resulting in differences in prevalence estimates and diagnostic
methods in different studies. In addition, there are insufficient longitudinal studies on the
progression of MCI to dementia in older adults in China, which limits our exploration of the
trajectory of the disease. Similarly, there is still no consensus on the heterogeneity of the MCI
population, inconsistent diagnostic criteria, and the best treatment methods (Van der Steen,

Page 4 of 48
2017). Furthermore, the translation of research findings into clinical practice remains a
significant bottleneck, with few evidence-based interventions available for preventing or
delaying the onset of dementia among individuals with MCI.
Alzheimer’s Disease International has advocated for and funded several studies,
including some investigating the effectiveness of pharmacological and non-pharmacological
interventions for early dementia (Alzheimer’s Disease International 2011). There is a great
deal of ongoing research into pharmacological treatments, but traditionally, less research has
been done into non-pharmacological treatments (Van der Steen, 2017). Interventions can be
broadly divided into those aimed at modifying the course of the disease, those targeting the
cause of the disease, and those controlling the manifestations of the disease. PMT is often
considered to fall into the last category because they may help slow cognitive decline,
address symptoms related to psychosocially challenging behaviors, and improve quality of
life.
Problem statement
At present, there is a lot of discussion on MCI and dementia prevention. In addition to
drug treatment, non-drug treatment is also a hot issue, such as music therapy, transcranial
magnetic stimulation (TMS), light therapy (phototherapy), electrotherapy, acupuncture
therapy, Taijiquan, Baduanjin, hyperbaric oxygen therapy (HBOT), memory therapy, etc. (Fu
Yuxiang, 2021; Tian Huan et al., 2021). At present, most of the non-drug treatments target a
relatively single cognitive domain, and it is difficult to solve the decline of multiple cognitive
domains with one therapy. It still needs more research and discussion.
PMT is not a traditional biological model, but a kind of rehabilitation therapy under the
biological-psychological-social model (Duan Zhouying, Chen Wenhua, 2021), which focuses
on the concept of integrity. It is not focused on motor functions, but on motor skills in
relationships, and is related to emotional, sensory, and cognitive functions. By mobilizing the
initiative of dementia patients, stimulating their own weakened function (Xu Haoqin et al.,
2019), and assisting with personalized PMT treatment plans, a better effect of rehabilitation
nursing treatment is achieved. Few published literature has applied PMT theory to the
rehabilitation treatment of older adults with MCI, and the intervention plans are not uniform.
At present, PMT therapy just started in China. Is it effective for older adults with MCI in
China? Which group is it applicable to? Do older adults and their families accept them?
There are few studies on it.

Page 5 of 48
The purpose of this study is to develop a PMT rehabilitation nursing plan and evaluate
the effectiveness of the rehabilitation nursing plan in older adults with MCI. The findings of
this study may be useful for future studies and provide useful reference for nursing care
homes, rehabilitation hospitals, communities, and families.
Research Question(s)
1. Is the PMT rehabilitation nursing plan effective in promoting cognitive health for
older adults with MCI?
2. How does the PMT rehabilitation nursing plan affect the cognitive health in older
adults?
Objective
General: This study aimed to develop a psychomotor rehabilitation nursing plan and
elucidate the effect of the PMT rehabilitation nursing plan among older adults with mild
cognitive impairment in promoting cognitive function.
Specific:
1. To develop the psychomotor therapy (PMT) rehabilitation nursing plan through
Delphi method for older adults with mild cognitive impairment (MCI) in promoting
cognitive function.
2. To validate the psychomotor therapy (PMT) rehabilitation nursing plan for older
adults with mild cognitive impairment (MCI) through content and face validation.
3. To evaluate the effectiveness of the psychomotor rehabilitation nursing plan in
enhancing cognitive function among older adults with mild cognitive impairment.
Literature review
Mild cognitive impairment (MCI) affects a significant proportion of the aging
population, posing challenges to their cognitive health and quality of life. Despite the
availability of pharmacological interventions and traditional care strategies, these approaches
often fail to holistically address the multifaceted needs of older adults with MCI. Emerging
evidence suggests that psychomotor therapy (PMT) can play a pivotal role in enhancing
cognitive functions; however, its integration into nursing practices remains underexplored.

Page 6 of 48
The development of a psychomotor rehabilitation nursing plan based on the Delphi-
method addresses both clinical and academic needs by offering a structured, evidence-based
approach to improving cognitive health among older adults with MCI. This study will
contribute to closing the gap in existing literature by evaluating the effectiveness of PMT-
based interventions in a nursing context. This study aligns with global health priorities, such
as the World Health Organization's emphasis on promoting healthy aging and cognitive
health. By validating and implementing an innovative nursing plan, this research seeks to
enhance nursing practices and improve patient outcomes in real-world settings.
Research status of Delphi-method
The Delphi Method is a structured communication technique developed in the 1950s by
the RAND Corporation. Initially designed by Olaf Helmer and Norman Dalkey, it aimed to
systematically gather and distill the judgments of experts through a series of questionnaires
interspersed with controlled feedback. The primary objective was to forecast the impact of
technology on warfare and other societal issues. The method’s core principle is anonymity,
allowing experts to express their opinions without the influence of dominant personalities or
groupthink. This iterative process involves multiple rounds of questionnaires, with feedback
provided between each round to refine the experts' responses and converge towards a
consensus.
Over the decades, the Delphi Method has evolved and found applications in diverse
fields including technology forecasting, public policy, healthcare, education, and market
research. The Delphi Method has been widely used to predict technological trends and
innovations. For instance, Martino (1983) discussed its application in forecasting new
technologies and their societal impacts. Linstone and Turoff (1975) highlighted its use in
public policy to evaluate the potential impacts of proposed policies and to develop long-term
strategic plans. In healthcare, the Delphi Method helps in developing clinical guidelines and
assessing medical technologies. Keeney et al. (2006) demonstrated its utility in achieving
consensus on healthcare interventions. The method is employed in curriculum development
and educational policy-making. Gordon and Pease (2006) illustrated its effectiveness in
identifying future educational needs. The Delphi Method aids in forecasting market trends
and consumer behavior, helping businesses make informed strategic decisions (Rowe &
Wright, 1999).

Page 7 of 48
Over the years, several enhancements have been made to the original Delphi Method to
address its limitations and increase its efficiency:
E-Delphi: The use of electronic platforms for conducting Delphi studies, known as e-
Delphi, has streamlined the process, making it faster and more accessible for participants
(Gordon & Pease, 2006).
Mixed Methods: Combining quantitative and qualitative methods has enriched the
depth and breadth of Delphi studies, allowing for more comprehensive analyses (Skulmoski
et al., 2007).
Real-Time Delphi: Implementing real-time feedback mechanisms has accelerated the
consensus-building process, reducing the time required for each iteration (Gordon, 1994).
Future research on the Delphi Method can explore several promising areas:
Automation and AI: Leveraging artificial intelligence and machine learning to partially
automate the Delphi process can enhance efficiency and reduce human biases (Bojarczuk et
al., 2018).
Cross-Disciplinary Applications: Expanding the application of the Delphi Method to
new and emerging interdisciplinary fields can uncover its potential in addressing complex
global challenges (Landeta, 2006).
Methodological Integration: Integrating Delphi with other forecasting and decision-
making techniques can create robust hybrid models that capitalize on the strengths of
multiple methodologies (Murry & Hammons, 1995).
Global Studies: Conducting Delphi studies in diverse cultural and geographic contexts
can provide insights into the method's adaptability and effectiveness in different settings
(Hasson et al., 2000).
The Delphi Method remains a vital tool for structured expert elicitation and consensus-
building. Its wide-ranging applications and iterative, anonymous approach provide significant
advantages for addressing complex and uncertain issues. Despite its limitations, ongoing
methodological advancements and the integration of new technologies continue to enhance
its effectiveness. As the method evolves, its future research and application hold promising
potential for contributing to various fields of study and practice.
Research status of rehabilitation nursing for MCI
Before 1998, the research related to MCI and dementia in China focused on disease
diagnosis and treatment and epidemiological investigation, while less is related to nursing. In
1999, China entered the aging society, and domestic scholars gradually attached importance

Page 8 of 48
to older adults care or long-term care of patients with senile dementia. At present, there have
been a large number of studies and systematic clinical guidelines or consensus on the
prevention and treatment of dementia around the world, which provide strong support for the
development of standardized full-cycle rehabilitation programs for dementia and the
establishment of management systems. However, more clinical research is still needed to
provide support for the rehabilitation treatment plan for each stage of dementia, especially the
comprehensive care mode for MCI (Yang Qing, Jia Jie, 2021).
In China, although there is no effective method for the treatment of MCI, the nursing
model has been tried to improve the quality of life of older adults with MCI (Ma Dongfei et
al., 2019) to slow down the progress of the disease and improve clinical symptoms (Medina
M et al., 2017). At present, Orem self-care mode (Wang Enshi et al., 2016), Habituation
nursing mode (Peng Ali et al., 2020), 3R specialty nursing mode (Spagnolo P et al., 2015),
Hospital-Community-Family triple linkage nursing mode (Tang Yue et al, 2017), Traditional
Chinese medicine rehabilitation nursing mode (Yu Mei, Wu Qinying, Lin Xiaomei, 2018)
and “3+1” Holistic rehabilitation nursing model (Sun Jingna et al., 2021) have shown some
efficacy in improving the quality of life and/or cognitive function of patients with mild senile
dementia.
Experts pointed out that the comprehensive rehabilitation nursing objectives for patients
with MCI should be formulated individually based on the level of cognition and other
functions and the level of daily living ability. For mild and moderate patients, cognitive
stimulation therapy and cognitive training combined with computer-assisted cognitive
rehabilitation technology can be used to improve the cognitive function level of patients as
much as possible. Combining exercise therapy, physical exercise and rehabilitation treatment
for apraxia, can improve the patients' exercise ability and promote the improvement of
cognitive function (Special Committee of Neurodegenerative Diseases of Chinese Society of
Microcirculation et al., 2020). In addition, music therapy (Dorris, J. L.., 2021), nostalgia
therapy, virtual reality technology, and non-invasive neural regulation technology can also be
used to improve the cognitive function of patients with dementia, and alleviate or eliminate
mental and behavioral symptoms, and improve their daily life and participation ability, but
their efficacy needs to be confirmed by more clinical trials (Lefaucheur J P et al., 2020; Van
Der Steen J T et al., 2018; Bao Feng, 2019; Ding Duyu, Zhang Wei, 2019).
The basic characteristics and quality evaluation results of the references are shown in
Table.

Page 9 of 48
Table：Studies reporting the intervention measures for rehabilitation nursing mode in older adults
Population
Intervention
duration
(month)
Interventions
Outcome assessment
Primary Outcomes
Studies
MCI
patients
(n=58),
Age >= 65
3
Cognitive
Training
Mini mental State
Examination
(MMSE);
Montreal Cognitive
Assessment (MoCA);
Wechsler Memory
Scale Revised (WMS-
R) ; Wechsler Adult
Intelligence Scale-III
Delayed verbal
memory;
Improved
attention and
executive function.
(Suziki H et
al., 2014)
MCI
patients
(n=72),
Age >70
3
Cognitive
Training
Mini mental State
Examination
(MMSE); Health-
related quality of life
(HRQoL) ; Yesavage
Geriatric Depression
Scale; Hamilton
Rating Scale; SF-12
Improved cognitive
performance,
anxiety, depression.
(Carcelen-
Fraile MDC
et al., 2022)
MCI
patients
(n=293),
Age = 50-
85
3
Cognitive
Training
Mini mental State
Examination
(MMSE);
Alzheimer’s
Disease Assessment
Scale-cognitive
subscale (ADAS-
Cog); Con
trolled Oral Word
Association Test
(COWAT); Geriatric
Depression Scale
(GDS-15);
Multifactorial
Metamemory
Questionnaire
(MMQ)
Cognitive
improvements.
(Jeong,
2016)
MCI
patients
(n=60),
Age = 50-
85
3
Exercise
therapy
Mini mental State
Examination
(MMSE);
Montreal Cognitive
Assessment (MoCA);
Functional Activities
Questionnaire, FAQ);
Short-Form 36 item
health survey
questionnaire (SF-36).
Improved cognitive
function and quality
of life.
（Wu Han,
2016)

Page 10 of 48
AD
patients
(n=80),
Age >= 65
6
Orem self-
care mode
Dementia Quality of
Life (DQOL).
Improved quality of
life and self-
efficacy.
(MA Jing,
2023)
MCI
patients
(n=45),
Age > 65
2
Cognitive
Training
Mini mental State
Examination
(MMSE);
Montreal Cognitive
Assessment (MoCA);
Loewenstein
Occupational Therapy
Cognitive Assessment
(LOTCA);
Hamilton Depression
Scale (HAM-D).
Beneficial effects on
attention,
language,
orientation, visual
perception,
organization of
visual movement,
and logical
questioning.
(LIU Xin
Yan et al.,
2016)
MCI
patients
(n=47),
Age > 65
3
Exercise
therapy
Montreal Cognitive
Assessment (MoCA);
Senior Fitness Test
(SFT); Controlled
Oral Word
Association Test
(COWAT).
Delayed cognitive
decline and
improved physical
fitness.
(Hong SG,
2018)
AD
patients
(n=280),
Age > 60
—
Habituation
nursing
mode
Activity of Daily
Living Scale (ADL);
Montreal Cognitive
Assessment (MoCA);
Mini mental State
Examination
(MMSE).
Delayed the
progression and
improved the living
quality.
(Peng Ali et
al., 2020)
MCI
patients
(n=36),
Age = 65-
88
—
3R specialty
nursing
mode;
Cognitive
Training
Mini mental State
Examination
(MMSE); Basic
Activity of Daily
Living
(ADL) ; Instrumental
Activity of Daily
Living (IADL) ;
Geriatric Depression
Scale (GDS) ;
Neuropsychiatric
Inventory (NPI).
Benefit cognitive
functions and level
of autonomy in the
basic activities of
daily living; Reduce
behavioral disorders.
(Spagnolo P
et al., 2015)
AD
patients,
Age >= 60
—
Hospital-
Community-
Family triple
linkage
nursing
mode
Mini mental State
Examination(MMSE);
Activity of Daily
Living Scale (ADL).
Delayed the
progression.
(Tang Yue et
al, 2017)
AD
patients
(n=86),
Age = 60-
84
—
Traditional
Chinese
medicine
rehabilitation
nursing
mode
Mini mental State
Examination(MMSE);
Activity of Daily
Living Scale (ADL);
Nursing satisfaction.
Improved self-care
ability and improve
patients' satisfaction
with care.
(Yu Mei, Wu
Qinying, Lin
Xiaomei,
2018)
MCI
3
Exercise and
Multimodal
Mini mental State
Examination(MMSE);
Improved verbal
recognition memory;
(Bisbe, 2020)

Page 11 of 48
patients
(n=36),
Age = 65-
85
Physical
Therapy
Hospital Anxiety and
Depression Scale
(HADS); 36-Short
Form (36-SF).
Improved visual
delayed recall;
Improved balance
and gait
performances;
Affects cognition
positively.
MCI
patients
(n=34)
3
VR
Montreal Cognitive
Assessment (MoCA);
Instrumental Activity
of Daily
Living (IADL)
Improved cognitive
function, IADL and
neural efficiency.
(Liao YY,
2019)
AD
patients
(n=1796),
Age >= 60
2, 6, 12
“3+1”
Holistic
rehabilitation
nursing
model
Mini mental State
Examination
(MMSE);
Barthel index;
Activity of Daily
Living Scale (ADL);
Chinese rehabilitation
Research Center
Standard
Aphasia Examination
(CRR-CAE).
Improved the mental
condition and
quality of life;
Improved self-care
ability and language
ability.
(Sun Jingna
et al, 2021 )
AD
patients
(n=100),
Age >= 60
6
“3+1”
Holistic
rehabilitation
nursing
model
Mini mental State
Examination
(MMSE);
Barthel index
Improved the mental
condition and
quality of life.
(Wang
Lijuan et al.,
2018)
MCI
patients
(n=495),
Age >= 60
3
Music
intervention
Mini mental State
Examination
(MMSE);
Geriatric Quality of
Life-Dementia;
Positive and Negative
Affect Schedule.
A small but
statistically
significant effect on
cognitive function.
(Dorris, J.
L.., 2021)
MCI
patients
(n=32),
Age >= 60
2
Virtual
Shopping
Training
Korean version of the
Executive Function
Performance Test
(EFPT-K);
Korean Instrumental
Activities of Daily
Living (K-IADL)
Executive function
and instrumental
activities of daily
living were
improved.
(Park, J.H.,
2022)
MCI
patients
(n=88),
Age >= 60
0.5
Behavioral
Interventions
Quality of Life-AD
(QoL- AD);
Center for
Epidemiologic
Studies Depression
Scale (CES-D);
REACH Anxiety
Inventory Form
(REACH-anx);
Self-efficacy for
Managing MCI Scale
(Sem-MCI);
Dementia Rating
Scale-2 (DRS-2)
Efficacious and
effective in
impacting the
trajectory of MCI.
(Levy et al.,
2022)

Page 12 of 48
MCI
patients
(n=126),
Age >= 65
—
Balint group
activity
Montreal Cognitive
Assessment (MoCA);
Geriatric Depression
Scale (GDS);
Signs of Depression
Screening Scale
(SDSS)
Improved negative
emotions; Enhanced
social functions and
quality of life.
(Wang Lijun
et al, 2023)
In the late 1990s, American medical experts introduced the Montessori education
method into the treatment of dementia (Wilson N L et al., 1997), which is called the
Montessori - Based Dementia Programming(MBDP). It emphasizes that patients with
dementia should participate in activities that match their ability and state under prepared
conditions, and repeatedly practice and strengthen language, sense, or related intellectual
activities through independent selection of teaching aids, to exercise the patient's thinking
ability and practical ability, and rebuild self-esteem (Van Der Ploeg E S, O’Connor D W,
2010). Research shows that Montessori method can improve the participation enthusiasm of
dementia patients, effectively alleviate the symptoms of dementia, reduce complications
(Sheppard C L et al., 2016), improve mental and behavioral symptoms (YUEN I, KWOK T,
2019; Van Der Ploeg E S, Eppingstall B, 2013; Roberts G et al., 2015), improve cognitive
ability, improve swallowing function and eating ability, and improve daily living ability and
quality of life (Wilks S E et al., 2019). In recent years, it has been widely used in dementia
care institutions in America and Canada.
In America, continuing care for Alzheimer's disease mainly existed in the form of a
continuing care community for a long time. At the same time, a professional institution for
the continuing care of Alzheimer's disease, "Alzheimer's Care Center", was established to
provide comprehensive hospital-community-family continuing care services for patients in
cooperation with adult day care centers and medical homes for continuing care at home.
According to the survey, the hospital-community-family continuous care for Alzheimer's
disease in America has effectively improved patients' participation and sense of security,
reduced disease mortality, and relieved the psychological and emotional pressure and burden
of family caregivers (Sun Fei et al., 2019).
The British government released the National Strategy for Alzheimer's Disease in 2009,
which will improve the recognition and understanding of Alzheimer's disease, early diagnosis
and intervention, and high-quality care as three key areas to improve service level (Wang
Ning, 2021). Accordingly, the main objectives for coping with Alzheimer's disease and the

Page 13 of 48
evaluation criteria for the quality of life of patients and caregivers/family members were put
forward.
As one of the countries with the highest degree of population aging in the world, the
Japanese government has proposed the prevention and control goal of "delaying the onset of
dementia in the 70~79 age group for one year within 10 years, and reducing the incidence
rate by 1%". It has successively launched the Orange Plan (2012) and the New Orange Plan
(2015) for Alzheimer's patients (Tian Xianglan, 2020). The comprehensive care system from
hospital to community to family in the new orange plan is worth learning.
According to Alzheimer's Disease International (2022), South Korea has integrated a
medical and social care model to meet the diverse and complex needs of dementia patients
and their caregivers, from diagnosis until the end of life, according to the clinical stage of
dementia. One of the most important features of this model is the Local Dementia Centers
(LDCs). They can provide many services in the community, such as dementia prevention,
diagnosis, and post-diagnosis care. Usually, LDCs provide personalized services for each
dementia patient based on some relevant information from the community. This model was
officially launched in September 2017 as part of the National Dementia Initiative (NDI). It
has brought many changes in raising awareness of dementia among Koreans and building
infrastructure such as LDCs and dementia-specialized institutions. NDI has been expanding
the number of beneficiaries of long-term care services and working to reduce the costs caused
by medical treatment and long-term care.
Research status of PMT
Psychomotor Therapy (PMT) originated in France. In 1950, Ms. Giselle Soubiran
founded the clinical branch of psychomotor and the treatment method of psychomotor
rehabilitation (Duan Zhouying, Chen Wenhua, 2021). It is the theory and method system of
non-drug and non-large instrument treatment for psychomotor dysfunction (individual's
psychosomatic function development obstacle and adaptability obstacle to the surrounding
human environment, manifested as cognitive function, motor function, and emotional
expression obstacle, which may be accompanied by mild neuropathological signs) caused by
various reasons such as gene, development or functional disorder and degeneration. It collects
all motor functions closely related to thinking, psychology, emotion, and brain functions
(Faulkner G, Carless D, 2006) and improves the patients' motor, cognitive, and participation
abilities through a series of "physical and mental remodeling" methods.

Page 14 of 48
PMT
is
especially
suitable
for
neuropsychological
disorders
caused
by
brain
degeneration in the elderly, and has developed into a mature treatment technology in France.
However, this therapy just started in China, and domestic research is scattered in various
fields. Shao Quanwei and Li Bai (2015) mentioned in their research that PMT applies to the
treatment of sports injury, diabetes, hypertension and other diseases. Zhang Ruixing et al.
(2017) introduced the application of PMT in depression, schizophrenia, eating disorders,
personality disorders and mental disorders. The research points out that PMT has an overall
coordination and integration effect on human physiological, psychological, and social
functions, has a positive impact on patients' emotions, cognition, and behavior, and can
effectively promote the maintenance or improvement of patients' social functions. Chen
Xuelian et al. (2018) pointed out that PMT has effectively improved the residual mental
symptoms of mental patients, improved the cognitive and social functions of the brain, and
reduced the functional disability of patients with mental disorders.
Wang Qiong et al. (2021) found that the intervention of senile dementia patients based
on PMT theory can improve part of their cognitive function, and the patient's memory,
memory ability, language, visuospatial ability and self-care ability. Zhang Weiwei (2022)
proposed that PMT treatment can effectively improve the cognitive function of mild to
moderate Alzheimer's patients, but whether it is suitable for severe Alzheimer's patients
remains to be studied. Liang Jingzhao and Zhi Yanmin (2022) found that the nursing model
based on PMT theory can improve the intelligence and psychological state of senile dementia
patients, promote the recovery of mental symptoms, and improve the ability of daily living.
At present, the research on rehabilitation nursing based on PMT in China is relatively weak,
and especially the PMT intervention measures for senile dementia patients have not been
carried out. It is necessary to learn from foreign experience to form an application system
suitable for China in the future.
Kluger et al. (1997) conducted extensive motor or psychomotor and cognitive
assessments on 41 cognitively normal older adults, 25 non-demented patients with mild
cognitive impairment and future risk of dementia, and 25 patients with mild (early) AD to
determine the association between cognitive impairment and motor behavior in older adults.
The results showed that an important factor in cognitive decline in older adults is decreased
motor ability. The motor/psychomotor assessment was found to be as sensitive as traditional
cognitive function tests in identifying people affected by older adults stages of AD pathology.
The ability to identify at-risk non-demented older adults can be improved in older adults with
different educational levels.

Page 15 of 48
A study of dementia prevalence and risk factors (W. D. Oswald et al., 2001) found that a
comprehensive memory and psychomotor training program developed within the SIMA-
Studies framework had a risk-reducing effect.
A study (M Hofman et al.，2000) aimed at investigating the discriminative value of
simple psychomotor and visuospatial tasks implemented in a computer-assisted test battery
reported that a simple psychomotor test battery could be used to discriminate between
patients with AD, patients with depression, and age-matched healthy controls. The results of
the study showed that psychomotor tests were effective in discriminating healthy older adults
from patients with AD and depression.
In 2010, the French Higher Health Agency issued the supplementary provisions of the
decree "National 2008-2012 Family Care Plan for Alzheimer's Disease", which officially
included psychomotor rehabilitation treatment in the care plan for older adults living at home
with Alzheimer's disease and related diseases (Haute Autorité de Santé, 2010). PMT can
effectively improve the cognitive function of AD patients, delay the deterioration of cognitive
function, and improve the quality of life of AD patients.
A review (Vandewoude et al., 2016) showed that 26% to 80% of community-dwelling
patients with AD were at risk of under-nutrition by the Mini Nutritional Assessment (MNA)
score. Another study (Odete Vicente de Sousa et al., 2017) aimed to determine the
effectiveness of an oral nutritional supplementation (ONS) intervention combined with a
PMT rehabilitation program on nutritional, functional, and cognitive parameters in
community-dwelling AD patients who were nutritionally inadequate or at risk. Develop a
multi-component/modular geriatric psychomotor rehabilitation program for patients with AD
with targeted goals, including attention, body strength, tension, static and dynamic balance
exercises, body awareness, spatial and temporal reorganization, immediate and working
memory and practice, fine motor skills, and gross motor skills training. The sessions
consisted of 1 hour of exercise in the morning, twice a week. Each participant was required to
complete 12 sessions. The results of the study suggest that a 21-day low-dose, high-protein,
high-energy ONS combined with a psychomotor rehabilitation program is effective in
improving long-term nutritional and functional status in community-dwelling older adults
with mild AD.

Page 16 of 48
In summary, the application of psychomotor therapy (PMT) has been predominantly
studied in populations with dementia and AD, demonstrating its effectiveness in improving
motor coordination and cognitive engagement. Only one study (E Kwang, 2021) showed that
11 MCIs and 11 subjectively healthy older adults(sHE) underwent a single 45-minute PMT
intervention. Resting-state electroencephalography, the Rey Auditory-Verbal Learning Test,
MoodMeter®, and the Positive and Negative Affect Schedule were compared between
groups and pre- and post-PMT. PMT intervention does have functional influences on the
central nervous level and therefore, might prevent and treat cognitive, psychological, and
psychiatric symptoms of people with mild cognitive impairment. However, this study only
conducted a single intervention and had a small number of subjects. Currently, there is
limited research exists specifically addressing its role in mild cognitive impairment (MCI).
This gap highlights the need for targeted investigations to evaluate PMT's potential to delay
cognitive decline in MCI populations.
Conceptual framework
Rehabilitation Nursing Plan for Mild Cognitive 
Impairment (MCI) Using Delphi Method and 
Psychomotor Therapy (PMT).
Historical Development of Delphi Method:
– Structured communication technique
– Anonymity for experts' judgments
– Iterative rounds with feedback for 
consensus-building.
Applications in Various Fields:
–Technology forecasting
–Public policy and healthcare (Keeney et 
al., 2006)
Enhancements to Delphi:
– E-Delphi (Gordon & Pease, 2006)
– Mixed Methods (Skulmoski et al., 2007)
– Real-Time Delphi (Gordon, 1994)
– Future directions: AI integration and 
interdisciplinary research.
Delphi Method Research Historical
Development and Evolution in China:
– Early 2000s: Focus shifts to MCI and dementia care.
– Various nursing models implemented: Orem self-care, 
3R specialty, Traditional Chinese Medicine 
rehabilitation, etc.
Intervention Techniques:
– Cognitive training (Suzuki H et al., 2014)
– Exercise therapy (Wu Han, 2016)
– VR-based rehabilitation (Liao, 2020)
– Holistic models (Sun Jingna et al., 2021)
Global Insights:
– Montessori-Based Dementia Programs (USA, UK, 
Japan)
– Integrated care in South Korea.
Research in Rehabilitation Nursing for MCI   
History of PMT:
– Originated in France in the 1950s (Giselle 
Soubiran)
– Focus on motor, cognitive, and emotional 
rehabilitation.
Applications in Older Adults and Cognitive Decline:
– Improving motor and cognitive functions 
(Kluger et al., 1997)
– Studies supporting PMT for dementia and MCI 
(Chen Xuelian et al., 2018; Wang Qiong et al., 
2021)
Global Policies and Future Directions:
– French National Care Plans for Alzheimer's 
(2010)
– Nutrition and cognitive enhancement programs 
combining PMT and dietary supplements 
(Vandewoude et al., 2016).
PMT Research and Applications   
Methodology
Description of methodology
1) Research design: Quasi-Experimental Design (Non-randomized controlled trial) with
experiment and control groups for comparison. Because of ethical considerations on older
adults for logistical and economical wise, easy to travel, practical, less budget. Similar studies
involving rehabilitation or behavioural interventions in real-world settings have widely used
quasi-experimental designs. Studies by MA Handley(2018) and AD Harris (2006)
demonstrated reliable outcomes using this approach.

Page 17 of 48
2) Study area: Liaoning Province, China.
3) Study population
i) Reference population: Older adults living in Liaoning.
ii) Source population / sampling pool: Elderly care institutions and rehabilitation centers,
Liaoning Province.
iii) Target population: Jinzhou Comprehensive Elderly Care Institution and Rehabilitation
Center, Liaoning Province.
iv) Sampling frame: List of members from the two elderly care institution and rehabilitation
center; Jinzhou Pension Comprehensive Service Center (JPCSC)), and Jinzhou Rehabilitation
Hospital (JRH), Liaoning Province.
4) Subject criteria
Objective No. 1 and 2: To develop and validate the psychomotor rehabilitation nursing plan
through content/face validation using the Delphi method.
Inclusion criteria:
i) Professionals with ≥5 years of experience in geriatric care, neurological rehabilitation,
cognitive rehabilitation, or psychomotor therapy.
ii) Academic researchers with publications in related fields.
iii) Intermediate professional title or above.
iv) Willingness to participate in multiple Delphi rounds and provide informed feedback.
Exclusion criteria:
i) Experts without sufficient relevant experience.
ii) Those unable to commit to the Delphi process.
Objective No. 3: To evaluate the effectiveness of the psychomotor rehabilitation nursing
plan in enhancing cognitive function among older adults with mild cognitive
impairment.（Experimental and control group）
Inclusion criteria:
i) Older adults are aged 50 years and above.
ii) Subjective cognitive complaints from the individual or caregiver.
iii) Screening for MCI using the Mini-Cog scores between 0-2 ( SN Abayomi, 2024).
iv) Basic language communication, listening, speaking, and understanding skills.

Page 18 of 48
v) Ability to provide informed consent.
Exclusion criteria:
i) Diagnosed with severe psychiatric conditions (e.g., schizophrenia, major depressive
disorder).
ii) It is at the end stage of important functional organ diseases, such as malignant tumors,
cardiac failure, etc.
iii) Limb dysfunction.
iv) Diagnosed with dementia.
Withdrawal criteria:
i) Withdrawal of consent by the participant.
ii) Non-compliance with study requirements (e.g., missing >25% sessions).
iii) Significant health deterioration affecting participation.
5) Study groups
Experimental group: Older adults with MCI from Jinzhou Rehabilitation Hospital (JRH),
with psychomotor rehabilitation uursing plan.
Control group: Older adults with MCI from Jinzhou Pension Comprehensive Service
Center (JPCSC), without psychomotor rehabilitation uursing plan.
6) Operational definition:
i) Mild cognitive impairment (MCI): Mild Cognitive Impairment (MCI) is defined as a
condition characterized by noticeable cognitive decline beyond what is expected for an
individual’s age and education level, but not severe enough to interfere significantly with
daily life or independent functioning. It serves as an intermediate stage between normal
aging and dementia. (Petersen, R.C., 2004; B. Winblad, 2004).
ii) Psychomotor therapy (PMT): Psychomotor therapy is a form of therapeutic
intervention that focuses on the connection between psychological and motor (physical)
functions (Duan Zhouying, Chen Wenhua, 2021).
7) Sample size determination
Objective No. 1 and 2: To develop and validate the psychomotor rehabilitation nursing plan
through content/face validation using the Delphi method for older adults with mild cognitive
impairment in promoting cognitive function.

Page 19 of 48
A sample size of 8 to 15 respondents has been recommended for Delphi studies, given
that smaller samples reduce reliability and bigger ones do not appear to add much value
(Kenney et al., 2010). For this study, we aimed to recruit 10-12 participants.
Objective No. 3: To determine the effectiveness of the psychomotor rehabilitation nursing
plan in enhancing cognitive function among older adults with mild cognitive impairment .
The sample size was calculated for specific objective 2. It was estimated by using the
sample size formula compared with the average of two samples（Ni Ping et al., 2010）. The
sample size calculation formula and parameters were as below:
N1= N2= 2[(tα/2+tβ)S/δ]2
N1 is the sample content of the experimental group.
N2 is the sample content of the control group.
S is the estimated value of the standard deviation between the two populations.
δ is the difference between the two averages.
The S and δ were the values of the MMSE scale decided by the researcher based on
expert opinion (Liang Jingzhao, Zhi Yanmin, 2022), S= 2.75 ，δ= 2.14. The level of
significance (α) was 0.05, t0.05/2= 1.96, β was 0.10, t0.1= 1.28. By substituting the formula, 34
samples were required for each of the two groups.
An estimated 10% was added to the calculated sample size in anticipation of some missing
data. The calculated sample size for this study was 76 patients (EG: 38 patients, CG: 38
patients).
8) Sampling method: Purposive sampling
9) Subject setting and participant
PHASE 1 (Delphi-method study for screening and recruitment)
The psychomotor rehabilitation nursing plan design will use Delphi-method which is an
integration involving multiple expertise for the PMT development. The participants are the
professionals with academic and/or practical experience in Neurology and cognitive training
in China’s hospitals or universities. There is no agreed method to consider someone an expert
in a given field. To facilitate the selection process, it will use a simple point evaluation
system. It will include all professionals with a final evaluation of at least 2 points. Regarding
academic experience, it will consider the following factors: At least one publication on the

Page 20 of 48
field of cognitive training (1 point) & at least one publication on the field of Neurology (1
point) OR at least one publication on the field of cognitive training in MCI (2 points).
Concerning practical experience, it will consider experience in the development of a
cognitive training program (1 point). Moreover, it will also consider if the professional had
clinical experience in the application of cognitive training (1 point).
Purposive sampling. Potential participants will be identified through a literature review,
existing academic contacts, and a web search for cognitive training programs ( for MCI or
Neurology or other conditions) and the respective scientific teams. After being evaluated in
accordance to the point system previously described, professionals who met the inclusion
criteria (2 points or more) will be invited to participate by email. In the initial questionnaire,
they will be asked to recommend other professionals who they considered to be experts in the
field. Recommended professionals who met the inclusion criteria will be contacted and
invited to join the expert panel.
PHASE 2 (Quasi-Experimental design for PMT rehabilitation nursing interventional
study)
This experimental method will be used in Quasi-Experimental Design (Non-randomized
controlled trial) with experiment and control groups for comparison. Ethics consideration on
older adults which would psychologically and emotionally impact in case not selected for
experimental group. This research will be carried out in Liaoning Province of China. The
rehabilitation nursing intervention will be carried out for older adults with MCI admitted in
two China elderly care institutions which the name is Jinzhou Pension Comprehensive
Service Center (JPCSC) and Jinzhou Rehabilitation Hospital (JRH). Because of ethical
consideration on older adults for logistical and economical wise, easy to travel, practical, less
budget. So the experimenatl group is JRH, and the control group is JPCSC. Purposive
sampling, whereby older adults with MCI will be selected and invited to participate the study.
The PMT rehabilitation nursing intervention plan
From Table in the literature review, we can see that most interventions lasted for 3
months. Therefore, older adults will be engaged in a 12-week PMT rehabilitation nursing
plan involving 2 phases of relaxation and breathing exercises, face exercises, hand exercises
and mind exercises to promote cognitive health. The experimental group will be given
interventions, twice a week every Tuesday and Thursday 9-10 am along with the study

Page 21 of 48
intervention. Meanwhile, the control group will be given a standard health education on
cognitive health.
Table The Mind-body Exercise of Psychomotor Rehabilitation Nursing Plan
Week
Phase
Intervention methods
Assessment
Week 0-6
Tuesday
Thursday
9:00-10:00
am
Psychomotor
function
Phase 1
1.Do relaxation and breathing exercises before
and after exercise (10 minutes).
2.Blink alternately, bulge left and right cheeks,
and
improve
facial
motor
function
(10
minutes).
3.(10 minutes)
4.(10 minutes)
5.Carry out upper limb gymnastics exercises to
improve limb motor function (20 minutes).
Assessment time is at the
baseline (before
intervention).
Week 7-12
Tuesday
Thursday
9:00-10:00
am
Psychomotor
function
Phase 2
1. Do relaxation and breathing exercises before
and after exercise (10 minutes).
2.(10 minutes)
3.(10 minutes)
Assessment time is at the
12 week (after
intervention).

Page 22 of 48
1. (10 minutes)
2. Carry out upper limb gymnastics exercises
with music to improve limb motor function (20
minutes).
10) Data collection and Research tool
Phase 1: To develop and validate the psychomotor rehabilitation nursing plan through
content/face validation using the Delphi Method for older adults with mild cognitive
impairment.
The draft of the PMT rehabilitation nursing plan will be summarized through a literature
review. An expert letter questionnaire will be formulated to make the PMT rehabilitation
nursing plan more suitable for MCI older adults in China, and specialist consultation will be
conducted face-to-face or by email, according to the actual situation. The Delphi method was
used to reach a consensus on each program’s characteristics, structure, and cognitive training
tasks of the PMT rehabilitation nursing plan. A panel of experts was invited to participate in
the content validation by answering two rounds of questions (scale and free-text boxes)
regarding the program. Changes were made between the rounds according to the results of
the first round. The consensus was defined as at least 70% of the experts agreeing on the
validity of a characteristic. Experts will be invited to rate the importance and feasibility of the
questionnaire items. The experts will be required to provide feedback to us within 2 weeks
after receiving the questionnaire. After the first round of expert inquiry, the PMT

Page 23 of 48
rehabilitation nursing program will be modified, deleted and supplemented based on the
experts' scores and opinions on the items, so as to determine the second round of expert
inquiry questionnaires and conduct the second round of expert inquiry. There will be a 3-
week interval between the first and second rounds. After receiving the questionnaires from
the experts, the inquiry results will be summarized and statistically analyzed until the experts'
opinions reach a consensus, and the entire inquiry process will be terminated.
The duration of participant involvement in the Delphi method will be approximately 6–
10 weeks in total, depending on the number of rounds required to reach expert consensus.
Each Delphi round will require participants to complete the questionnaire, which is estimated
to take 20–30 minutes per round. Between rounds, there will be a 1–2-week interval for
data analysis and feedback preparation. While we anticipate achieving consensus within two
rounds, a third or fourth round may be necessary if the responses require further refinement.
In such a case, participants will be informed in advance, and their continued involvement will
be requested. We will strive to minimize the burden on participants while ensuring robust and
reliable results.
Phase 2: To evaluate the effectiveness of the psychomotor rehabilitation nursing plan
among older adults with mild cognitive impairment.
The data will be collected from January 2025 to December 2025 in China's older adults
care institutions. The data collection form was created by the researcher to record general
information about older adults, such as age, gender, education level, family history of
dementia, marital status, personal annual income, chronic disease. It will take no more than 5
minutes. Then, It will conduct questionnaire surveys before the intervention (baseline) and
after the intervention (12 weeks). The questionnaires involved include MoCA, which has 11
questions and takes about 10 minutes; PANSS, which has 30 questions and takes about 20
minutes; HAMA-14, which has 14 questions and takes about 10 minutes; HAMD-17, which
has 17 questions and takes about 15 minutes. All questionnaires will take no more than 60
minutes. Due to ethical issues, the names of the elderly participating in this study are only
used for data collection, and their identity information will not be disclosed.
Data/Specimen handling：
1. Collection: Participant data will be collected through questionnaires and assessments
during the study. No biological specimens will be collected as part of this research.

Page 24 of 48
2. Storage and Security: All participant data will be anonymized and stored in a password-
protected electronic database. Hard copies, if any, will be kept in a locked cabinet accessible
only to the research team.
3. Usage: The data will be used exclusively for this study to evaluate the effectiveness of the
psychomotor rehabilitation nursing plan. No secondary use of data will occur without
additional consent from participants.
4. Retention and Destruction: Data will be retained for 5 years following the publication of
the study findings, after which it will be securely destroyed by permanent deletion of digital
files and shredding of hard copies.
5. Confidentiality: Participant confidentiality will be strictly maintained throughout the study.
All identifiers will be replaced with unique codes to ensure privacy."

Page 25 of 48
Research material: The materials used in PMT rehabilitation nursing intervention plan.
i) Rehabilitation functional training hand coordinator
ii) Rehabilitation training geometric figure cognitive plug-in board
iii) Hand-eye-brain coordination training ball
iv) Finger Function Dexterity Trainer
v) Intelligence training puzzle board
vi) Music for upper limb gymnastics exercises
Questionnaire：
i) Cognitive assessment：
The cognitive status of older adults was assessed by the Montreal Cognitive Assessment
(MoCA) scale. Developed by Nasreddine et al. in Canada with reference to the MMSE, the
MoCA evaluates multiple cognitive domains, including attention, executive function,
memory, language, visuospatial skills, abstract thinking, calculation, and orientation, making
it suitable for a comprehensive assessment of various types of cognitive impairment
(Nasreddine ZS, 2005). In Western countries, a cutoff score of 26 is commonly used to
identify MCI.
In China, various versions of the MoCA are available, including the Beijing, Changsha,
and Cantonese versions, with the Beijing version being the most widely used. The cutoff
scores of the MoCA Beijing version vary for different populations. According to a study by
Lu et al. (2011) involving 8,411 community-dwelling older adults aged 65 years and above,
the optimal cutoff scores for diagnosing MCI with the Beijing version are ≤13 for illiterate

Page 26 of 48
individuals, ≤19 for those with primary education, and ≤24 for those with middle school
education or higher. The sensitivity and specificity for identifying MCI were 80.5% and
82.5%, respectively.
ii) Psychological assessment：
The psychological of older adults was assessed by the Positive and Negative Syndrome
Scale (PANSS),
including the positive scale
(7 items, 7~49 points),
the general
psychopathology scale (16 items, 16~112 points), and the negative scale (7 items, 7~49
points). The higher the score is, the worse the rehabilitation.
The reliability and validity of the Chinese version of PANSS have been verified (SI
Tianmei et al. , 2004) and applied in clinical practice. The internal consistency reliability was
0.87(Cronbach α). The internal consistency reliability of the 5 dimensions ranged from 0.74
~ 0.90. The structure, validity and reliability of PANSS ( Chinese version) are acceptable.
iii) Emotional assessment：
The emotional assessment was assessed by the Hamilton Depression Rating Scale
(HAMD-17) and the Hamilton Anxiety Rating Scale (HAMA-14), which are among the most
widely used scales for evaluating emotional status. HAMA-14 contains two aspects; physical
and mental. It includes 14 items with a total score of 56. HAMD-17 covers; despair,
somatization symptoms, sleep disorders, and anxiety. It consists of 17 items with a total score
of 52.
(Maier, 1988; Maier, 1990). The 2025 Expert Consensus on Neuropsychological
Assessment of Mild Cognitive Impairment (2025) recommends the use of these scales, as
they effectively identify and quantify depressive and anxiety symptoms in patients with MCI.
These tools have been widely adopted due to their high sensitivity and specificity, as well as
their ease of administration and interpretation.
11) Data analysis
Objective No. 1 and 2 : To develop and validate the psychomotor rehabilitation nursing
plan through content/face validation using the Delphi Method for older adults with mild
cognitive impairment in promoting cognitive health.
Quantitative analyses will be conducted using SPSS version 28. The mean, standard
deviation, coefficient of variation (CV), and full score ratio of all items will be calculated.
The positive coefficient and authority coefficient (Cr) of the experts will be calculated. The

Page 27 of 48
authority coefficient will equal to the mean value of the expert's self-assessed familiarity and
the basis of expert judgment. The coordination degree of expert opinions will be expressed by
Kendall's coordination coefficient (W). The P value < 0.05 will be considered to indicate
statistical significance.
Expected result (Dummy Table): The Delphi-method of the PMT rehabilitation nursing plan
Table General information of experts
Items
Groups
Number of people
Composition ratio
(%)
Gender
Male
Female
Age (years)
30-40
40-50
> 50
Education level
Undergraduate
Master
Years of working
experience
< 10
10-20
> 20
Professional title
Intermediate
Senior
Professional
composition
Nursing
Neurology
Rehabilitation Medicine
Province
Liaoning
Beijing
Shanghai
Guangzhou
Table Specific data statistical results of each item in the first round of correspondence consultation
Item
Statements
Score
(±)
CV
Consensus,
n (%)
1. General Aspects of The PMT Rehabilitation Nursing Plan
1.1
The Plan
Structure
Older adults will be engaged in a 12-week PMT
rehabilitation nursing plan involving 2 phases (twice
a week every Tuesday and Thursday 9-10 am).
1.2
Performance
Sequence
All older adults will perform the same
execution/performance sequence. The tasks must take
place sequentially according to the pre-defined logic.
In total, the plan comprises 5 distinct tasks in each
phase.

Page 28 of 48
2. Description of The PMT Rehabilitation Nursing Plan
2.1 Phase 1
-Task 1
Do relaxation and breathing exercises before and
after exercise (10 minutes).
2.2 Phase 1
-Task 2
Blink alternately, bulge left and right cheeks, and
improve facial motor function (10 minutes).
2.3 Phase 1
-Task 3
Hand-eye coordination training：The older adults
followed instructions to grab the colorful beads with
their hands and slide them along the curved track (10
minutes).
2.4 Phase 1
-Task 4
Cognitive training puzzle board：The older adults
put puzzle pieces of different colors and shapes into
the corresponding grooves according to the
instructions (10 minutes).
2.5 Phase 1
-Task 5
Carry out upper limb gymnastics exercises to
improve limb motor function (20 minutes).
2.6 Phase 2
-Task 1
Do relaxation and breathing exercises before and
after exercise (10 minutes).
2.7 Phase 2
-Task 2
Hand muscle training/flexibility training/hand-eye
coordination/improved circulation：The older adults
held and rotated two balls with one hand according to
instructions (10 minutes).
2.8 Phase 2
-Task 3
Hand fine training/flexibility training/hand-eye
coordination/endurance and concentration training
(10 minutes).
2.9 Phase 2
-Task 4
Hand-eye coordination training/cognitive ability
training/fine skills training/teamwork and social
interaction training (10 minutes).
2.10 Phase 2
-Task 5
Carry out upper limb gymnastics exercises with
music to improve limb motor function (20 minutes).
Objective No. 3: To evaluate the effectiveness of psychomotor rehabilitation nursing
plan in enhancing cognitive function among older adults with mild cognitive
impairment.
Data entry and analysis will be performed using SPSS 28.0 software. Descriptive
statistics will be used to summarize the general information of older adults. Numerical data
will be presented as mean (SD) or median (IQR) based on their normality distribution.
Categorical data will be presented as frequency (%). The comparison of scores of various
scales are based on paired t-test statistical methods. The P value <0.05 will be considered to
indicate statistically significant with 95% confidence interval (CI).
Expected result (Dummy Table): The effect assessment of the PMT rehabilitation
nursing plan

Page 29 of 48
Table Comparison of cognitive status between two groups ( ϳņ± Ϯ，Ϯ푐표ϭϡϮ)
Assessment
Before (n = 76)
After (n = 76)
Diff (95%
CI)
t
P
Orientation
Registration
Attention and
Calculation
Recall
Language and Praxis
MoCA total score
Table Comparison of psychological status between two groups (ϳņ± Ϯ，Ϯ푐표ϭϡϮ)
Assessment
Before (n = 76)
After (n = 76)
Diff (95%
CI)
t
P
Positive scale
General
psychopathology scale
Negative scale
Table Comparison of mental rehabilitation status between two groups (xņ± s，scores)
Assessment
Before (n = 76)
After (n = 76)
Diff (95%
CI)
t
P
Mood-related signs
Behavioral disturbance
Cyclic functions
Ideational disturbance

Page 30 of 48
Study
flowchart

Page 31 of 48
Gantt chart & milestone
Ethical consideration
This study will require ethical approval from the Human Research Ethics Committee of
USM (JePEM). The research activity will only be commenced after obtaining the ethical
approval.
1) Subject vulnerability
i) Informed consent: Before beginning the questionnaire or interview, clearly explain
the purpose, content, and participants’ choices, ensuring that they fully understand
their rights and know they can withdraw at any time without affecting their rights.
Research
Activities
2024
2025
2026
Jan–
Mar
Apr–
Jun
Jul-
Sep
Oct-
Dec
Jan–
Mar
Apr–
Jun
Jul-
Sep
Oct-
Dec
Jan–
Mar
Apr–
Jun
Jul-
Sep
Oct-
Dec
Preliminary
discussion
Preparing research
proposal
Ethical application
and approval from
USM
Data collection
Data analysis and
interpretation
Thesis write-up
and submission

Page 32 of 48
ii) Emphasize voluntary participation: Make it clear that participants are free to
refuse to answer any questions and can withdraw from the interview or questionnaire
at any point.
2) Declaration of absence of conflict of interest
i) Declaration of no conflicts of interest: I have not received any compensation, shares,
or other forms of remuneration from any company or financial interest involved in the
research, nor do I stand to gain any direct or indirect benefits from the research results.
I am not subject to any external pressure, and all research activities, data analysis, and
result reporting are based on scientific methods and objective judgment.
ii) Ensuring and maintaining the integrity of the research: Throughout the research
process, I will maintain transparency. All data collection, analysis, and reporting will
strictly adhere to scientific norms and standards, ensuring independence and freedom
from external influences. I will follow the ethical guidelines set by academic and
research institutions to ensure that no external parties influence the design, handling
of data, interpretation of results, or reporting. If a potential conflict of interest arises at
any stage of the research, I will immediately report it to the relevant institutions and
implement appropriate measures, such as introducing independent oversight or review
procedures, to eliminate or manage the conflict.
3) Privacy and confidentiality
The ethical issues considered in this study are related to older adults ’ confidential
information and means of intervention and rehabilitation care. Because their personal
information will be obtained and new rehabilitation care methods will be implemented.
The names in older adults data will not be disclosed.
4) Community sensitivities and benefits
When designing questionnaires or interview questions related to cognitive impairment
in the older adults, it is essential to minimize potential distress, anxiety. Avoid
negative or potentially embarrassing wording, using neutral and respectful terms. For
exemple, use “cognitive changes” instead of “cognitive impairment”. Refrain from
using stigmatizing terms such as “dementia”, and opt for more neutral or supportive
language like “memory issues” or “thinking difficulties”. Ensure the environment in
which the questionnaire is conducted is safe and stress-free, giving participants ample
time to respond. Foster an atmosphere of respect, empathy, and care to reduce tension.
If participants show signs of anxiety or distress during the interview, pause or stop the

Page 33 of 48
session, check in with their feelings, and decide whether to continue based on the
situation.
Direct benefits to participant: Participants may experience improvement in their
cognitive function and overall mental health through participation in the psychomotor
rehabilitation program. They will undergo regular health evaluations, which may help
in identifying and addressing potential health issues early. Free access to the
intervention program and related therapeutic activities may enhance their quality of
life during the study period.
Indirect benefits to participant: The participants’ involvement will contribute valuable
data to the development of better care strategies for individuals with mild cognitive
impairment. Their participation may increase awareness and understanding of MCI
among themselves and their families, potentially leading to improved daily care
practices. The findings of this study may have a positive impact on public health
policies and future interventions for similar populations.
5) Honorarium and incentives
All participants will receive a gift. Transportation costs will be covered by the
principal investigator of the study.
6) Potential risk to participant
All participants Fall or Injury Risk: Older adults may have weaker muscle strength,
balance, and coordination, which makes them more prone to falls or injuries during
rehabilitation activities. If participants fall or are injured during the intervention,
necessary medical support will be provided.
Feelings of Frustration: If older adults do not experience the expected progress during
rehabilitation, they may develop feelings of frustration, disappointment, or reduced
self-efficacy. If participants experience any discomfort, psychological support will be
provided, and they may withdraw from the study at any time.

Page 34 of 48
References
Abayomi, S. N., Sritharan, P., Yan, E. et al. (2024). The diagnostic accuracy of the Mini-Cog
screening tool for the detection of cognitive impairment—A systematic review and
meta-analysis. PLoS One, 19(3), e0298686.
A Kluger, J G Gianutsos, J Golomb et al.(1997). Motor/psychomotor dysfunction in normal
aging, mild cognitive decline, and early Alzheimer's disease: diagnostic and differential
diagnostic features. Int Psychogeriatr, Suppl 1,307-16; discussion 317-21.Alzheimer’s
Disease International(2018). World Alzheimer Report 2010: The Global Economic
Impact of Dementia. www.alz.co.uk/research/world-report-2010 (accessed 20 July 2018).
Alzheimer’s Disease International(2018). World Alzheimer Report 2011: The Benefits of
Early Diagnosis and Intervention. www.alz.co.uk/research/world-report-2011 (accessed
20 July 2018).
Alzheimer’s Disease International(2022). World Alzheimer Report 2022: Life after diagnosis:
Navigating treatment, care and support. https://www.alzint.org/u/World-Alzheimer-
Report-2022.
Bojarczuk, C. C., Lopes, H. S., & Freitas, A. A. (2018). Data mining with evolutionary
algorithms: A review of the state-of-the-art. Artificial Intelligence Review, 29(4), 293-
328.
Bott N T, Hall A, Madero E N, et al.(2019). Face-to-face and digital multidomain lifestyle
interventions to enhance cognitive reserve and reduce risk of Alzheimer’s disease and
related dementias: a review of completed and prospective studies. Nutrients, 11(9), 2258.
Bao Feng(2019). Thinking on diagnosis and treatment of mental and behavioral symptoms of
dementia. Chinese Journal of Medicine, 54(5), 483-485.
Bisbe M, Fuente-Vidal A, Lopez E, et al.(2020). Comparative cognitive effects of
choreographed exercise and multimodal physical therapy in older adults with amnestic
mild cognitive impairment: randomized clinical trial. J Alzheimers Dis, 73(2), 769-783.
Chen Chuanfeng, He Chenglin, Chen Hongxia, et al.(2012). A summary of dementia studies
in China. Journal of Ningbo University(Educational Science Edition), 34(02), 45-50.
Chen Xuelian, Sun Fugang, Zhou Haiwen(2018). Feasibility study on the application of
psychomotor rehabilitation to community rehabilitation of mental patients. Journal of
Electrocardiogram, 7(2), 234-236.
Carcelen-Fraile MDC, Llera-DelaTorre AM, Aibar-Almazan A, et al.(2022). Cognitive
stimulation as alternative treatment to improve psychological disorders in patients with
mild cognitive impairment. J Clin Med, 11(14), 3947.
Ding Duyu, Zhang Wei(2019). Neuroregulatory treatment of Alzheimer's disease. Chinese
Journal of Medicine, 54(5), 474-477.

Page 35 of 48
Dorris, J. L., Neely, S., Terhorst, L., VonVille, H. M., & Rodakowski, J. (2021). Effects of
music participation for mild cognitive impairment and dementia: A systematic review
and meta‐analysis. Journal of the American Geriatrics Society, 69(9), 2659-2667.
D. Oswald, B. Hagen & R. Rupprecht(2001). Nichtmedikamentöse Therapie und Prävention
der Alzheimer Krankheit. Zeitschrift für Gerontologie und Geriatrie, 34, 116-121.
Duan Zhouying, Chen Wenhua(2021). Thoughts on the integration of French psychomotor
rehabilitation into the professional education of rehabilitation therapy in China. Chinese
Journal of Rehabilitation Medicine, 36(02), 198-201,205.Fu Yuxiang(2021). Effects of
nostalgic therapy combined with severe aerobic exercise on cognitive function, daily
living ability and quality of life in patients with Alzheimer's disease. International
Journal of Nursing, 40(19), 3535-3538.
Duan Zhouying, Chen Wenhua(2021). Thoughts on the integration of French psychomotor
rehabilitation into the professional education of rehabilitation therapy in China. Chinese
Journal of Rehabilitation Medicine, 36(2), 198-202,205.
Faulkner G, Carless D(2006). Physical activity in the process of psychiatric rehabilitation：
theoretical and methodological issues. Psychiatr Rehabil J, 29(4), 258-266.
Feng, Z., & Wu, B. (2023). Embracing Challenges for Population Aging in China: Building
Scientific Evidence to Inform Long-Term Care Policymaking and Practice. In Journal of
Aging
and
Social
Policy
(Vol.
35,
Issue
5,
pp.
543–553).
Routledge.
https://doi.org/10.1080/08959420.2023.2217979
Gordon, T. J. (1994). The real-time Delphi method. In Futures Research Methodology.
Gordon, T. J., & Pease, A. (2006). RT Delphi: An efficient, "round-less" almost real time
Delphi method. Technological Forecasting and Social Change, 73(4), 321-333.
Handley, M. A., Lyles, C. R., McCulloch, C., & Cattamanchi, A. (2018). Selecting and
improving
quasi-experimental
designs
in
effectiveness
and
implementation
research. Annual review of public health, 39(1), 5-25.
Harris, A. D., McGregor, J. C., Perencevich, E. N., et al. (2006). The use and interpretation
of quasi-experimental studies in medical informatics. Journal of the American
Medical Informatics Association, 13(1), 16-23.
Hasson, F., Keeney, S., & McKenna, H. (2000). Research guidelines for the Delphi survey
technique. Journal of Advanced Nursing, 32(4), 1008-1015.
Haute Autorité de Santé(2010). Actes d’ergothérapie et de psychomotricité susceptibles
d’être réalisés pour la réadaptation àdomicile des personnes souffrant de la maladie
d’Alzheimerou d’une maladie apparentée. https://www.has-sante.fr/,2010-03.

Page 36 of 48
Hong
SG,
Kim
JH,
Jun
TW(2018).
Effects
of
12-week
resistance
exercise
on
electroencephalogram patterns and cognitive function in the elderly with mild cognitive
impairment: a randomized controlled trial. Chin J Sport Med, 28(6), 500-508.
Jeong JH, Na HR, Choi SH, et al. (2016). Group- and home-based cognitive intervention for
patients with mild cognitive impairment: a randomized controlled trial. Psychother
Psychosom, 85(4), 198-207.
Jia Jianping(2016). Guidelines for diagnosis and treatment of dementia and cognitive
impairment in China. Bei Jing: People's Medical Publishing House, 135-141.
Jia, L., Du, Y., Chu, L., Zhang, Z., Li, F., et al. (2020). Prevalence, risk factors, and
management of dementia and mild cognitive impairment in adults aged 60 years or older
in China: a cross-sectional study. The Lancet Public Health, 5(12), e661–e671.
https://doi.org/10.1016/S2468-2667(20)30185-7
KAY SR, FISZBEIN A, OPLER L A (1987). The positive and negative syndrome scale
(PANSS) for schizophrenia. Schizophrenia bulletin, 13(2), 261-276.
Katzman R, Zhang MY, Ouang YQ, et al(1988). A Chinese version of the Mini-Mental State
Examination impact of illiteracy in a Shanghai dementia survey. J Clin Epidemiol,
41(10), 971-978.
Keeney, S., Hasson, F., & McKenna, H. (2006). Consulting the oracle: ten lessons from using
the Delphi technique in nursing research. Journal of Advanced Nursing, 53(2), 205-212.
Keeney S, Hasson F, Mckenna H(2010). The delphi technique in nursing and health research.
Kwag, E., Stuckenschneider, T., Schneider, S., & Abeln, V. (2021). The effect of a
psychomotor
intervention
on
electroencephalography
and
neuropsychological
performances
in
older
adults
with
and
without
mild
cognitive
impairment. Psychogeriatrics, 21(4), 528-539.
Linstone, H. A., & Turoff, M. (1975). The Delphi Method: Techniques and Applications.
Addison-Wesley.
Landeta, J. (2006). Current validity of the Delphi method in social sciences. Technological
Forecasting and Social Change, 73(5), 467-482.
LIU Xin Yan, LI Li, XIAO Jia Qing, et al.(2016). Cognitive Training in Older Adults with
Mild Cognitive Impairment. Biomed Environ Sci, 29(5), 356-364.
Liu Xuan, Xiao Zemei (2020). Application of clown care in patients with dementia: a review.
Journal of Nursing Science, 35(17), 28-31.
Liao YY, Tseng HY, Lin YJ, et al.(2019). Using virtual reality-based training to improve
cognitive function, instrumental activities of daily living and neural efficiency in older
adults with mild cognitive impairment. Eur J Phys Rehabil Med, 56(1), 47-57.

Page 37 of 48
Lefaucheur J P, Aleman A, Baeken C, et al.(2020). Evidence-based guidelines on the
therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-
2018). Clin Neurophysiol, 131(2), 474-528.
Liang Jingzhao, Zhi Yanmin(2022). Effect of nursing model based on psychomotor
rehabilitation theory applied to senile dementia patients. Journal of HuaiHai YiYao
Medicine, 40(5), 526-529.
Levy, S. A., Smith, G., De Wit, L., et al.(2022). Behavioral Interventions in Mild Cognitive
Impairment (MCI): Lessons from a Multicomponent Program. Neurotherapeutics, 19(1),
117–131.Martino, J. P. (1983). Technological Forecasting for Decision Making. Elsevier.
Liang Jingzhao, Zhi Yanmin(2022). Effect of nursing model based on psychomotor
rehabilitation theory applied to senile dementia patients. Journal of Huaihai Medicine,
40(05), 526-529.
Lu J , Li D , Li F ,et al. Montreal cognitive assessment in detecting cognitive impairment in
Chinese
elderly
individuals:
a
population-based
study[J].
J
Geriatr
Psychiatry
Neurol, 2011,24(4):184-190.
Maier, W., Buller, R., Philipp, M., & Heuser, I. (1988). The Hamilton Anxiety Scale:
reliability, validity and sensitivity to change in anxiety and depressive disorders. Journal
of affective disorders, 14(1), 61-68.
Maier, W. (1990). The Hamilton Depression Scale and its alternatives: a comparison of their
reliability and validity. The hamilton scales, 64-71.
Murry, J. W., & Hammons, J. O. (1995). Delphi: A versatile methodology for conducting
qualitative research. The Review of Higher Education, 18(4), 423-436.
M Hofman , E Seifritz, K Kräuchi,et al.(2000). Alzheimer's disease, depression and normal
ageing: merit of simple psychomotor and visuospatial tasks. Int J Geriatr Psychiatry,
15(1), 31-9.
Medina M, Khachaturian Z S, Rossor M, et al.(2017). Toward common mechanisms for risk
factors in Alzheimer’s syndrome. Alzheimers Dement (N Y), 3(4), 571-578.
Ma Dongfei, Sun Jiao, Zhao Yingnan, et al.(2019). Nursing care mode of behavioral and
psychological symptoms in patients with dementia: a literature review. Chinese Journal
of Nursing, 54(07), 1017-1022.
MA Jing(2023). Application of Orem Self-care Theory in Daily Out-of-hospital Management
of Elderly Patients with Alzheimer’s Disease. Chinese Practical Journal of Rural Doctor,
30(2), 28-35.
Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA:
a
brief
screening
tool
for
mild
cognitive
impairment[J].
J
Am
Geriatr
Soc, 2005,53(4):695-699.

Page 38 of 48
Ni Ping, Chen Jingli, Liu Na(2010). Sample size estimation of quantitative research in
nursing research. Chinese Journal of Nursing, 45(04), 378-380.
Odete Vicente de Sousa, Rita Soares Guerra, Ana Sofia Sousa et al.(2017). Impact of
nutritional supplementation and a psychomotor program on patients with Alzheimer’s
disease. American Journal of Alzheimer’s Disease & Other Dementias, 32(6), 329-341.
Park, J.H.(2022). Does the virtual shopping training improve executive function and
instrumental activities of daily living of patients with mild cognitive impairment? Asian
Journal of Psychiatry, 69.
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of internal
medicine, 256(3), 183-194.
Peng Ali, Wang Yue, Zuo Congmin, et al.(2020). Improvement of daily living ability among
patients with mile and moderate Alzheimer’s disease based on Habilitation nursing
model. Chinese Health Quality Management, 27(4), 114-118.
Prince M, Comas-Herrera A, Knapp M, et al.(2018). World Alzheimer Report 2016:
Improving healthcare for people living with dementia: coverage, quality, and costs now
and in the future. www.alz.co.uk/research/world-report-2016 (accessed 7 July 2018).
Rowe, G., & Wright, G. (1999). The Delphi technique as a forecasting tool: issues and
analysis. International Journal of Forecasting, 15(4), 353-375.
REN Ru-Jing, WANG Gang, ZHANG Shi, et al. (2008). Validation of the Chinese Version
of the Cornell Scale for Depression in Dementia and Its Applications for Clinical
Research. Chinese Journal of Clinical Neuroscience, 16(2), 170-174.
Roberts G, Morley C, Walters W, et al.(2015). Caring for people with dementia in residential
aged care: successes with a composite person-centered care model featuring Montessori-
based activities. Geriatr Nurs, 36(2), 106-110.
SI Tianmei, YANG Jianzhong, SHU Liang, et al. (2004). The reliability, validity of PANSS
( Chinese version) and its Implication. Chinese Journal of Mental Health, 18(1), 45-47.
Skulmoski, G. J., Hartman, F. T., & Krahn, J. (2007). The Delphi method for graduate
research. Journal of Information Technology Education: Research, 6(1), 1-21.
Suzuki H, Kuraoka M, Yasunaga M, et al.(2014). Cognitive intervention through a training
program for picture book reading in community-dwelling older adults: a randomized
controlled trial. BMC Geriatr, 14, 122.
Spagnolo P, Arico M, Bergamelli C, et al.(2015). A pilot study on behavioral and cognitive
effects of cognitive stimulation training based on 3R mental stimulation. The Treviso
Dementia (TREDEM) Study. Neuro Rehabilitation, 36(1), 151-156.

Page 39 of 48
Shao Quanwei, Li Bai(2015). Applying psychomotor therapy to improve soldiers physical
fitness recovery. Hosp Admin J Chin PLA, 22(2), 165-166, 180.
Sheppard C L, Mcarthur C, Hitzig S L(2016). A systematic review of Montessori-based
activities for persons with dementia. Journal of the American Medical Directors
Association,17(2), 117-122.Shi Qi, Zhu Li-ping, Yan Wei, et al.(2018). Epidemic
situation of Alzheimer’s disease and hypomnesia among residents aged 60 years and
above in Jiangxi Province. Practical Clinical Medicine, 19(01), 83-87.
Sun Fei, Zhong Xin, Li Xia(2019). Construction and development of dementia friendly
community: a comparative analysis of community cases between China and U.S.
Chinese
Nursing
Management,
19(9),
1295-1301.Special
Committee
of
Neurodegenerative Diseases of Chinese Society of Microcirculation, Neuropsychology
and Behavioral Neurology Group, Neurology Branch, Chinese Medical Association,
Neurological
Rehabilitation
Group,
Neurological
Branch,
Chinese
Medical
Association(2020).
Chinese
expert
consensus
on
rehabilitation
management
of
Alzheimer's disease. Chinese Journal of Geriatrics, 39(01), 9-19.
Sun Jingna, Fu Rong, Hou Xiaojie, et al.(2021). Effectiveness of 3+1 holistic rehabilitation
nursing model in elderly patients with Alzheimer’s disease: a meta-analysis. Journal of
Nursing Science, 36(24), 85-89.
Tang Yue, Zhang Yuan, Wang Zhiliang, et al.(2017). Hospital-Community-Family Network
and Alzheimer’s Community Intervention. Chinese General Practice, 20(S3), 457-459.
The Dementia and Cognitive Disorders Group of the Chinese Society of Neurology. (2025).
Expert consensus on neuropsychological assessment for mild cognitive impairment
(2025 edition) . National Medical Journal of China, 105(3), 204-218.
Tian Xianglan(2020). Research on Japan's Policy and Care System for Alzheimer's Disease.
Japanese Research, 34(2), 33-40.
Tian Huan, Zhou Lin, Wang Lichao, et al.(2021). Research progress of acupuncture in
treating Alzheimer’s disease. China’s Naturopathy, 29(18), 118-122.
Van Der Ploeg E S, O’Connor D W(2010). Evaluation of personalized,one-to-one interaction
using Montessori-type activities as a treatment of challenging behaviors in people with
dementia: the study protocol of a crossover trial.BMC Geriatrics,10, 3.
Van Der Ploeg E S, Eppingstall B(2013). A randomized crossover trial to study the effect of
personalized, one-to-one interaction using Montessori-based activities on agitation,
affect, and engagement in nursing home residents with Dementia. Int Psychogeriatr,
25(4), 565-575.
Vandewoude M, Barberger-Gateau P, Cederholm T, et al(2016). Healthy brain ageing and
cognition: nutritional factors. Eur Geriatr Med, 7(1), 77-85.Van der Steen JT, Van
Soest-Poortvliet MC, Van der Wouden JC, et al.(2017). Music-based therapeutic

Page 40 of 48
interventions for people with dementia. Cochrane Database of Systematic Reviews,
Issue 5. [DOI:10.1002/14651858.CD003477.pub3]
Van Der Steen J T, Smaling H J, Van Der Wouden JC, et al.(2018). Music-based therapeutic
interventions for people with dementia. Cochrane Database Syst Rev, 7(7), Cd003477.
Wang ZY, Zhang MY(1989). Application of the Chinese version of the Mini-Mental State
Examination (MMSE). Shanghai Psychiatry, 7(3), 108-111.
Wilson N L, Camp C J, Judge K S, et al(1997).An intergenerational program for persons with
dementia using Montessori methods. The Gerontologist,37(5), 688-692.
Wu Han, Zhu Yi, Wang Shiyan, et al.(2016). Effects of aerobic exercise on mild cognitive
impairment. Chinese Journal of Physical Medicine and Rehabilitation, 38(2), 113-117.
Wang Enshi, Sun Aiguo, Ma Weili, et al.(2016). Application effects of Orem self-care
nursing mode on patients with Alzheimer’s. Chinese Journal of Modern Nursing, 22(17),
2458-2461.
Wang Lijuan, Zhou Lina(2018). Exploration of the 3+1 holistic rehabilitation nursing model
in the rehabilitation of senile dementia patients. The Medical Forum, 22(30), 4312-4313.
Wang Lijun, Jin Huan, Xiao Tian(2023). Effects of Balint group activities combined with
cognitive intervention on negative emotions in elderly patients with mild cognitive
impairment. Chinese General Practice Nursing, 21(10), 1370-1373.
Wang Ning(2021). A national strategy study on dementia in the UK. Social Governance
Review, (1), 75-85. Xu J, Wang J, Wimo A, et al.(2017). The economic burden of
dementia in China, 1990-2030: implications for health policy. Bull World Health Organ,
95(1), 18.
Wang Qiong, Wu Zhongwen, Geng Li, et al.(2021). Intervention based on psychomotor
rehabilitation theory for senile dementia patients. Journal of Nursing Science, 36(3), 1-4.
Winblad, B., Palmer, K., Kivipelto, M., et al.(2004). Mild cognitive impairment–beyond
controversies, towards a consensus: report of the International Working Group on Mild
Cognitive Impairment. Journal of internal medicine, 256(3), 240-246.
Wilks S E, Body P A, Bates S M, et al.(2019). Montessori-based activities among persons
with late-stage dementia: evaluation of mental and behavioral health outcomes.
Dementia (London), 18(4), 1373-1392.
Xu Haoqin, Yan Lirong, Lv Nianqing, et al.(2019). The practice of French psychomotor
rehabilitation technology in Chinese people with cognitive impairment. Nan Jing:
Southeast University Press, 1-332.

Page 41 of 48
Xue Jinggang, Qin Jin(2021). Analysis of the application effect of virtual reality technology
in rehabilitation training for patients with mild cognitive impairment。Chinese General
Practice, 24(S1), 110-112.
Yu Mei, Wu Qinying, Lin Xiaomei(2018). Effect of rehabilitation nursing of traditional
Chinese medicine on self-care ability and mental state of senile dementia patients.
Chinese and Foreign Medical Research, 16(23), 112-113.
YUEN I, KWOK T(2019). Effectiveness of dementi ability methods: the montessori way on
agitation in long-term care home residents with dementia in Hong Kong. International
Journal of Geriatric Psychiatry, 34(9), 1352-1358.
Yang SY, Lee HC, Huang CM, et al.(2021). Efficacy of Tai Chi-style multi-component
exercise on frontal-related cognition and physical health in elderly with amnestic mild
cognitive impairment. Front Aging, 2, 636390.
Zhang Ruixing, Li Li, Michel Probst, et al.(2017). Application and research progress of
psychomotor therpay in psychiatric rehabilitation. Chinese General Practice, 20(20),
2539-2542.
Zhang Weiwei, Xu Haoqin, Zhang Yanyan, et al.(2022). Application of psychomotor
rehabilitation therapy in elderly patients with mild and moderate Alzheimer's disease.
Practical Geriatrics, 36(5), 495-497.

Page 42 of 48
APPENDICES
Data Collection Form
Name:
ID :
Elderly’s General information:
1. Sex
Female
：______________
Male
：______________
2. Age (years)
：______________
3. Education Level
Illiteracy
：______________
Primary school
：______________
Middle school
：______________
College or above
：______________
4. Family history of dementia ( Yes or No )
：______________
5. Marital status
Single / Divorced / Widowed
：______________
Married
：______________
6. Personal annual income
：______________
7. Chronic disease (Yes or No. If yes, please write the specific disease name)
：______________

Page 43 of 48

Page 44 of 48
POSITIVE AND NEGATIVE SYNDROME SCALE (PANSS)
ITEMS
SCORE
POSITIVE SCALE (P)：
P1. DELUSIONS - Beliefs which are unfounded, unrealistic and idiosyncratic.
□
P2. CONCEPTUAL DISORGANISATION - Disorganized process of thinking
characterized by disruption of goal-directed sequencing, e.g. circumstantiality, loose
associations, tangentiality, gross illogicality or thought block.
□
P3. HALLUCINATORY BEHAVIOUR - Verbal report or behavior indicating
perceptions that are not generated by external stimuli. These may occur in the
auditory, visual, olfactory, or somatic realms.
□
P4. EXCITEMENT - Hyperactivity as reflected in accelerated motor behavior,
heightened responsivity to stimuli, hypervigilance or excessive mood lability.
□
P5. GRANDIOSITY - Exaggerated self-opinion and unrealistic convictions of
superiority, including delusions of extraordinary abilities, wealth, knowledge, fame,
power and moral righteousness.
□
P6. SUSPICIOUSNESS/PERSECUTION - Unrealistic or exaggerated ideas of
persecution,
as
reflected
in
guardedness,
ad
distrustful
attitude,
suspicious
hypervigilance or frank delusions that others mean harm.
□
P7. HOSTILITY - Verbal and nonverbal expressions of anger and resentment,
including sarcasm, passive-aggressive behavior, verbal abuse, and assualtiveness.
□
NEGATIVE SCALE (N)：
N1. BLUNTED AFFECT - Diminished emotional responsiveness as characterized by
a reduction in facial expression, modulation of feelings and communicative gestures.
□
N2. EMOTIONAL WITHDRAWAL - Lack of interest in, involvement with, and
affective commitment to life’s events.
□
N3. POOR RAPPORT - Lack of interpersonal empathy, openness in conversation and
sense of closeness, interest or involvement with the interviewer. This is evidenced by
interpersonal distancing and reduced verbal and nonverbal communication
□
N4. PASSIVE/APATHETIC SOCIAL WITHDRAWAL - Diminished interest and
initiative in social interactions due to passivity, apathy, anergy or avolition. This leads
to reduced interpersonal involvements and neglect of activities of daily living.
□
N5. DIFFICULTY IN ABSTRACT THINKING - Impairment in the use of the
abstract-symbolic mode of thinking, as evidenced by difficulty in classification,
forming generalizations, and proceeding beyond concrete or egocentric thinking in
problem-solving tasks.
□
N6. LACK OF SPONTANEITY AND FLOW OF CONVERSATION - Reduction in
the normal flow of communication associated with apathy, avolition, defensiveness or
cognitive deficit. This is manifested by diminished fluidity and productivity of the
verbal interactional process.
□
N7. STEREOTYPED THINKING - Decreased fluidity, spontaneity and flexibility of
thinking, as evidenced in rigid, repetitious or barren thought content.
□
GENERAL PSYCHOPATHOLOGY SCALE(G)：
G1. SOMATIC CONCERN - Physical complaints or beliefs about bodily illness or
malfunctions. This may range from a vague sense of ill being to clear-cut delusions of
catastrophic physical disease.
□
G2. ANXIETY - Subjective experience of nervousness, worry, apprehension or
restlessness, ranging from excessive concern about the present or future to feelings of
□

Page 45 of 48
panic.
G3. GUILT FEELINGS - Sense of remorse or self-blame for real or imagined
misdeeds in the past.
□
G4. TENSION -Overt physical manifestations of fear, anxiety, and agitation, such as
stiffness, tremor, profuse sweating and restlessness.
□
G5. MANNERISMS AND POSTURING – Unnatural movements or posture as
characterized be an awkward, stilted, disorganised, or bizarre appearance.
□
G6. DEPRESSION -
Feelings
of sadness, discouragement, helplessness and
pessimism.
□
G7. MOTOR RETARDATION – Reduction in motor activity as reflected in slowing
or lessening or movements and speech, diminished responsiveness of stimuli, and
reduced body tone.
□
G8. UNCOOPERATIVENESS - Active refusal to comply with the will of significant
others, including the interviewer, hospital staff or family, which may be associated
with distrust, defensiveness, stubbornness, negativism, rejection of authority, hostility
or belligerence.
□
G9. UNUSUAL THOUGHT CONTENT - Thinking characterized by strange,
fantastic, or bizarre ideas, ranging from those that are remote or atypical to those that
are distorted, illogical, and patently absurd.
□
G10. DISORIENTATION - Lack of awareness of one’s relationship to the milieu,
including persons, place and time, which may be due to confusion or withdrawal.
□
G11. POOR ATTENTION - Failure in focused alertness manifested by poor
concentration, distractibility from internal and external stimuli, and difficulty in
harnessing, sustaining or shifting focus to new stimuli.
□
G12.
LACK
OF
JUDGEMENT
AND
INSIGHT
-
Impaired
awareness
or
understanding of one’s own psychiatric condition and life situation. This is evidenced
by failure to recognize past or present psychiatric illness or symptoms, denial of the
need for psychiatric hospitalization or treatment, decisions characterized by poor
anticipation or consequences, and unrealistic short-term and long-range planning.
□
G13. DISTURBANCE OF VOLITION – Disturbance in the wilful initiation,
sustenance, and control of one’s thoughts, behavior, movements, and speech.
□
G14. POOR IMPULSE CONTROL - Disordered regulation and control of action on
inner urges, resulting in sudden, unmodulated, arbitrary or misdirected discharge of
tension and emotions without concern about consequences.
□
G15. PREOCCUPATION - Absorption with internally generated thoughts and
feelings and with autistic experiences to the detriment of reality orientation and
adaptive behavior.
□
G16. ACTIVE SOCIAL AVOIDANCE - Diminished social involvement associated
with unwarranted fear, hostility, or distrust.
□
(Adapted from SR Kay, A Fiszbein, LA Opler, 1987)

Page 46 of 48

Page 47 of 48

Page 48 of 48