Due to an increase in life expectancy and a decrease in fertility, rapid population aging is a pertinent concern worldwide. This phenomenon also exists in Taiwan, where the proportion of older adults has been growing annually, constituting 17.56% of the entire population in December 2022 (Department of Statistics, Ministry of the Interior, Taiwan [DSMI], 2022). This increasing longevity has caused the number of people being diagnosed with dementia to rise. According to the World Alzheimer Report of 2022, there are over 50 million people living with dementia globally, and the number is expected to increase to 139 million by the year 2050. The annual cost of dementia is currently estimated at US $1 trillion, a figure expected to double by 2030 (Alzheimer's Disease International, 2022). Many studies have shown that MCI is the most important risk factor for dementia, with one study reporting a progression rate of MCI to dementia of 60–100% within 5–10 years (Dunne et al, 2021). A survey of the dementia epidemiology found that the pooled prevalence of MCI in Taiwan was 18.06%, which is much higher than in other developed countries (Taiwan Alzheimer’s Disease Association, 2020).
Mild cognitive impairment (MCI) is an intermediate mental state between physiologic aging and early dementia (Chehrehnegar et al., 2020). People with MCI may experience difficulties with memory, language, thinking or judgement that are greater than the cognitive changes expected with normal aging (Geda, 2012). In recent years, MCI has been recognized as a pre-dementia state, becoming an important subject for investigation in the prevention of dementia (Porsteinsson, Isaacson, Knox, Sabbagh, & Rubino, 2021). Mild cognitive impairment (MCI) affects older adults’ independence, especially their ability to engage in the activities of daily living. Dementia exerts profound impacts on affected individuals, their caregivers and society as a whole. For country, dementia puts great pressure on the long-term care system and economic development. Taiwan society is increasingly faced with the problems of dementia prevention, diagnosis, treatment, and care. Clinically, the neuropsychiatric symptoms of most people with MCI can be delay the progression with psychoactive drugs. However, these treatment methods often harm patients physically and psychologically, which can cause them to behave even more inappropriately (Scherder, Bogen, Eggermont, Hamers, & Swaab, 2010). Previous research suggested that because of cognitive plasticity, nonpharmacological interventions can potentially alleviate cognitive decline and improve psychosocial aspects of MCI and dementia without significant adverse effects (Rodakowski, Saghafi, Butters, & Skidmore, 2015). In recent years, such interventions may have become an important tool for improving negative emotions and behavioral symptoms than the drugs (Herholz, Herholz, & Herholz, 2013 ).
Activities involving art and social interaction are complex interventions and the positive effects on quality of life can increase dementia with older adults’ motivation to engage in targeted, leading to improvements in communication, attention, and pleasure while reducing the neuropsychiatric symptoms of dementia, which have been observed in older adults with cognitive disorder (Iizuka et al., 2019 ; Young, Camic, & Tischler, 2017). However, existing interventions for MCI are mainly unidimensional activities on memory or physical programs (Yang et al, 2020).
Expressive art therapy, also known as creative art therapy, is a form of is a form of art interventions which are designed to give participants an opportunity of creative expression through art tasks, such as photography, ceramics, knitting, crocheting, videography, painting, sketching, collaging, and stone carving, and expressive arts therapy evaluation with the aim of improving one’s mental, cognitive, and psychological well-being (Hinz, 2019; Zhao, Li, Lin, Wei, & Yang, 2018). A typical in a group and involves socialization, art education, reminiscence, art processing, art sharing, and art analysis evaluation (Alders & Levine-Madori, 2013). The mechanisms for which expressive art therapy are believed to improve cognitive and psychological functions could be explained by three parts. First, expressive art therapy provides an opportunity and supportive environment for participants to actively explore self-capacity, self-expression, and personal interests while integrating stimuli from multiple sensory modalities (Malchiodi, 2003). Second, it also involves the creation of a personal system of meaning across the four dimensions of information processing, including cognitive, perceptual, kinesthetic, and creative, whereas sharing the story in plenary related to their artwork stimulates language skills and self expression (Duhovska, Lusebrink, & Martinsone, 2018; Safar, 2014). Furthermore, expressive art therapy can arouse participants’ curiosity and interactive stimulation as well as strengthen their verbal responses and interactions with other participants, and results in reduced loneliness, enhanced social connectivity, and improved mood status (Kim, Kim, & Nomura, 2016). However, there has been little research on the benefits of expressive arts therapy in MCI with older adults.
The expressive art therapy intervention, which has not been tested in Taiwan. Therefore, we need more studies to assess the effectiveness of this strategy and its specific benefits for seniors with MCI. It is significantly meaningful to study the content design of expressive art therapy with feasibility and regional characteristics. Expressive arts therapy can be tailored to the needs, predispositions, and preferences of older adults with MCI and can improve cognitive function and psychological wellbeing by promoting active engagement, enjoyment, empowerment, and creativity. The purpose of this study was to explore the effects of expressive art therapy interventions on the cognitive function and depression of older adults with MCI in Taiwan.