Art therapy is associated with sustained improvement in cognitive function in the elderly with mild neurocognitive disorder: findings from a pilot randomized controlled trial for art therapy and music reminiscence activity versus usual care

Abstract

Background: Mild cognitive impairment (MCI) is a phase in cognitive decline when it is still possible to intervene to reverse the decline. Cognitive stimulation delivered through psychosocial interventions provides both psychological intervention and social stimulation to improve cognition. A pilot open-label parallel-arms randomized controlled trial was undertaken to examine the effects of art therapy (AT) and music reminiscence activity (MRA) compared to the control, on the primary outcome of neurocognitive domain assessments in elderly people with MCI.

Methods: Community-living elderly people with MCI (Petersen's criteria), assessed for study eligibility, were randomized using a web-based system with equal allocation to two intervention arms: AT (guided viewing of art pieces and production of visual arts) and MRA (listening, and recalling memories related to music) and a control arm (standard care without any intervention). Interventions were led by trained therapists weekly for 3 months, then fortnightly for 6 months. Neurocognitive domains (mean of memory, attention, and visuo-spatial abilities standardized scores), psychological wellbeing (subsyndromal depression and anxiety) and telomere length as a biological marker of cellular ageing, were assessed by intervention-blinded assessors at baseline, 3 months and 9 months.

Results: In total, 250 people were screened and 68 were randomized and included in the analysis. In the AT arm, neurocognitive domains improved compared to the control arm at 3 months (mean difference (d) = 0.40; 90% CI 0.126, 0.679) and were sustained at 9 months (d = 0.31; 90% CI 0.068, 0.548). There was some improvement in depression and anxiety at 3 and 9 months and in telomere length at 9 months, but this was not significant. Similar improvements were observed in the MRA arm over the control arm, but they were not significant. There were no intervention-related adverse effects.

Conclusions: Art therapy delivered by trained staff as "art as therapy" and "art psychotherapy" may have been the significant contributor to cognitive improvements. The findings support cognitive stimulation for elderly people with cognitive decline and signal the need for larger studies and further investigation of carefully designed psycho-social interventions for this group.

Trial registration: Clinical Trials.gov, NCT02854085 . Registered on 7 July 2016.

Keywords: Art therapy; Elderly; Mild cognitive impairment; Music reminiscence activity.

Conflict of interest statement

Ethics approval and consent to participate

The study protocol was reviewed by the Ethics Board of the National University of Singapore Institutional Review Board (NUS-IRB Ref Code: B-16-095) and the approval was dated 6 June 2016. Written informed consent was obtained from every participant and confidentiality was strictly maintained. All data were anonymized and maintained according to Ethics Board guidelines.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

Participants disposition (Consolidated Standards of Reporting Trials (CONSORT) diagram)

Fig. 2

Estimated mean change in memory-related neuropsychological outcomes at 3 months (3M) and 9 months (9M) from baseline: *p < 0.05 for comparison with the control group. RAVLT, Rey Auditory Verbal Learning Test. Outcomes are presented as standardized z-score (see the “Methods” section). Mean values were estimated using a linear mixed-effects model adjusted for baseline values and gender