Increased practice of Chinese calligraphy strengthens brain network in older adults

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.