The effectiveness of non-pharmacological interventions using information and communication technologies for behavioral and psychological symptoms of dementia: A systematic review and meta-analysis

Background: Although behavioral and psychological symptoms of dementia are a global public health challenge, non-pharmacological interventions using information and communication technologies can be an affordable, cost-effective, and innovative solution.Objectives: This study aimed to examine the effectiveness of non-pharmacological interventions using informa-tion and communication technologies on the behavioral and psychological symptoms of dementia and identify potential moderators of intervention effects.Design: Systematic review and meta-analysis of randomized controlled trials.Methods: A systematic literature review was conducted using PubMed, CINAHL, PsycINFO, Embase, and the Cochrane Library from May 2022. Randomized controlled trials that examined the effects of non -pharmacological interventions using information and communication technologies on the behavioral and psy-chological symptoms of dementia were included. A meta-analysis using a random-effects model was performed to calculate the pooled standardized mean differences between overall symptoms and each type of symptom. For moderator analyses, subgroup and meta-regression analyses were performed.Results: Sixteen trials (15 articles) met the eligibility criteria. The interventions were grouped into activity engage-ment interventions using digital health that provided music and reminiscence therapy, physical exercise, social inter-action interventions using social robots, and telehealth-based care aid interventions that provided coaching or counseling programs. Pooled evidence demonstrated that non-pharmacological interventions using information and communication technologies exerted a large effect on depression (SMD = -1.088, 95% CI -1.983 to -0.193, p = 0.017), a moderate effect on overall behavioral and psychological symptoms of dementia (SMD = -0.664, 95% CI -0.990 to -0.338, p < 0.001), and agitation (SMD = -0.586, 95% CI-1.130 to -0.042, p = 0.035). No effects on neuropsychiatric symptoms (SMD = -0.251, 95% CI-0.579 to 0.077, p = 0.133), anxiety (SMD = -0.541, 95% CI -1.270 to 0.188, p = 0.146), and apathy (SMD = -0.830, 95% CI -1.835 to 0.176, p = 0.106) were reported. Moderator analyses identified the mean age of the participants as a potential moderator of intervention effects.Conclusions: Evidence from this systematic review and meta-analysis suggests that non-pharmacological interven-tions, using information and communication technologies, were an applicable approach to managing behavioral and psychological symptoms among older adults with dementia, with moderate to large effect sizes. However, evi-dence on anxiety and apathy is inconclusive due to the limited number of existing randomized controlled trials. Fu-ture studies with subgroup analyses are warranted to conclude the most effective types of intervention using information and communication technologies for each type of symptom.Registration: CRD42021258498.(c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).