Mitigating cellular aging and enhancing cognitive functionality: visual arts-mediated Cognitive Activation Therapy in neurocognitive disorders

Abstract

The growing phenomenon of population aging is redefining demographic dynamics, intensifying age-related conditions, especially dementia, projected to triple by 2050 with an enormous global economic burden. This study investigates visual arts-mediated Cognitive Activation Therapy (CAT) as a non-pharmacological CAT intervention targets both biological aging [leukocyte telomere length (LTL), DNA methylation age (DNAmAge)] and cognitive functionality. Aligning with a broader trend of integrating non-pharmacological approaches into dementia care. The longitudinal study involved 20 patients with mild to moderate neurocognitive disorders. Cognitive and functional assessments, and biological aging markers -i.e., LTL and DNAmAge- were analyzed before and after CAT intervention. Change in LTL was positively correlated with days of treatment (p =0.0518). LTL significantly elongated after intervention (p =0.0269), especially in men (p =0.0142), correlating with younger age (p =0.0357), and higher education (p =0.0008). DNAmAge remained instead stable post-treatment. Cognitive and functional improvements were observed for Copy of complex geometric figure, Progressive Silhouettes, Position Discrimination, Communication Activities of Daily Living-Second edition, Direct Functional Status (p < 0.0001) and Object decision (p =0.0594), but no correlations were found between LTL and cognitive gains. Visual arts-mediated CAT effectively mitigates cellular aging, especially in men, by elongating LTL. These findings underscore the potential of non-pharmacological interventions in enhancing cognitive and functional status and general well-being in dementia care. Further research with larger and longer-term studies is essential for validation.

Keywords: Alzheimer’s disease; Cognitive Activation Therapy; DNA methylation age; biological aging; dementia; leukocytes telomere length; neurocognitive disorders; visual art.

Figure 1

Strategy, selection criteria and results of a literature review on the effects of non-pharmacological interventions on LTL and DNAmAge. Out of the 15 studies found on the effects of non-pharmacological interventions on LTL, 53% (n=8) showed a positive effect, mainly due to mindfulness, meditation and yoga (light blue, 70%), music listening (orange, 20%), and art therapy (light grey, 10%). Out of the 7 studies found on the effects of non-pharmacological interventions on DNAmAge, 57% (n=4) showed a positive effect, mainly due to lifestyle changes integrative (orange, 50%), meditation and music listening (light blue - 25%), and diet (light grey - 25%).

Figure 2

Correlation curve between ∆LTL (∆LTL = LTL T1–LTL T0) and days of treatment of patients with mild to moderate neurocognitive disorders (n = 20). A simple linear regression plot shows the correlation between ∆LTL and days of treatment [correlation coefficient (r) = 0.440705; two-sided p = 0.0518]. Mean, standard error (SE), and 95% coefficient intervals (CI) are represented as orange, pink, and black lines, respectively.

Figure 3

LTL of patients with mild to moderate neurocognitive impairments receiving visual arts-mediated Cognitive Activation Therapy (CAT). Box plots show levels of LTL in patients with mild to moderate neurocognitive impairments before (T0) and after CAT (T1) (n = 20). In box plots, the boundary of the box closest to the x-axis indicates the 25th percentile, the line within the box marks the mean, and the boundary of the box farthest from the x-axis indicates the 75th percentile. Whiskers (error bars) above and below the box indicate the 95 and 5th percentiles. The horizontal bar with one asterisk indicates the significant comparison between T0 and T1 LTL of the same patient (n = 20) (T1 vs. T0, paired t-test: mean 1.19 ± 0.28 T/S vs. 1.09 ± 0.32 T/S, p = 0.0269).

Figure 4

Correlation curves between DNAmAge and chronological age of n = 20 patients with mild to moderate neurological disorders before (A) and after (B) visual arts-mediated CAT. In (A), a simple linear regression plot shows the correlation between DNAmAge and chronological age before treatment [correlation coefficient (r) = 0.641485; two-sided p = 0.0023]; while in (B), simple linear regression plot showing the correlation between DNAmAge and chronological age after treatment [correlation coefficient (r) = 0.587001; two-sided p = 0.0065]. Mean, standard error (SE), and 95% coefficient intervals (CI) are represented as orange, pink, and black lines, respectively.