Inconclusive findings on the effects of art therapy for people with dementia

Title
Art therapy for people with dementia

Background

Dementia is a common condition that affects people’s memory. It can also affect people's thinking, emotions and behaviour. Dementia has a major impact on health and society across the world. Some types of treatment other than medication may help people with dementia.

Art therapy is a type of psychological therapy, which means a treatment for problems of the mind and behaviour. Art can be used as a way to express and communicate thoughts and feelings. The aim of art therapists is to work with patients in ways that help them change and 'grow' on a personal level. This is done by using art materials in a safe environment that allows this process.

Study Characteristics

We looked at research trials of people with dementia doing art therapy, compared with usual care and other activities. We looked at effects of art therapy on memory and thinking, emotions, well-being, social behaviour and quality of life. We also looked at negative effects and costs of art therapy. We found two research studies with a total of 88 older people taking part. There were results for 60 people. One study compared groups doing art therapy or simple calculation activities over 12 weeks. The other study compared groups doing art therapy or recreational activities over 40 weeks. The evidence is current to October 2017.

Key Results

These two studies found no clear changes in memory or most other outcomes looked at when comparing art therapy to other activities.

Quality of the Evidence

The studies were limited by many factors that reduced the quality of findings - considered 'very low' with well-known methods for evaluating this. Each study used different types of art therapy. This made it difficult to look at all the results together. One study had a high rate of people not completing the research trial. The studies included small numbers of people, which makes it difficult to be sure how accurate the findings are. This also makes it difficult to know if the effects will be the same in more people. Art therapy is difficult to test for its effects.

More research is needed on this topic. There is not enough information from research trials about the effects of art therapy for people with dementia. This review suggests ways to do this.

Authors' conclusions: 

There is insufficient evidence about the efficacy of art therapy for people with dementia. More adequately-powered and high-quality studies using relevant outcome measures are needed.

Read the full abstract...
Background: 

Art therapy is defined by the British Association of Art Therapists as: “a form of psychotherapy that uses art media as its primary mode of communication. Clients who are referred to an art therapist need not have experience or skill in art. The art therapist is not primarily concerned with making an aesthetic or diagnostic assessment of the client’s image. The overall aim of its practitioners is to enable a client to change and grow on a personal level through the use of art materials in a safe and facilitating environment”. Historically, drawings and paintings have been recognised as a useful part of therapeutic processes within psychiatric and psychological specialties, and this has been acknowledged within medical and neurology-based disciplines.

Arts-based therapies are generally considered as interventions managing manifestations of dementia, as they may help to slow cognitive deterioration, address symptoms related to psychosocially challenging behaviours and improve quality of life.

Objectives: 

To review the effects of art therapy as an adjunctive treatment for dementia compared with standard care and other non-pharmacological interventions.

Search strategy: 

We identified trials from ALOIS - the Cochrane Dementia and Cognitive Improvement Group’s Specialised Register - on 12 May 2014, 20 March 2015, 15 January 2016, 4 November 2016, and 4 October 2017. We also handsearched the grey literature and contacted specialists in the field and authors of relevant reviews or studies to enquire about other sources of relevant information.

Selection criteria: 

All randomised controlled trials examining art therapy as an intervention for dementia.

Data collection and analysis: 

Two review authors independently extracted data. We examined scales measuring cognition, affect and emotional well-being, social functioning, behaviour and quality of life.

Main results: 

We found two studies that met the inclusion criteria, incorporating data on a total of 60 participants (from 88 randomised), in experimental groups (n = 29) and active control groups (n = 31). One study compared group art therapy with simple calculation activities over 12 weeks. The other study compared group art therapy with recreational activities over 40 weeks. It was not possible to pool the data for analysis from the included studies, due to heterogeneity in terms of differences in the interventions, control treatments and choice of outcome measures.

In both studies there were no clear changes reported between the intervention group and the control group in the important outcome measures. According to GRADE ratings, we judged the quality of evidence for these outcome measures to be 'very low'.

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