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Effects of a culturally adapted group based Montessori based activities on engagement and affect in Chinese older people with dementia: a randomized controlled trial

Contact Information


Helen Yue-lai Chan,

Community; Dementia; Group activity; Person-centered; Support.


The Montessori Method underpinned by the principle of person-centered care has been widely adopted to design activities for people with dementia. However, the methodological quality of the existing evidence is fair. The objectives of this study are to examine the feasibility and effects of a culturally adapted group-based Montessori Method for Dementia program in Chinese community on engagement and affect in community-dwelling people with dementia. Methods This was a two-arm randomized controlled trial. People who were aged 60 years or over and with mild to moderate dementia were recruited and randomly assigned to the intervention group to receive Montessori-based activities or the comparison group to receive conventional group activities over eight weeks. The attendance rates were recorded for evaluating the feasibility. The Menorah Park Engagement Scale and the Apparent Affect Rating Scale were used to assess the engagement and affect during the activities based on observations. Generalized Estimating Equation model was used to examine the intervention effect on the outcomes across the sessions. Results A total of 108 people with dementia were recruited. The average attendance rate of the intervention group (81.5%) was higher than that of the comparison group (76.3%). There was a significant time-by-group intervention effect on constructive engagement in the first 10 minutes of the sessions (Wald χ2 = 15.21–19.93, ps = 0.006–0.033), as well as on pleasure (Wald χ2 = 25.37–25.73, ps ≤ 0.001) and interest (Wald χ2 = 19.14–21.11, ps = 0.004–0.008) in the first and the middle 10 minutes of the sessions, adjusted for cognitive functioning. Conclusions This study provide evidence that Montessori-based group activities adapted to the local cultural context could effectively engage community-dwelling Chinese older people with mild to moderate dementia in social interactions and meaningful activities and significantly increase their positive affect.


Chan, H. Y., Yau, Y. M., Li, S. F., Kwong, K. S., Chong, Y. Y., Lee, I. F., & Yu, D. S. (2021). Effects of a culturally adapted group based Montessori based activities on engagement and affect in Chinese older people with dementia: a randomized controlled trial. BMC geriatrics, 21(1), 24.





Conent Area

Helen Yue-lai Chan

EWB-Related Construct

(3) positive affect

Study Design

Species or Study Population

(5) RCT

Sex (%Female)


Age (Mean, SD)

83.9, 7.0

Younger Controls?


Longitudinal Data?


Sample Size



Montessori-based for dementia (MMD) program (culturally adapted, group based)

Ethnicity (%white)

not stated (Hongkong)

Inclusion Criteria

(1) aged 60 years or above,
(2) with a diagnosis of dementia at a stage 3 to 5 on the global deterioration scale (GDS)
(3) were not joining any other dementia training activities

Exclusion Criteria

(1) if one presented a hazard to others through disruptive behaviors
(2) proxy consent could not be obtained.

EWB Measures

(1) Apparent Affect Rating Scale (AARS)

Non-EWB Behavioral

(1) Global Deterioration Scale
(2) MoCa score
(3) Menorah Park Engagement Scale (MPES)

Physiological Measures


Brain IMaging Modality

Brain IMaging Paradigm


Brain Region/Circuit


Biological Measures


Other Neural Measures

Data Availability?


Data Avalability Details

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Diagnostic Measures

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