Effects of emotion-oriented interventions on cognitive, behavioral, and psychological symptoms in people with dementia: a systematic review and meta-analysis of randomized controlled trials

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BACKGROUND: Dementia is a major global health challenge associated with progressive cognitive decline and neuropsychiatric symptoms that greatly affect patients and caregivers. Emotion-oriented interventions (EOIs) are nonpharmacological approaches designed to address not only cognitive deficits but also the emotional and psychological needs of people with dementia. OBJECTIVES: This systematic review (SR) and meta-analysis (MA) focused on the efficacy of EOIs in dementia care, particularly examining their impact on cognitive, behavioral and psychological symptoms. METHODS: A comprehensive search of electronic databases, such as PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, Scopus, and Web of Science, supplemented by manual consultations of reference lists was performed. The inclusion criteria included studies involving people diagnosed with dementia and employing EOIs such as supportive psychotherapy, validation therapy, sensory integration, simulated presence therapy, and reappraisal therapy. Risk of bias assessment utilized the Cochrane risk-of-bias tool, with data synthesis conducted through meta-analyses, incorporating post hoc subgroup analyses and meta-regression to explore variations. Statistical analyses and corrections for publication bias were performed using Stata v17. RESULTS: The analysis included 34 randomized controlled trials (RCTs) that compared emotion-oriented interventions such as reminiscence therapy, Snoezelen, and validation therapy against standard care and other therapeutic modalities. The synthesized data indicate that emotion-oriented interventions can significantly improve cognition, depressive symptoms, health-related quality of life and functional abilities, particularly in settings lacking alternative therapeutic options. These interventions also show some potential, although their effectiveness varies compared to that of active controls and depends on the specific intervention and context of the study. CONCLUSION: Emotion-oriented therapies could offer a valuable complement to traditional dementia treatments, especially in resource-limited settings where conventional therapies may not be readily available. These interventions address not only the cognitive deficits but also the emotional and psychological well-being of people with dementia, suggesting a holistic approach to dementia care. The findings highlight the need for further research to optimize these interventions, evaluate their long-term benefits, and establish guidelines for their implementation in diverse clinical settings.

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