Calligraphy Writing for Cognitive and Emotional Enhancement Among Older MCI People

Study Overview
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Brief Summary
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This study is aimed to investigate the efficacy of an 12-week Chinese calligraphy training program for enhancing cognitive and emotional functions of older adults with mild cognitive impairment. Participants are tested with several cognitive tests and electroencephalography (EEG), psycho-physical parameters and brain activities are recorded. Results are compared at pre-intervention, post-intervention, and 6-month post-intervention to provide evidence of benefits of Chinese calligraphy practice.

Detailed Description
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Participants are older adults with mild cognitive impairment, who will be recruited from several community elderly centers in Hong Kong according to selective criteria. The participants are randomly assigned to an experimental or a control group. The experimental group is invited to participate in 16 sessions of structured Chinese calligraphy program over 12 weeks. Each session lasts for 1.5 hours. The control group is invited to participate in an iPad learning program with navigating the Internet. The iPad program is also consisted of 16 sessions of 1.5 hours each over 8 weeks. Cognitive tests and physiological measures are conducted immediately before and after intervention and at 6-month post-intervention follow-up. Statistical analysis are performed to investigate the significant differences and interactions among the three time points. The association of cognitive performance and emotional calmness is also investigated. Selected participants are invited to take part in a EEG session while doing some computer tasks related to Chinese calligraphy. EEG results of are used to explore neural activities associated with visuospatial working memory and to provide evidence for neural changes at functional level as a result of Chinese calligraphy training and practice.

Official Title
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Can Chinese Calligraphy Writing Enhance Cognitive Performance and Emotional Calmness in Older Adults With Mild Cognitive Impairment? A RCT Study

Conditions
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Mild Cognitive Impairment

Intervention / Treatment
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* Behavioral: Calligraphy Training
* Behavioral: iPad Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Meeting Petersen's criteria for mild cognitive impairment Being able to read simple Chinese characters Community-dwelling Clinical Dementia Rating score of 0.5 No substantial prior experience of calligraphy writing Willing to write using a brush and willing to participate Exclusion Criteria: Presence of musculoskeletal problems preventing participants from writing Known chronic cardiovascular (e.g. systolic BP > 140mmHg) or pulmonary conditions requiring long-term medication Presence of severe mental disorder such as psychosis or depression.

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Calligraphy Training<br>This group receives a Chinese calligraphy training program of 16 sessions over 8 weeks in a class of 8-12 participants. Each session is 1.5 hours. | Behavioral: Calligraphy Training<br> <br> |
| Active Comparator: iPad Training<br>This group receives an iPad training program of 16 sessions over 8 weeks in a class of 8-12 participants. Each session is 1.5 hours. | Behavioral: iPad Training<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Digit span backward test (DSB) from baseline, after end of training, and 6-month follow-up. | DSB evaluates working memory, which requires recalling digits in reverse order. The DSB test is structured with increased levels of difficulty. | Baseline, within 2 weeks after end of training, and 6-month follow-up. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Color Trails Test (CTT) | CTT is consisted of two parts. CTT 1 evaluates attention and perceptual speed. Participants are asked to draw a line to between circles in consecutive order numbered 1 - 25, as quickly as possible. CTT 2 evaluates set-shifting. Each number (1 - 25) of CTT 2 is printed twice, one in pink and another in yellow color circle. Subjects are asked to connect the numbers in consecutive order but alternating between pink and yellow. | Baseline, within 2 weeks after end of training, and 6-month follow-up. | 
| Symbol-digit Modalities Test (SDMT) | SDMT evaluates executive function, in particular mental flexibility, of older people with cognitive impairment. It is a simple substitution task in which participants are asked to substitute series of symbols with specific digits within a period of 90 seconds. | Baseline, within 2 weeks after end of training, and 6-month follow-up. | 
| Heart rate and heart rate variability. | It is measured by the Polar RS800C. | At the week 1, 5, 9, 12 during the intervention period, and at 6-month post-intervention. | 
| Blood pressure. | It is measured by the Portapres. | At the week 1, 5, 9, 12 during the intervention period, and at 6-month post-intervention. | 
| Geriatric Depression Scale - Short Form (GDS-SF) | GDS-SF measures subjective appraisal of the mood state. It consists of 15 statements about various aspects of mood such as appetite, quality of sleep, hope, and social functioning. Each statement is responded using a dichotomous format (yes/no). | Baseline, within 2 weeks after end of training, and 6-month post-intervention. | 
| Consortium to Establish a Registry for Alzheimer's Disease - Neuropsychological Assessment Battery (CERAD-NAB) | CERAD-NAB is used to ask subjects to recall or identify the list of words learnt after a five minute delay. | Baseline, within 2 weeks after end of training, and 6-month post-intervention. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mild Cognitive Impairment, Cognitive training, Calligraphy, Emotional calmness, Working memory