
Increased practice of Chinese calligraphy strengthens brain network in older individuals who already practice the cognitive activity regularly and experienced subjective cognitive decline (SCD), a two-arm, parallel-design, assessor-blind, randomized controlled trial conducted by the Chinese University of Hong Kong (CUHK) has found.
“Our study revealed that increased practice time of Chinese calligraphy enhanced functional connectivity [FC] in the brain’s default mode network [DMN] at rest, particularly in areas such as the medial prefrontal cortex [mPFC], hippocampal formation [HF], temporal cortex [TC] and inferior parietal lobe [IPL],” said Professor Winnie Chu of the Department of Imaging & Interventional Radiology, CUHK. “These improvements may be due to reorganization and strengthening of the DMN, leading to better brain network connectivity and optimized activity functions [at rest].” [eBioMedicine 2024;102:105082]
While increased participation in cognitive activities can delay cognitive decline, neuroimaging evidence of the effect of cognitive activity participation on the DMN – a functionally interconnected network of brain regions that is active at rest and associated with Alzheimer’s disease – remains limited. [Ageing Res Rev 2014;15:28-43; Neuropsychol Rev 2017;27:403-439; Neuropsychol Rev 2020;30:167-193; Lancet 2020;396:413-446; Lancet 2015;385:2255-2263; JAMA Netw Open 2023;6:e2324465; Ann N Y Acad Sci 2008;1124:1-38; Alzheimers Dement (Amst) 2017;8:73-85; Alzheimers Dement 2018;4:395-413; Brain 2016;139:547-562; J Alzheimers Dis 2017;59:169-187; Front Aging Neurosci 2017;9:109]
To investigate the effect of increased cognitive activity participation on FC in the DMN, the researchers recruited 112 community-dwelling Chinese older individuals (mean age, 66.3 years; female, 74.1 percent) with positive SCD screening (mean Alzheimer’s Disease Assessment Scale-Cognitive Subscale [ADAS-Cog] score, 5.4; mean Montreal Cognitive Assessment [MoCA] score, 28.5), but no mild cognitive impairment or dementia, between 15 January 2020 and 31 December 2021. At baseline, the participants had been practicing Chinese calligraphy for a mean of 9.7 years, with an average of 3.1 hours of practice weekly in the past 6 months. They were randomized in a 1:1 ratio to either double their weekly practice time (intervention group) or continue their usual practice (control group) for 6 months. [eBioMedicine 2024;102:105082]
The primary outcome was FCs of the DMN. Throughout the study, 85.7 percent of participants (n=96) completed follow-up with functional MRI scan.
After 6 months, participants in the intervention group demonstrated either strengthening or lower degrees of weakening of most FCs in the DMN vs the control group. Significant between-group differences were observed in FCs between the mPFC and right lateral TC (LTC; mean difference, 0.25; p=0.009), mPFC and right IPL (mean difference, 0.23; p=0.007), left HF and right LTC (mean difference, 0.28; p=0.04), and left HF and right IPL (mean difference, 0.34; p=0.009).
“[These results indicated that] increased Chinese calligraphy practice may have neuromodulatory effects on the DMN in older individuals with prior regular practice who experienced SCD,” noted the researchers.
Global cognition remained relatively stable at 6 months in both groups, with no statistically significant differences between the two groups (ADAS-Cog: mean between-group difference, -0.15; p=0.40) (MoCA: mean between-group difference, -0.03; p=0.88). However, participants in the intervention group showed better working memory vs those in the control group (Digit Span Backward test: mean between-group difference, 0.43; p=0.01).
“Participating in more cognitive activities can be a safe and effective nonpharmacological intervention for maintaining [functional integrity of] brain network among older individuals residing in the community,” concluded principal investigator Dr Allen Lee of the Department of Psychiatry, CUHK.