Credentialed art therapy as a non-pharmacological intervention for neuropsychiatric symptoms reduction in persons living with dementia-a systematic review and meta-analysis

BACKGROUND: Neuropsychiatric symptoms (NPS) of dementia contribute to accelerated decline and caregiver burden. Clinical guidelines increasingly recommend non-pharmacological approaches, yet the specific impact of credentialed art therapy (AT) remains unclear because previous reviews have often merged AT with general creative activities delivered outside of a therapeutic framework. OBJECTIVES: To synthesize evidence evaluating credentialed AT delivered to reduce NPS in people living with dementia (PLWD). METHODS: A mixed-methods systematic review was conducted. Seven databases were searched from inception to April 2022, with updates in November 2022 and April 2025. Eligible studies evaluated AT delivered by credentialed art therapists. A meta-analysis of standardized mean differences was conducted for depression, and qualitative findings for other NPS were synthesized thematically. RESULTS: Eleven studies met inclusion criteria. Meta-analysis of between-group post-intervention differences showed a non-significant pooled effect (random-effects g=-0.11). A sensitivity analysis excluding one low-quality RCT produced a larger but non-significant effect (g=-0.59). A meta-analysis of within-group pre-post changes also showed a non-significant pooled effect (g = -0.42), with a larger non-significant effect after exclusion of the low-quality study (g = -0.80). Qualitative evidence from six studies described in-session improvements in agitation, anxiety, and wandering through mechanisms such as sensory grounding, emotional expression, behavioral redirection, and relational support. CONCLUSIONS: Credentialed AT may offer in-session benefits for agitation, anxiety, and wandering; however, quantitative evidence for reducing depressive symptoms remains inconclusive. Given the small and heterogeneous evidence base, rigorous trials using standardized outcome measures are needed to clarify AT's role in dementia care.