Table 2.
Summary of eligible studies
| Author (y) | Summary | Description of art therapy | Clinical measures | Effect on QOL/BPSD | Findings/Benefits |
| Loizeau et al. 2015 [17] | A mixed method study that utilized TimeSlips to encourage persons living with dementia to create stories. It was conducted at the Kunsthaus Museum in Switzerland. Participants were four people with dementia and their caregivers and four volunteers, who supported the people with dementia during the sessions. | Art appreciation: Museum visits with storytelling sessions. | CBS DAS-D Interviews SFAS | Yes / Yes | There was a statistically significant positive effect on all participants’ mood (all participants: Z = –4.84, p < 0.001; people with dementia: Z = –3.57, p < 0.001; Caregivers: Z = –3.34, p < 0.001). No significant differences in the caregivers’ and volunteers’ attitudes towards dementia or Caregiver Burden Inventory were found. All caregivers and most of the volunteers reported a positive change in their attitude towards dementia. People with dementia reported that they welcomed the opportunity to contribute and express their thoughts. All participants were highly satisfied with their experience. |
| Hazzan et al. (2016) [18] | Pilot study with 8 male participants with dementia diagnosis. | Art appreciation and art making sessions across several art domains. | MMSE CMAI ADL | Yes / Yes | Increase in meaningful communication and engagement with care partners. |
| Sauer et al. (2016) [2] | Exploratory study using video data on 38 people with dementia living in long-term care. | A person-centered and intergenerational art making activity program called Opening Minds through Art (OMA), including traditional visual arts activities (e.g., coloring books, scrapbooking). | GCCWOT | Yes / Not tested | Descriptive results indicated a high percentage of moderate or high intensities of well-being during OMA sessions, with little to no ill-being. Paired-sample t-tests comparing OMA showed significantly higher intensity scores in the domains of engagement and pleasure, as well as significantly lower intensity scores for disengagement when compared to traditional visual arts activities alone. |
| Johnson et al. (2017) [3] | Quasi-experimental crossover design study investigating impact of museum activities on subjective wellbeing. | Art appreciation: object handling and art viewing. | VAS | Yes / Not tested | Significant increase in subjective wellbeing during the session, irrespective of the order activities were presented, for both people with dementia and their caregivers. An end of intervention questionnaire indicated that experiences of the session were positive. |
| Participants were people with early to middle stage dementia and their caregivers (66 in total: 36 people with dementia and 30 caregivers). | |||||
| Seifert et al. (2017) [13] | Pilot study on 12 people dementia (n = 6 each in experimental and control group), examining how a sculpture-based therapy influences wellbeing. | Visual Art Sculpture making for experimental and control group; they also participated in singing, painting and playing board games. | MMSE NPI | Yes / Yes | The experimental (sculptural activity) group showed improvements in wellbeing across all five domains: mental state and concentration, corporeal memory, self-reliance, self-esteem and physicality. |
| Tyack et al. (2017) [4] | Quasi-experimental study exploring technology assisted art therapy. 12 pairs of volunteers with dementia and informal caregivers were recruited (n = 24). | Art appreciations using technology, i.e., touchscreen tablet device displaying art images. | VAS QOL-AD | Yes / On mood and behavior | Well-being subdomains generally increased with number of sessions. Qualitative positive findings included changes in cognition, behavior, mood and relationships. |
| Graham and Fabricius (2018) [11] | Qualitative study examining effect of a live mural painting in two long-term care dementia facilities (n = 76). | Visual art painting of institutional (i.e., care home, hospital) doors into a mural. | Qualitative study | Yes / Yes | Reduction in exit-seeking behavior; benefits in sustained attention, aesthetic awareness, memory, gender identity and community building. |
| Hammani and Khadhar (2018) [19] | Observational study investigating the impact of art therapy on behavior in 12 people with a diagnosis of Alzheimer’s disease dementia. | Visual art: Painting workshops. | MMSE | Yes / Yes | Improvements in motivation and concentration, with reduction in agitation and aggressive behavior. |
| Mondro et al. (2018) [20] | 30 dyads of carers-dementia participants took part in the 8 weeks Retaining Identity Program. Study was based on a qualitative analysis. | Visual art: Art making sessions and discussions. | Questionnaire | Yes / Not tested | The main themes that emerged from the survey were: caregiver growth, caregiver awareness, and creative discovery. The participants’ artwork supports that art making has the potential to encourage an equitable exchange and outcome for people with memory loss and their caregivers. |
| Ramsey et al. 2018 [12] | Quasi-experimental study investigating structured and unstructured art activities and the use of scaffolding in 8 people with dementia. | Visual art: painting and drawing | DEMOQOL | Yes (not significant) / Not tested | Structured scaffolding optimized individuals’ success during sessions. The use of dementia-tailored scaffolding for art activity sessions allowed people to use their retained skills in visual art production (painting and drawing). |
| Structured and unstructured activities. | |||||
| Schall et al. (2018) [10] | A randomized controlled study on the influence of the ARTEMIS intervention on the emotional state, well-being, and quality of life of dementia patients. People with mild-to-moderate dementia (n = 44) and their care partners (n = 44) participated in once a week museum visits on six pre-arranged occasions. | A weekly museum visits once a week on six pre-arranged occasions. The intervention consisted of six different guided art tours (60 min), followed by art-making in the studio (60 min). Independent museum visits served as a control condition. | MMSE QOL-AD GDS ADAS-COG NPI FAHW | Yes / Yes | Art museum-based art interventions are able to improve the subjective well-being, mood, and quality of life in people with dementia. In particular, improvements in participants’ self-rated quality of life (p < 0.05) and a statistically significant positive changes with medium effect sizes (dcorr = 0.74–0.77). The total NPI score as well as the affective (depressed mood and anxiety) and apathy subscales were significantly lower after the ARTEMIS intervention (NPI total = 2.43; NPI affective = 2.24; NPI apathy = 2.52; p < 0.05). |
| Windle et al. (2018) [21] | A mixed method longitudinal study included 125 participants with dementia and explored the impact of visual art program on QOL, wellbeing and communication. | Visual art program with variety of art making tasks. | GCCWBOT DEMQOL HCS | Yes (not significant) / Not tested | Scores for the well-being domains of interest (attention, pleasure, self-esteem, negative affect, and sadness) were significantly better in the art program than the alternative condition. Proxy-reported QoL significantly improved between baseline and 3-month follow-up, but no improvements in QoL were reported by the participants with dementia. |
| Camic et al. (2019) [22] | Quasi-experimental study looking at the impact of object handling. 80 participants diagnosed with early to moderate stage dementia took part. | Art appreciation: object handling. | CWS VAS | Yes / Not tested | People with early and moderate impairment had positive increases in wellbeing, regardless of the type of dementia, but those with early stage dementia showed larger positive increases in their wellbeing. |
| D’Cunha et al. (2019) [23] | A quasi-experimental, exploratory study investigating cortisol levels, QOL and BPSD in 25 people with dementia (mean age 84.6±7.27 years), 22 provided viable saliva samples. 6 weeks duration. | Art appreciation: Art appreciation sessions with discussions as part of the Art and Dementia program at the National Gallery of Australia’s (NGA). | BADL DEMOQOL DMOQOLC GDS M-ACE GWO Handgrip measure | No /Yes | Improvement in hypothalamic-pituitary-adrenal axis function. The waking to evening salivary cortisol ratio was higher post-intervention (p = 0.033), but no change in Interleukin-6 levels. No improvements in QoL (DEMQOL-Carer) between baseline and post-intervention (p = 0.076). However, self-reported depressive symptoms decreased post-intervention compared with baseline (p = 0.015), and memory (immediate recall) (p = 0.009) and verbal fluency (p = 0.027) improved between the same timepoints. |
| Hendriks et al. (2019) [9] | Cross-sectional observational study 144 people, 72 with dementia and 72 caregivers, examined responsiveness to artwork. | Art appreciation: Museum tour guided by trained professional. | GDS BCRS INTERACT Scale | Yes / Not tested | The appreciative and active responsiveness and interaction with others during the program appeared related to the severity of dementia, to specific cognitive impairments and to type of artworks. People with more severe dementia responded less to art than people with mild dementia. Artworks with more natural elements revealed less interaction with others. Artifacts (i.e., objects not originally meant as artworks) evoked more reactions than artworks. |
| Humphrey et al. (2019) [24] | A pilot study on 8 men diagnosed with dementia. | Art appreciation and art making activities. | MMSE CMAI ADL | Yes / Yes | Supportive communication and positive engagement. |
| Lokon et al. (2019) [25] | Exploratory study investigating impact of activity in 67 people with dementia living in care homes. | Comparison of five different activities on the well-being of institutionalized people with dementia: The intergenerational art program OMA, art and music therapies, creative activities, non-creative activities, and no activities at all. | SM-GCCWOT | Yes / Not tested | People with dementia showed the highest well-being scores during OMA compared to all other activities. Although no significant well-being differences were found between creative activities led by licensed art/music therapist versus regular activity staff, or between creative and non-creative activities (led by regular activity staff), people with dementia benefited from participating in activities, regardless of the type (creative or non-creative), or who conducted them (licensed therapists or activity staff). |
ADAS-Cog, Alzheimer’s Disease Assessment Scale; ADL, Activities of Daily Living; BCRS, Brief Cognitive Rating Scale; BADL, Bristol Activities of Daily Living Scale for dementia; BPSD, Behavioral and Psychological Symptoms of Dementia; CBS, Cornell-Brown Scale for Quality of Life; CMAI, The Cohen-Mansfield Agitation Inventory; CWS, Carer Well-Being and Support Questionnaire; DAS-D, Dementia Attitudes Scale; DEMOQOL, Dementia Quality of Life Instrument; DEMOQOLC, DEMOQOL-Carer; FAHW, Questionnaire of General Habitual Well-being; VAS, Visual Analogue Scale; GCCWBOT, The Greater Cincinnati Chapter Well-Being Observation Tool; GDS, Geriatric Depression Scale; GWQ, General Wellbeing Questionnaire; HCS, Holden Communication Scale; M-ACE, Mini-Addenbrooke’s Cognitive Examination; MMSE, Mini-Mental State Examination; NPI, Neuropsychiatric Inventory; QOL, Quality of Life; QOL-AD, Quality of Life in Alzheimer’s Disease; SFAS, Smiley-Face Assessment Scale; SM-GCCWOT, The Scripps Modified Greater Cincinnati Chapter Well-Being Observational Tool.