Ask an answerable question (PICO)：
Taiwan has entered an aging society, and dementia is a common elderly problem. According to the International Dementia Association (ADI), number of dementia patient is added one every three seconds. Currently, western medicine or reminiscence therapy is the standard of management for the dementia. Dementia patients in the outpatient clinic have some abnormal behaviors, such as cognitive impairment, getting lost, depression, falls, and so on. The most commonly found is cognitive impairment, which causes caregiver stress and physical fatigue. In the literature, we found that doing Tai Chi Quan could train the balance of muscles, but was rarely reported its effect on the cognitive functions. Therefore, we wanted to evaluate whether the elderly people who had been doing Tai Chi Quan could improve their cognitive function. If these elderly people can improve their cognitive function, we can promote the Tai Chi Quan to the elderly.
The Method and Analysis of Literature Review：
This article established clinical issues, based on PICO keywords and synonyms. Using the MeSH Term and Bollinger logic union and intersection, we searched databases, including Cochrane Library, PubMed, Ovid Databases, Embase, Airiti Library and Nation Digital Library of Theses and Dissertations in Taiwan as well as Huayi Online Library (in Chinese). We searched for systematic reviews or random controlled trials in Chinese or English literature in the past five years. A total of 201 articles were preliminarily extracted. Finally, by screening the content to match the topic, a total of two articles of random controlled trials were selected and analyzed.
Evaluation of the two articles with the Joanna Briggs Institute (JBI, 2014) Evidence Rating System revealed two of them are Level 1D. The effectiveness, importance, and applicability were evaluated with the Critical Appraisal Skill Program (CASP, 2018). The purpose of the two articles was to examine the cognitive function scores of elderly patients after practicing Tai Chi Quan. The Mini-Mental Status Examination (MMSE) and the Wechsler Memory Scale-III (WMS) -III) were used to measure the change of scores for subjects before and after intervention of measures. In the evaluation section of importance, the results of one randomized controlled trials showed that the MMSE scores of elderly people doing Tai Chi Quan have improved (p<0.01), and even the improvement score was greater than that of control group (p=0.001). Evaluation in the memory scale with Wei’s showed that the memory and constructiveness scores increased significantly (p=0.006, p=0.01), indicating doing Tai Chi Quan can significantly improve cognitive function increase muscular balance, reduce the chance of falling, and promote interpersonal relationship. In the applicability part, playing Tai Chi Quan does not require drugs, is not complicated, has no side effects, and is not invasive. Furthermore, it can also increase the chance of getting along with family members and society. Therefore, its benefits outweigh the harm.
Conclusions and Recommendations：
The overall evaluation result revealed that playing Tai Chi Quan improved the cognitive function to the elderly, and was more freedom in clinical treatment. In the clinic or clinical care, we can use the videos to teach and guide patients or their families in the waiting area. In nursing education, we can integrate Tai Chi Quan into the nursing course so that when the nursing staff enters the community, it can be taught safely. The activities do not need to spend money and can be promoted to the public, and the Tai Chi group courses can be designed for the community bases in conjunction with the Long-Term Care 2.0 policy to increase the elder ’s physical fitness and cognitive function. It can prevent not only dementia but also increase the social participation of the elderly