BACKGROUND

Cognitive impairment is common in our society caused by disorders, such as dementia, stroke, mental retardation, cerebral palsy, and other neurological conditions. 

One of the main causes is dementia, which is an irreversible degenerative brain disease

affecting one’s memory, thinking, behaviour and emotion.

Cognitive decline can lead to loss of memory, decline in executive function, impairments in the sensory and motor system, disruption in daily living.

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Treatments :

• Medication                

• Non-pharmacological Interventions, eg. Cognitive Training

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Sources:

Alzheimer’s Disease International Department of Health

Dementia in Hong Kong

Cognitive Dysfunction

Executive function

Difficulty to performing familiar tasks
Difficulty in planning, organization and decision making

Language

Forgetfulness, especially names of people and objects
Difficulty in following conversation involving more than one person

Learning and memory

Short-term memory loss

Orientation

Confusion in time and places 

Attention

Increased difficulty in concentration and easy distraction 

Social cognition

Lost in initiatives to socialise

Calligraphy Therapy

Research has shown that calligraphy can​ significantly improve CMMSE global score and cognitive functions such as memory, attention, and orientation for older adults with mild cognitive impairment [1][2]. Other than a positive impact on cognitive health, calligraphy can also lead to an improvement in mental and physical health [3]. In particular, it can lead to a reduction in stress, decrease in blood pressure, and improve in mood [4].​ 

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[1] Kwok, Timothy C Y et al. “Cognitive effects of calligraphy therapy for older people: a randomized controlled trial in Hong Kong.” Clinical interventions in aging vol. 6 (2011): 269-73. 

[2] Chan, Sam C C et al. “Chinese Calligraphy Writing for Augmenting Attentional Control and Working Memory of Older Adults at Risk of Mild Cognitive Impairment: A Randomized Controlled Trial.” Journal of Alzheimer's disease : JAD vol. 58,3 (2017): 735-746. 

[3] Kao, Henry Sr et al. “Calligraphy and meditation for stress reduction: an experimental comparison.” Psychology research and behavior management vol. 7 47-52. 

[4] Yang, Xue-Ling et al. “The effects of Chinese calligraphy handwriting and relaxation training in Chinese Nasopharyngeal Carcinoma patients: a randomized controlled trial.” International journal of nursing studies vol. 47,5 (2010): 550-9.

Mahjong Therapy

​Mahjong Therapy can delay cognitive decline and prevent dementia in older adults, even for those with significant cognitive impairment  [1][2]. In particular, it has been shown to significantly improve short term and verbal memory, MMSE scores, attention, and hand-eye coordination [3]. Also, studies have shown that playing mahjong lead to a drop in depression score and feelings of loneliness as well as an improvement in self confidence and moods [4][5]. Thus, mahjong therapy can have a significant positive effect on players' cognitive and mental health. ​

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[1] Lee, Allen T C et al. “Association of Daily Intellectual Activities With Lower Risk of Incident Dementia Among Older Chinese Adults.” JAMA psychiatry vol. 75,7 (2018): 697-703.

[2] Cheng, Sheung-Tak et al. “Mental and physical activities delay cognitive decline in older persons with dementia.” The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry vol. 22,1 (2014): 63-74.

[3] Cheng, Sheung-Tak et al. “An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia.” International journal of geriatric psychiatry vol. 21,7 (2006): 611-7.

[4] Cheng, Sheung-Tak et al. “Leisure activities alleviate depressive symptoms in nursing home residents with very mild or mild dementia.” The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry vol. 20,10 (2012): 904-8.

[5] Teh, Jane Kimm Lii and Nai Peng Tey. “Effects of selected leisure activities on preventing loneliness among older Chinese.” SSM - Population Health 9 (2019): n. pag.

Game-based Intervention

Game-based intervention can have positive impact on players' cognitive, physical, and mental health. Research has shown that cognitive activities can improve executive functioning and delay memory decline, which is often a predictor for dementia [1].  Game-based intervention can also alleviate mood and improve balance and gait in older adults [2]. Furthermore, it can reduce behavioural symptoms for people with dementia and increase their interactions with family, caregivers and other patients [3]. ​

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[1] Hall, C B et al. "Cognitive activities delay onset of memory decline in persons who develop dementia." Neurology vol. 73,5 (2009): 356-61

[2] Zheng, Jiaying et al. “Game-based interventions and their impact on dementia: a narrative review.” Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists vol. 25,6 (2017): 562-565.

[3] Narme, Pauline. “Benefits of game-based leisure activities in normal aging and dementia.” “Intérêts des activités ludiques dans le vieillissement normal et chez les patients présentant une pathologie neurodégénérative.” Geriatrie et psychologie neuropsychiatrie du vieillissement vol. 14,4 (2016): 420-428.