Effectiveness of animal-assisted therapy for dementia patients: An evidence mapping of randomized controlled trials, systematic reviews, and meta-analyses

Dementia is a multi-domain disorder syndrome characterized by progressive cognitive decline. At present, there is insufficient evidence regarding the efficacy and safety of animal-assisted therapy for dementia. This study aims to identify, describe, evaluate, and summarize the currently available controlled trial evidence on animal-assisted therapy for dementia, using an evidence map to identify evidence gaps. The system searched 9 databases (PubMed, EMBASE, Cochrane Library, Clinical Key, Web of Science, CNKI, Wanfang, CQVIP, and SinoMed) from the time of inception to December 18, 2024. Randomized controlled trials (RCTs) on animal-assisted therapy for dementia or its complications were included. Risk of bias was assessed using the Cochrane RoB 2.0 tool. A bubble plot evidence map was developed to visually summarize evidence across predefined dimensions (e.g., intervention type, outcome domain, effect direction, and study quality). Existing systematic reviews were consulted for background/context only. A total of 36 RCTs met the inclusion criteria. Many published RCTs had limitations such as suboptimal study design and small sample sizes, resulting in concerns about risk of bias and heterogeneity. The evidence map suggests that AAT may improve neuropsychiatric symptoms and selected patient-centered outcomes (e.g., quality of life and functional independence); however, findings varied across outcomes. Evidence suggests Animal-assisted therapy may improve neuropsychiatric symptoms and some patient-centered outcomes in dementia, but study quality is low and heterogeneity high; findings should be interpreted cautiously and confirmed in well-designed, adequately powered trials. • This study synthesizes controlled trial (RCT) evidence on animal-assisted therapy (AAT) for dementia using an evidence map, and uses existing systematic reviews/meta-analyses for contextual comparison only. • Most randomized controlled trials focus on neuropsychiatric symptoms, quality of life, cognitive function, and functional independence. • The evidence map suggests that AAT may improve neuropsychiatric symptoms and some patient-centered outcomes (e.g., quality of life and functional independence), but the evidence is limited by study quality and heterogeneity