Comparative Effectiveness of Emotion-Oriented Therapies for Behavioral and Cognitive Outcomes in People With Dementia: A Network Meta-Analysis.

BACKGROUND

Emotion-oriented therapies benefit behavioral disturbances and cognitive function in people with dementia (PwD), but the relative effectiveness of specific approaches including simulated presence therapy, multisensory stimulation, reminiscence therapy, validation therapy, and supportive psychotherapy remains unclear. This study aims to compare the effectiveness of these therapies on behavioral and cognitive outcomes in PwD.

METHODS

A systematic search was conducted in CINAHL, Cochrane Library, EMBASE, ProQuest, PsycINFO, PubMed, Scopus, and Web of Science databases. Outcomes included behavioral disturbance (with subdomains of mood disturbance and agitation) and global cognitive function. A frequentist random-effects framework was performed. Effect sizes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs), and the relative ranking of interventions was determined using P-scores. Heterogeneity was assessed using Cochrane's Q, τ2 and I². Subgroup analyses were conducted to examine potential moderators of the effect.

RESULTS

Fifty studies involving 4,533 PwD were included. Multisensory stimulation showed the strongest effect on behavioral disturbance (SMD = -1.12; 95% CI: -1.93, -0.31). Simulated presence therapy demonstrated the largest improvements in mood disturbance (SMD = -1.57; 95% CI: -1.98, -1.17) and agitation (SMD = -1.38; 95% CI: -1.82, -0.95), and the greatest enhancement in global cognitive function (SMD = 3.04; 95% CI: 1.78, 4.30). Moderator analyses indicated large effects when interventions were delivered in institutionalised settings, for <12 weeks, and in individual formats.

CONCLUSION

This study offers evidence-based guidance for selecting emotion-oriented therapies tailored to symptom profiles and supports clinical decision-making in dementia care.