The association between HE and cognitive changes
cognitive impairments, cognitive decline, MCI
Notably, cognitive benefits were also observed in the HE group. Regarding the cognitive benefits of HE, we believe this may be attributed to the higher brain plasticity of patients with MCI [This study has some limitations. First, given that we performed a single-center study with relatively small sample size, the documented findings should have been confirmed in a larger sample. Second, the effect of rEAP may have been highlighted in that the average level of neuropsychological tests in the control group at baseline in this study was poorer. In addition, we did not quantify the amount of time the participants spent in contact with the researcher in each arm; therefore, we could not assess the impact of this potentially important variable. Due to the limited time and budget, this study did not include healthy controls, so conclusions related to functional connectivity should be carefully examined. Besides, the number of voxels detected in this study was small. However, this may be because brain function change is a relatively slow process, and the intervention cycle in this study was only 12 weeks. Short-term artistic interventions may not be enough to make a significant difference in brain function. In addition, the fMRI data loss rate was also significant, with one-third of the patients in the study not participating in fMRI measurements, which may have limited the study’s ability to detect significant therapeutic effects of rEAP after the intervention. The main reason for this attrition is that many patients refuse to participate in fMRI scanning because they worry about physical discomfort caused by scanning. However, some patients have relative contraindications to scanning. Future studies should expand the sample size to retain as many participants qualified for fMRI as possible. Finally, in this study, the neuropsychological assessment was only recorded offline, and future studies could be designed so that both assessment and intervention could be completed remotely. Extending the scope of the study and increasing the follow-up time would also better highlight the duration of long-term effects caused by the application of treatment.Conclusively, our study shows that older patients with MCI can benefit from rEAPs and yield improvements in cognitive function, ReHo, and FC activity in the DMN brain regions. This study supports the feasibility and benefits of rEAP for cognitive maintenance, which is especially important for individuals with limited access to treatment because of geographical distance, transportation barriers, or lack of local services. Additionally, the COVID-19 pandemic has emphasized the importance of remote cognitive stimulation and social support programs to ensure long-term continuous cognitive management of patients with cognitive impairments and delay cognitive decline.