Most of the people with dementia exhibit behavioural and psychological symptoms of dementia (BPSD), for example agitation, repetition, restlessness, wandering, apathy and depressed mood, resulting from cognitive impairment [1, 2]. Non-pharmacological interventions have been advocated as the first line management for addressing the modifiable factors, and thereby reducing the use of anti-psychotic or sedative medications to prevent the associated adverse effects and mortality risk, and improve the quality of life of people with dementia [3,4,5,6]. The effects of non-pharmacological interventions, for example, multisensory stimulation, cognitive or emotion-oriented interventions, behavioral management strategies, and physical exercise, have been widely studied for matching the unmet psychosocial need for sensory deprivation, social interaction and meaningful activities in people with dementia [4, 6, 7]. While systematic reviews concluded that the effects of these non-pharmacological interventions on managing challenging behaviors are inconsistent, it is widely agreed that strategies that only passively engage people with dementia have poor effects, whereas those personalized to individual needs are more promising [1, 5,6,7].
The Montessori Method has been adopted to design activities for people with dementia over the past two decades [8, 9]. This method was originally developed by Dr Maria Montessori, a physician and educator, in the early 1900s as an educational approach for training children with functional skills for practical life challenges through sensorial experiences in the everyday environment. Montessori programming highlights task breakdown, guided repetition, progression in task difficulty from simple to complex or concrete to abstract, the careful matching of individual past interests and occupations, and self-correcting, all aligned with the concept of rehabilitation [8, 10, 11]. Dr Cameron Camp and his associates proposed the Montessori Method as a strength-based approach for creating personalized interventions in dementia care to maximize the spared capacity and abilities of each individual . The activities in the Montessori-based for dementia (MMD) program highlights the importance of considering the individual’s past experiences and interests [9, 10]. The essence of these activities is consistent with the person-centered care approach recommended for dementia care [12, 13]. The acronym “CREATE” is used to represent the principles of activity design, they are: Create a prepared environment, Remove unnecessary distractions, Error free process, All materials are familiar to the participants in real life setting, Templates and manipulatives are provided according to individual needs and ability, and Environment is prepared in home-like. Generally speaking, the activities aim to engage participants in meaningful activities and, through which, promote learning through procedural or implicit memory with the support of prepared environment and external cues [9, 10]. Thus far, Montessori-based activities for dementia have been conducted in a variety of formats, such as Memory Bingo or sorting pictures or words into categories, fine-motor tasks such as cutting and stringing beads, reading groups, the use of templates, and the creation and production of certain products, on an individual or group basis [10, 11]. While activities conducted on a one-to-one basis may allow more flexibility in activity design and greater attention for people with dementia, literature suggests that group format creates opportunities for people with dementia to take up meaningful social roles in the group that allow them to use their social skills, and promotes peer interaction and learning [8, 14, 15].
Literature generally suggested that Montessori-based activities increased constructive engagement in people with dementia [3, 11, 14, 16, 17] but there were mixed results on positive and negative affect [11, 18, 19]. Moreover, the practices of conducting Montessori-based activities varied widely  and were mainly conducted on individual format . Previous studies which examined the effects of Montessori-based activities in the Chinese people with dementia focused on agitation and were only conducted in care home setting [20, 21]. Moreover, the methodological quality of these existing studies were limited by single subject design and lack of randomization [3, 11, 17, 19, 20]. The purposes of this study were to evaluate the feasibility of culturally adapted group-based Montessori-based activities in the Chinese communities and examine the effects of these activities on the type and level of engagement and affect of Chinese older people with mild to moderate dementia.