Long-term Cognitive Improvements with Community-based Activities

A recently published study by Mind Science Centre showed the results of a naturalistic follow-up study on novel cognitive stimulating activities (CSAs) as an intervention to cognitive decline (Ng et al., 2022). The CSAs of interest are novel community-based interventions curated by researchers at Mind Science Centre. These include mindfulness practice, horticulture, art and music reminiscence therapy, and choral singing.

Results from the study showed sustained improvements in global cognitive function in those who joined at least one activity. In addition, there were also improvements in numerous cognitive domains including: short-term memory, attention span, orientation to time and space, language skills, as well as visual-spatial functions.

What are Cognitive Stimulating Activities (CSAs)?

CSAs refer to a group of activities aimed at enhancing cognitive functioning. Its regular use has long been recommended for mild and moderate dementia.

Over the years, various randomized controlled studies (RCT) have shown CSA’s potential in preventing cognitive decline in cognitively healthy older adults and those with mild cognitive impairment (MCI). However, there is still one big question left unanswered:

“Can the effects of these activities be sustained long-term?”

Importance of a Follow-up Study on CSAs

Previous research is mostly short-term (on average 3 months) and does not involve any follow-up. From those studies, we only know that CSAs can show improvements in cognitive function during the period of intervention. We can’t be sure if the improvements will stay in the long run.

Mind Science Centre’s study aims to further analyse the effects of four novel CSAs in preventing cognitive decline amongst community-dwelling older adults without dementia. Our study is a long-term naturalistic follow-up study, with interventions done in the real-world setting.

MSC’s Novel Community-based Cognitive Stimulating Activities

From 2014 to 2019, Mind Science Centre embarked on four separate studies on:

A total of 264 participants were involved in at least 1 of the 4 programmes above. Out of those, 19 participants were involved in two studies.

These four activities are novel community-based interventions, that are by design, easy to implement, low-cost, widely acceptable, and quite pragmatic yet effective. Each programme lasted from 6 months to 2 years. You can click the links above to find out more details on each activity.

For the follow-up study, participants were contacted at an average 4.82 years following the initial programmes.

All these participants are part of larger cohort recruited for the 10-year longitudinal Jurong Ageing Study. This overarching study investigated a multitude of biological, psychosocial, and social factors impacting cognitive function in older adults.

Assessment Tools to Measure Cognitive Function in Older Adults

In this follow-up study participants were screened with the Mandarin-translated modified version of the mini-mental state examination (MMSE). The test was previously validated for use in the Singaporean population (Feng et al., 2012), with total scores indicating global cognitive function.

It also comprises of sub-scales assessing various cognitive domains including:

Orientation to time and place (knowing the date and where you are)
Attention span
Short-term memory (immediate recall)
Long-term memory (delayed recall)
Language skills
Constructional and visual-spatial functions (visual and spatial relationship between objects)

Improvements in Global Cognitive Function Following Cognitive Stimulating Activities (CSAs)

Results from our follow-up study found improvements in total MMSE scores, indicating improved cognitive function. This contrasts with the decreased MMSE scores of those who did not participate in any of the activities.

The estimate of the difference between the CSA and control groups was indicated by the Cohen’s d value. Positive values indicate an increase in the CSA group and vice-versa.

Looking into the specific domains, there was a notable increase in short-term memory (immediate recall) as well as orientation to time and place in those who participated in at least one CSAs. Scores also improved across ALL other domains, except for long-term memory (delayed recall), albeit to a smaller extent.

Improvements in overall cognitive function, especially in immediate memory is quite remarkable as it is usually one of the earliest signs of cognitive decline, and in extension, dementia.

Our 5-year follow-up study show that community-based cognitive stimulating activities such as mindfulness practice, horticulture, art therapy, and choir singing could really benefit older adults in the long run.

Moderate effect size found in the MCI sub-group

Looking specifically into only those with mild cognitive impairment (MCI), we can observe a trend toward improvement in total cognition scores. This again contrasts with the control group whose scores deteriorated over the follow-up period as shown in the figure above. The difference between the two groups has a medium effect size (0.415), suggesting moderate practical significance.

In addition, there is an increase in ALL domain scores with effect sizes ranging from small (0.199) to medium (0.413).

Results from our study showed that there are greater improvements in those with MCI as compared to cognitively healthy participants. These findings further highlighted MCI as a potential interventional target population for future studies and implementation of CSAs.

Involvement in multiple activities were associated with greater improvement in cognitive scores

Our study found that those who participated in more cognitive stimulating activities had a greater improvement in their total cognitive score. This is shown by the larger effect size of improvement as compared to those involved in only one activity.

From baseline to follow-up, the domain scores in the CSA group improved across all MMSE domains.

Take Charge of Your Ageing with Cognitive Stimulating Activities!

Our study provided scientific evidence that CSAs in a real-world and community-based setting can prevent cognitive decline in cognitively health older adults and those with MCI. Even more, we have shown that the effects of such interventions can be sustained long-term.

Our Age Well Everyday (AWE) programme aims to empower older adults to take charge of their ageing through these community-based interventions. It’s not too late, start your positive ageing journey now!

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Join us in for a beginner-friendly 30-minute session every Friday 1.00 – 1.30pm.

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References

Ng, T. K. S., Feng, L., Chua, R. Y., Goh, L. G., Kua, E. H., & Mahendran, R. (2022). A 5‐year community program in Singapore to prevent cognitive decline. Asia-Pacific Psychiatry. https://doi.org/10.1111/appy.12518

Feng. (2012). The Modified Mini-Mental State Examination test: normative data for Singapore Chinese older adults and its performance in detecting early cognitive impairment. Singapore Medical Journal, 53(7). https://pubmed.ncbi.nlm.nih.gov/22815014/