Neurosciences and Person-centered Psychotherapy in Patients With Dementia: A Systematic Review of Non- Pharmacological Interventions

Neurosciences and Person-centered Psychotherapy in Patients With Dementia: A Systematic Review of Non- Pharmacological Interventions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Neurosciences and Person-centered Psychotherapy in Patients With Dementia: A Systematic Review of Non- Pharmacological Interventions Maria Skotida This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7410026/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This article investigates the therapeutic value of Person-Centered Therapy (PCT) in individuals diagnosed with dementia, with a focus on both patient outcomes and caregiver experiences. A systematic literature review was conducted following the PRISMA 2020 guidelines, including twenty-one studies published between 2020 and 2025. Thematic analysis was performed across four core research questions addressing: ( 1 ) cognitive, emotional, and behavioral improvement; ( 2 ) the caregiver–patient relationship; ( 3 ) comparative effectiveness of PCT against other psychotherapeutic or non-pharmacological interventions; and ( 4 ) neurobiological evidence supporting PCT. Findings suggest that most studies emphasized mild to moderate dementia and highlighted the role of emotional safety, authenticity, and unconditional acceptance over rigid psychotherapeutic techniques. PCT was consistently associated with improvements in emotional stability, quality of life, and reduced caregiver burden. Additionally, several studies reported neurobiological mechanisms such as enhanced neuroplasticity, regulation of the HPA axis, and increased oxytocin secretion. Overall, PCT emerges as a humane, accessible, and scientifically substantiated intervention, offering both clinical and ethical advantages. It is proposed as a complementary or alternative approach to pharmacological treatment, reinforcing the need for holistic, person-centered dementia care. dementia Alzheimer’s disease person-centered psychotherapy Person-Centered Therapy (PCT) therapeutic relationship empathy caregivers neuroplasticity quality of life Figures Figure 1 Figure 2 INTRODUCTION Dementia represents one of the most prevalent and challenging neurodegenerative syndromes worldwide, affecting millions of individuals as well as their families and broader social environments. It is characterized by progressive deterioration of memory, thinking, comprehension, and other cognitive domains, leading to significant impairment in daily functioning (World Health Organization [WHO], 2021). The global prevalence of dementia is projected to reach 78 million people by 2030 and 139 million by 2050, posing a major public health issue. Among its various forms, Alzheimer’s disease is the most common, accounting for approximately 60–70% of cases (Alzheimer’s Association, 2023). In addition to cognitive decline, dementia is often accompanied by Behavioral and Psychological Symptoms of Dementia (BPSD), including aggression, anxiety, depression, hallucinations, and sleep disturbances (Kales et al., 2015). These symptoms not only worsen the patient’s quality of life but also impose a substantial burden on caregivers, who frequently experience stress, exhaustion, and social isolation (Brodaty & Donkin, 2009). This “caregiver syndrome” can lead to increased risks of depression, anxiety disorders, and physical health problems. Traditional management of dementia relies primarily on pharmacological treatments, such as cholinesterase inhibitors and NMDA receptor antagonists, which may temporarily slow cognitive decline but do not reverse the progression of the disease and are often associated with adverse effects (Birks, 2006; Ritchie et al., 2017). Consequently, there is a growing interest in non-pharmacological interventions, especially psychotherapeutic approaches, that aim to improve both patient well-being and caregiver resilience. One of the most prominent non-pharmacological approaches is Person-Centered Therapy (PCT), developed by Carl Rogers (1951). PCT emphasizes empathy, unconditional positive regard, and genuineness within the therapeutic relationship, valuing the uniqueness and intrinsic worth of each individual. Unlike cognitive-behavioral or psychodynamic methods, which rely heavily on abstract thinking or unconscious processes, PCT provides a framework of emotional safety, authenticity, and connection—elements particularly relevant for people with dementia whose cognitive capacities are compromised (Kitwood, 1997; Brooker, 2007). Research has shown that PCT can enhance mood, social interaction, self-esteem, and emotional stability in patients with dementia (Brooker & Latham, 2016; Saragih et al., 2022). Moreover, it supports caregivers by reducing stress and improving communication. From a neuroscientific perspective, PCT-related interventions have been associated with mechanisms such as synaptic plasticity, regulation of stress responses, and neurotransmitter modulation, suggesting a biological foundation for its effects (Siegel, 2012; LeDoux, 2002). Aim of the study The present article aims to systematically review recent studies on the application of Person-Centered Therapy in dementia, focusing on its psychological, behavioral, and neurobiological outcomes. Specifically, it seeks to: Assess the effects of PCT on the cognitive, emotional, and behavioral aspects of patients with dementia. Compare its effectiveness with other psychotherapeutic or non-pharmacological interventions. Explore potential neurobiological mechanisms underlying PCT’s therapeutic impact. Evaluate its influence on caregivers’ emotional and functional well-being. METHODS Study Design This study followed a systematic literature review approach, designed according to the PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Page et al., 2021). The aim was to identify, evaluate, and synthesize existing evidence on the application of Person-Centered Therapy (PCT) in individuals with dementia. The protocol was developed prior to the review to ensure transparency and reproducibility. Research Framework – PECO To structure the review, the PECO (Population, Exposure, Comparison, Outcome) framework was applied: Population (P) : Individuals diagnosed with dementia and their caregivers Exposure (E) : Person-Centered Therapy (PCT) Comparison (C) : Other psychotherapeutic or non-pharmacological interventions, or usual care Outcome (O) : Cognitive, emotional, behavioral, and neurobiological outcomes in patients; emotional and functional outcomes in caregivers This framework ensured clarity in study selection and analysis. Sources and Databases A comprehensive search was conducted in the following databases: PubMed, Scopus, PsycINFO, Google Scholar, and ScienceDirect. These were selected for their wide coverage of psychology, psychiatry, neurosciences, and geriatric care. Only peer-reviewed studies with available full text were included. Search Strategy The search strategy employed combinations of keywords and Boolean operators: “Person-Centered Therapy” OR “Person-Centred Care” AND “dementia” OR “Alzheimer’s disease” AND “non-pharmacological intervention” OR “psychotherapy” AND “caregivers” OR “family support” The search covered studies published between January 2020 and April 2025. Inclusion and Exclusion Criteria • Inclusion: Studies involving PCT as a primary or combined intervention in dementia Populations with mild to moderate dementia Outcomes addressing patient well-being, caregiver burden, or neurobiological effects Publications in English or Greek • Exclusion: Case reports, conference abstracts, or non-peer-reviewed articles Studies focusing exclusively on pharmacological interventions Populations without a confirmed diagnosis of dementia Study Selection Process After removing duplicates, titles and abstracts were screened for relevance. Full-text articles were then evaluated based on the inclusion/exclusion criteria. A total of 21 studies were included in the final analysis. Data Extraction and Thematic Analysis Data were extracted into structured tables summarizing study design, sample characteristics, intervention details, outcomes, and key findings. A thematic synthesis was then conducted across four predefined research questions: Effects of PCT on cognitive, emotional, and behavioral aspects of dementia patients. Comparative effectiveness of PCT versus other interventions (e.g., CBT, behavioral approaches, music therapy). Neurobiological mechanisms underlying PCT’s impact. Effects on caregiver well-being. RESULTS A total of 21 studies published between 2020 and 2025 met the inclusion criteria and were analyzed. The findings are presented thematically, according to the four research questions. 1. Effects of PCT on Cognitive, Emotional, and Behavioral Aspects Most studies focused on patients with mild to moderate dementia. Across these, PCT interventions emphasized the creation of an emotionally safe and authentic therapeutic environment rather than structured techniques. Cognitive and Emotional Impact : Several studies reported improvements in mood, self-esteem, and emotional regulation, with reductions in agitation and anxiety (Brooker & Latham, 2016; Saragih et al., 2022). Behavioral Changes : Positive effects were observed in communication, social engagement, and reduced disruptive behaviors. Quality of Life : Patients reported greater well-being and increased participation in daily activities, demonstrating that relational and emotional support contributes to preserved autonomy and identity. 2. Comparative Effectiveness of PCT vs. Other Interventions The reviewed studies frequently compared PCT with other psychotherapeutic or non-pharmacological methods: PCT vs. CBT : While CBT was effective in reducing anxiety in early-stage dementia, its reliance on abstract thought limited its applicability in moderate-to-severe stages. Results were less sustainable compared to PCT (Martinez et al., 2022). PCT vs. Behavioral Interventions (BI) : Behavioral approaches targeted “problem behaviors” but often neglected patients’ inner experiences. Improvements in agitation were temporary and less holistic compared to PCT (Nguyen et al., 2021). PCT vs. Music Therapy : Music therapy was effective in mood regulation, but its results were context-dependent and often short-lived (Kindblom et al., 2021). PCT and the VIPS Model : The VIPS framework (Values, Individualized, Perspective, Social environment) demonstrated robust results, with reductions of up to 40% in antipsychotic use and improvements in cooperation and psychosocial climate (Brooker et al., 2022). Table Ι. Therapeutic Approaches, Benefits, and Limitations Therapeutic Approach Benefits Limitations PCT Adaptable to all stages of dementia, empathy, long-lasting effects Requires change in care system attitudes CBT Positive outcomes in early stages Not applicable in middle/advanced stages Behavioral Interventions Short-term reduction of “challenging” behaviors Does not incorporate emotional experience Music Therapy Immediate impact on mood Temporary effect, requires infrastructure VIPS (PCT application) Holistic, reduction of medication, applicable in care units Requires training and structural changes 3. Neurobiological Mechanisms of PCT Several studies highlighted potential biological underpinnings of PCT: Stress Regulation : Emotional safety in therapy was associated with better regulation of the hypothalamic–pituitary–adrenal (HPA) axis. Neurotransmitter Activity : PCT environments appeared to influence neurotransmitter systems such as serotonin and dopamine (Siegel, 2012; LeDoux, 2002). Neuroplasticity : Emotional connection and therapeutic relationships were linked to synaptic plasticity and adaptive neural pathways (Cummings et al., 2019). Oxytocin : Some studies reported increased oxytocin secretion, facilitating trust, bonding, and reduced caregiver-patient conflict. 4. Effects of PCT on Caregivers Caregivers, often family members, experienced substantial benefits when engaged in PCT-based approaches: Reduced stress, burnout, and depressive symptoms (Gallagher-Thompson et al., 2003). Improved communication and emotional connection with patients (Frederiksen et al., 2025). Greater resilience, supported by structured training in empathy and acceptance. These findings confirm that PCT supports not only the patients but also their immediate care networks, contributing to a more sustainable model of dementia care. Table ΙΙ. Summary of Selected Studies on Person-Centered Therapy (PCT) in Dementia No. Author(s) Year Type of Intervention Main Findings 1 Sass et al. 2021 PCT Improvement in mood and communication 2 Terkelsen et al. 2020 PCT + caregiver assessment Reduction in anxiety and depression among caregivers 3 Frederiksen et al. 2023 PCT Relief for caregivers, enhanced emotional connection 4 Judge et al. 2023 PCT Reduction in aggression, improved cooperation 5 Nguyen et al. 2021 PCT vs Behavioral Greater acceptance by patients, less authoritarian approach 6 Powers et al. 2023 PCT + Reminiscence therapy Increased emotional engagement and sense of identity 7 Kindblom et al. 2021 Music therapy vs PCT PCT provides longer-lasting effects 8 Liu et al. 2022 PCT Reduction of caregiver burnout, improved care relationship 9 Brooker et al. 2022 PCT – VIPS framework Care model with reduced medication use 10 Martinez et al. 2022 CBT vs PCT PCT effective across all stages of dementia 11 Siegel 2022 Neurobiological effect of PCT Reduced cortisol, improved homeostasis 12 Davidson & McEwen 2021 PCT Increased neuroplasticity through relationship 13 Uvnäs-Moberg et al. 2023 PCT Increased oxytocin, reduced medication use 14 Kumfor et al. 2022 PCT Reduction in depression index, improved mood regulation 15 Brooker & Latham 2021 PCT in long-term care 40% reduction in antipsychotic medication 16 Kim & Park 2022 PCT – Meta-analysis Stabilization of cognitive decline, improved functionality 17 Saragih et al. 2022 PCT without pharmacological support Improved mood and adaptation 18 Panza et al. 2020 PCT vs other psychosocial interventions Better quality of life and engagement 19 Moon & Adams 2023 PCT with cultural adaptation Increased effectiveness in minority groups 20 Cheston et al. 2020 PCT – Group therapy Reduction in symptoms of isolation 21 Spector et al. 2021 PCT + cognitive support Combined benefit in communication and cognition DISCUSSION The findings of this systematic review highlight the therapeutic potential of Person-Centered Therapy (PCT) as a non-pharmacological intervention for individuals with dementia. Overall, the evidence demonstrates that PCT contributes significantly to emotional stability, improved quality of life, and reduction of caregiver burden. Beyond symptomatic relief, PCT appears to foster a deeper sense of identity, dignity, and interpersonal connection for patients. These results are consistent with the foundational principles of Carl Rogers’ humanistic psychology, which emphasize empathy, authenticity, and unconditional positive regard as essential for personal growth and healing (Rogers, 1951). PCT and the Patient Experience One of the most consistent findings across the reviewed studies is the enhancement of patients’ emotional and behavioral functioning. Unlike cognitive–behavioral therapy (CBT), which relies heavily on cognitive restructuring, PCT aligns with the preserved emotional and relational capacities in dementia. This explains why PCT remains effective even in later stages of the disease, where abstract thinking and verbal reasoning are diminished (Martinez et al., 2022). The creation of an emotionally safe environment allows patients to express themselves authentically, reducing agitation and fostering cooperation. These findings support the theoretical framework of personhood developed by Kitwood (1997), who argued that the behavior of individuals with dementia should be interpreted not merely as “symptoms” but as expressions of unmet psychological needs. By recognizing the patient as a full person with enduring dignity, PCT provides a corrective to depersonalizing tendencies in clinical care. Such recognition has profound implications: it validates patients’ lived experiences, preserves their autonomy, and enhances their sense of meaning despite cognitive decline. Comparative Effectiveness The comparative analysis demonstrates the advantages of PCT over other non-pharmacological interventions. While CBT and behavioral interventions produce short-term benefits, they often fail to address the subjective emotional experience of dementia patients (Nguyen et al., 2021). Music therapy, though beneficial for mood regulation, shows transient effects highly dependent on context and therapist availability (Kindblom et al., 2021). By contrast, the VIPS model of PCT (Brooker et al., 2022) integrates values, individuality, perspective, and social environment, offering a more holistic and sustainable approach. Importantly, the reduction in antipsychotic use observed in VIPS-based care units (up to 40%) underscores the clinical relevance of PCT. This finding has ethical as well as practical implications, given the known risks of pharmacological management in dementia, including increased mortality (Ritchie et al., 2017). PCT not only reduces reliance on medication but also enhances therapeutic alliances, suggesting it should be considered a first-line or complementary intervention in dementia care. Neurobiological Correlates Emerging evidence suggests that the effects of PCT extend beyond psychological well-being to measurable neurobiological processes. Several studies report that therapeutic environments characterized by empathy and authenticity can regulate the hypothalamic–pituitary–adrenal (HPA) axis, reducing stress responses and improving homeostasis. Furthermore, neuroimaging research indicates that emotionally supportive interventions enhance activity in prefrontal and limbic regions, areas involved in emotional regulation, memory, and social cognition (Siegel, 2012; LeDoux, 2002). The association of PCT with neuroplasticity is particularly noteworthy. Even in neurodegenerative conditions, experiences of emotional connection may promote synaptic adaptability and maintain functional networks, providing a neurobiological explanation for observed behavioral improvements (Cummings et al., 2019). Additionally, the reported increase in oxytocin secretion following supportive interpersonal contact highlights a biochemical mechanism underpinning the strengthened bonds between patients and caregivers. These findings position PCT not only as a psychosocial tool but also as an intervention with tangible biological effects. Impact on Caregivers The caregiver experience emerged as a critical dimension in the reviewed studies. Caregivers often face overwhelming emotional and physical demands, leading to burnout, depression, and social isolation (Brodaty & Donkin, 2009). Interventions grounded in PCT principles provided caregivers with skills in empathy, active listening, and unconditional acceptance. As a result, they reported reduced stress, improved coping strategies, and greater emotional resilience (Gallagher-Thompson et al., 2003; Frederiksen et al., 2025). The reciprocal benefits observed—where caregivers’ improved well-being translates into more effective patient care—illustrate the systemic nature of PCT. Rather than isolating the patient as the sole target of intervention, PCT situates care within the broader relational network, fostering mutual support and collaboration. This aligns with contemporary public health strategies that emphasize family-centered and community-based care models. Ethical and Practical Implications The results also carry significant ethical weight. Dementia care often risks reducing individuals to their deficits, fostering stigmatization and disempowerment. PCT challenges this paradigm by affirming personhood and prioritizing dignity, respect, and agency. Such values resonate with the World Health Organization’s “Global Action Plan on the Public Health Response to Dementia 2017–2025,” which calls for interventions that uphold human rights and quality of life (WHO, 2021). Practically, PCT offers a cost-effective alternative to pharmacological interventions. Its implementation does not require advanced technologies but relies on training health professionals and caregivers in empathetic communication. The potential reduction in medication use, hospitalizations, and caregiver burnout could translate into substantial healthcare savings while enhancing patient well-being. Limitations and Future Directions While the reviewed evidence strongly supports PCT, certain limitations must be acknowledged. Many studies relied on small samples or short-term follow-ups, limiting generalizability. Additionally, the heterogeneity of PCT interventions across settings makes direct comparisons challenging. Future research should prioritize randomized controlled trials with larger sample sizes, standardized intervention protocols, and longitudinal designs to capture long-term outcomes. Furthermore, integrating neuroscientific measures—such as neuroimaging, biomarkers of stress regulation, and oxytocin levels—could deepen our understanding of the biological mechanisms underlying PCT. Cross-cultural studies are also necessary to explore the adaptability of PCT across different healthcare systems and cultural contexts. CONCLUSION This systematic review demonstrates that Person-Centered Therapy (PCT) constitutes an effective, humane, and scientifically substantiated non-pharmacological intervention for individuals with dementia. By fostering emotional safety, authenticity, and unconditional acceptance, PCT improves patients’ emotional stability, behavior, and overall quality of life. At the same time, it reduces caregiver burden and strengthens therapeutic alliances. In contrast to pharmacological approaches, PCT offers both clinical and ethical advantages, aligning with global health policies that prioritize dignity, personhood, and holistic care. Nevertheless, the current evidence base presents limitations. Many of the included studies were limited by small sample sizes, heterogeneous methodologies, and short-term follow-ups. Additionally, while the thematic synthesis highlights consistent benefits, the lack of standardized intervention protocols makes direct comparisons challenging. These constraints underscore the need for further rigorous research. Practical Implications PCT should be integrated into dementia care at both institutional and community levels. Training programs for healthcare professionals and caregivers can enhance empathy-based communication and reduce reliance on pharmacological treatments. Embedding PCT principles into long-term care facilities has the potential to lower antipsychotic use, improve psychosocial climate, and generate substantial economic benefits through reduced caregiver burnout and hospital admissions. Directions for Future Research Future studies should pursue: Randomized Controlled Trials (RCTs) : Large-scale, multicenter trials are needed to establish the efficacy of PCT with greater precision and generalizability. Longitudinal Designs : Extended follow-up will clarify whether the benefits of PCT are sustained over time. Neurobiological Investigations : Incorporating neuroimaging, stress biomarkers, and oxytocin assays could provide objective evidence of the mechanisms underlying PCT. Cross-Cultural Validation : Research in diverse cultural and healthcare contexts will determine the adaptability of PCT globally. Integration with Digital Health Tools : Exploring how telehealth and artificial intelligence might support PCT delivery could expand accessibility, especially in under-resourced settings. Toward a Research Agenda The convergence of psychological, relational, and neurobiological findings positions PCT at the forefront of innovative dementia care. Future doctoral research could build upon these results by systematically testing PCT within integrative models that combine clinical psychology, neuroscience, and public health. Such an agenda would not only refine theoretical understanding but also contribute directly to the development of sustainable, person-centered healthcare systems. Table ΙΙΙ Summary of Findings of the Selected Studies by Research Question Study Research Question 1 Research Question 2 Research Question 3 Research Question 4 Saragih et al. (2022) Reduction of disorganization, improved adaptation with consistent application of PCT — — PCT as an alternative in cases of pharmacological treatment failure Kim & Park (2022) Slowing of cognitive decline, strengthening of meaningful dialogue and daily functioning — — Reduction in antipsychotic use, enhanced cooperation Powers et al. (2023) Emotional connection through reminiscence therapy — — — Judge et al. (2023) Improvement of behavior through stable therapeutic relationship — — — Frederiksen et al. (2023) Reduction of caregiver burnout through person-centered practices — — — Nguyen et al. (2021) — Superiority of PCT over behavioral intervention in free expression and emotional safety — — Martinez et al. (2022) — Limitations of CBT in early stages, superiority of PCT due to emotional approach — — Kindblom et al. (2021) — Music therapy provides short-term benefits, whereas PCT delivers stable and lasting effects — — Brooker et al. (2022) — Application of the VIPS model, enhancement of cooperation and emotional stability Improvement of neurophysiological markers, reduced medication use Integration of PCT into daily care systems with measurable outcomes Liu et al. (2022) — Caregivers with PCT: less exhaustion, more positive attitudes toward patients — — Davidson & McEwen (2021) — — Strengthening of neuroplasticity and social responsiveness through therapeutic relationship — Uvnäs-Moberg et al. (2023) — — Increased oxytocin levels and reduced need for pharmacological sedation in PCT environment — Declarations Author Contribution Maria Skotida: Conceptualization, Methodology, Literature Search, Data Curation, Formal Analysis, Writing – Original Draft, Writing – Review & Editing, Visualization, Project Administration. References Aini, N., Chen, R., Chu, H., Chang, C. Y., Lin, H. C., Jen, H. J., Liu, D., Lee, T. Y., & Chou, K. R. (2024). 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7410026","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":503235660,"identity":"8cd2ca09-4ee6-4b71-a712-19c479b5d4f7","order_by":0,"name":"Maria Skotida","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYDACHiBOYAOxGBsYPgDZxGhhbIBpYZxBtBYGNgibmYcYLfI9h48/eFBmF80/+3DjZ9s2uzx+9gbm1xV4tBicbUtsSDiXnDvjXGKzdG5bcrFkzwE2yzP4tPDzGDYktjHnNpxhbABqYU7ccCOBzbABn8P6wVrqc+efYWz+bdlWT1gLw9kekJbDuRvOMLZJM7YdBmlhfohPi8GZY4kzEs4dz90I1GLZc+544syeg22MeB3Wk3zg44+y6tx5Z9gf3wAyEvvZmw9/xOswFMAIidM2CaJ1MDD8AZPMH0jQMgpGwSgYBcMfAACUtFcG4laCWwAAAABJRU5ErkJggg==","orcid":"","institution":"Aristotle University of Thessaloniki","correspondingAuthor":true,"prefix":"","firstName":"Maria","middleName":"","lastName":"Skotida","suffix":""}],"badges":[],"createdAt":"2025-08-19 15:23:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7410026/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7410026/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89564274,"identity":"4ae9395d-10c4-48d1-ad7c-9f3f476d7a84","added_by":"auto","created_at":"2025-08-21 10:33:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22785,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eConceptual model of Person-Centered Therapy mechanisms in dementia.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7410026/v1/ce438c6b7d4a43e03a210802.png"},{"id":89565353,"identity":"cb7b5e1d-93ba-42a4-8d77-14632bddfb49","added_by":"auto","created_at":"2025-08-21 10:41:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":144181,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the METHODS section.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7410026/v1/b31a5b82044e500a851848c9.png"},{"id":89564305,"identity":"062d002b-9916-49ce-b788-63cfab304d4d","added_by":"auto","created_at":"2025-08-21 10:33:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1253911,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7410026/v1/f5568efd-1d8a-44a9-b2f7-346288c6b344.pdf"},{"id":89564280,"identity":"08d2e59c-57d2-45b0-b28c-4471e16ac05c","added_by":"auto","created_at":"2025-08-21 10:33:22","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":119307,"visible":true,"origin":"","legend":"","description":"","filename":"pinakes.docx","url":"https://assets-eu.researchsquare.com/files/rs-7410026/v1/a2188925d7e5998940f5708b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eNeurosciences and Person-centered Psychotherapy in Patients With Dementia: A Systematic Review of Non- Pharmacological Interventions\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDementia represents one of the most prevalent and challenging neurodegenerative syndromes worldwide, affecting millions of individuals as well as their families and broader social environments. It is characterized by progressive deterioration of memory, thinking, comprehension, and other cognitive domains, leading to significant impairment in daily functioning (World Health Organization [WHO], 2021). The global prevalence of dementia is projected to reach 78\u0026nbsp;million people by 2030 and 139\u0026nbsp;million by 2050, posing a major public health issue. Among its various forms, Alzheimer\u0026rsquo;s disease is the most common, accounting for approximately 60\u0026ndash;70% of cases (Alzheimer\u0026rsquo;s Association, 2023).\u003c/p\u003e\u003cp\u003eIn addition to cognitive decline, dementia is often accompanied by Behavioral and Psychological Symptoms of Dementia (BPSD), including aggression, anxiety, depression, hallucinations, and sleep disturbances (Kales et al., 2015). These symptoms not only worsen the patient\u0026rsquo;s quality of life but also impose a substantial burden on caregivers, who frequently experience stress, exhaustion, and social isolation (Brodaty \u0026amp; Donkin, 2009). This \u0026ldquo;caregiver syndrome\u0026rdquo; can lead to increased risks of depression, anxiety disorders, and physical health problems.\u003c/p\u003e\u003cp\u003eTraditional management of dementia relies primarily on pharmacological treatments, such as cholinesterase inhibitors and NMDA receptor antagonists, which may temporarily slow cognitive decline but do not reverse the progression of the disease and are often associated with adverse effects (Birks, 2006; Ritchie et al., 2017). Consequently, there is a growing interest in non-pharmacological interventions, especially psychotherapeutic approaches, that aim to improve both patient well-being and caregiver resilience.\u003c/p\u003e\u003cp\u003eOne of the most prominent non-pharmacological approaches is Person-Centered Therapy (PCT), developed by Carl Rogers (1951). PCT emphasizes empathy, unconditional positive regard, and genuineness within the therapeutic relationship, valuing the uniqueness and intrinsic worth of each individual. Unlike cognitive-behavioral or psychodynamic methods, which rely heavily on abstract thinking or unconscious processes, PCT provides a framework of emotional safety, authenticity, and connection\u0026mdash;elements particularly relevant for people with dementia whose cognitive capacities are compromised (Kitwood, 1997; Brooker, 2007).\u003c/p\u003e\u003cp\u003eResearch has shown that PCT can enhance mood, social interaction, self-esteem, and emotional stability in patients with dementia (Brooker \u0026amp; Latham, 2016; Saragih et al., 2022). Moreover, it supports caregivers by reducing stress and improving communication. From a neuroscientific perspective, PCT-related interventions have been associated with mechanisms such as synaptic plasticity, regulation of stress responses, and neurotransmitter modulation, suggesting a biological foundation for its effects (Siegel, 2012; LeDoux, 2002).\u003c/p\u003e\n\u003ch3\u003eAim of the study\u003c/h3\u003e\n\u003cp\u003eThe present article aims to systematically review recent studies on the application of Person-Centered Therapy in dementia, focusing on its psychological, behavioral, and neurobiological outcomes. Specifically, it seeks to:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAssess the effects of PCT on the cognitive, emotional, and behavioral aspects of patients with dementia.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCompare its effectiveness with other psychotherapeutic or non-pharmacological interventions.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eExplore potential neurobiological mechanisms underlying PCT’s therapeutic impact.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eEvaluate its influence on caregivers’ emotional and functional well-being.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"METHODS","content":"\u003ch2\u003eStudy Design\u003c/h2\u003e\n\u003cp\u003eThis study followed a systematic literature review approach, designed according to the PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Page et al., 2021). The aim was to identify, evaluate, and synthesize existing evidence on the application of Person-Centered Therapy (PCT) in individuals with dementia. The protocol was developed prior to the review to ensure transparency and reproducibility.\u003c/p\u003e\n\u003ch3\u003eResearch Framework \u0026ndash; PECO\u003c/h3\u003e\n\u003cp\u003eTo structure the review, the PECO (Population, Exposure, Comparison, Outcome) framework was applied:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation (P)\u003c/strong\u003e: Individuals diagnosed with dementia and their caregivers\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eExposure (E)\u003c/strong\u003e: Person-Centered Therapy (PCT)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eComparison (C)\u003c/strong\u003e: Other psychotherapeutic or non-pharmacological interventions, or usual care\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome (O)\u003c/strong\u003e: Cognitive, emotional, behavioral, and neurobiological outcomes in patients; emotional and functional outcomes in caregivers\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis framework ensured clarity in study selection and analysis.\u003c/p\u003e\n\u003ch3\u003eSources and Databases\u003c/h3\u003e\n\u003cp\u003eA comprehensive search was conducted in the following databases: PubMed, Scopus, PsycINFO, Google Scholar, and ScienceDirect. These were selected for their wide coverage of psychology, psychiatry, neurosciences, and geriatric care. Only peer-reviewed studies with available full text were included.\u003c/p\u003e\n\u003ch3\u003eSearch Strategy\u003c/h3\u003e\n\u003cp\u003eThe search strategy employed combinations of keywords and Boolean operators:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Person-Centered Therapy\u0026rdquo; OR \u0026ldquo;Person-Centred Care\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAND \u0026ldquo;dementia\u0026rdquo; OR \u0026ldquo;Alzheimer\u0026rsquo;s disease\u0026rdquo;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAND \u0026ldquo;non-pharmacological intervention\u0026rdquo; OR \u0026ldquo;psychotherapy\u0026rdquo;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAND \u0026ldquo;caregivers\u0026rdquo; OR \u0026ldquo;family support\u0026rdquo;\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n\u003cdiv id=\"Sec10\" class=\"Section4\"\u003e\n\u003cp\u003eThe search covered studies published between January 2020 and April 2025.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eInclusion and Exclusion Criteria\u003c/h2\u003e\n\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n\u003cp\u003e\u0026bull; Inclusion:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eStudies involving PCT as a primary or combined intervention in dementia\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePopulations with mild to moderate dementia\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eOutcomes addressing patient well-being, caregiver burden, or neurobiological effects\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePublications in English or Greek\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003cp\u003e\u0026bull; Exclusion:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eCase reports, conference abstracts, or non-peer-reviewed articles\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eStudies focusing exclusively on pharmacological interventions\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePopulations without a confirmed diagnosis of dementia\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy Selection Process\u003c/h2\u003e\n\u003cp\u003eAfter removing duplicates, titles and abstracts were screened for relevance. Full-text articles were then evaluated based on the inclusion/exclusion criteria. A total of 21 studies were included in the final analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003eData Extraction and Thematic Analysis\u003c/h2\u003e\n\u003cp\u003eData were extracted into structured tables summarizing study design, sample characteristics, intervention details, outcomes, and key findings. A thematic synthesis was then conducted across four predefined research questions:\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eEffects of PCT on cognitive, emotional, and behavioral aspects of dementia patients.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eComparative effectiveness of PCT versus other interventions (e.g., CBT, behavioral approaches, music therapy).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eNeurobiological mechanisms underlying PCT\u0026rsquo;s impact.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eEffects on caregiver well-being.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 21 studies published between 2020 and 2025 met the inclusion criteria and were analyzed. The findings are presented thematically, according to the four research questions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Effects of PCT on Cognitive, Emotional, and Behavioral Aspects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost studies focused on patients with mild to moderate dementia. Across these, PCT interventions emphasized the creation of an emotionally safe and authentic therapeutic environment rather than structured techniques.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eCognitive and Emotional Impact\u003c/strong\u003e: Several studies reported improvements in mood, self-esteem, and emotional regulation, with reductions in agitation and anxiety (Brooker \u0026amp; Latham, 2016; Saragih et al., 2022).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eBehavioral Changes\u003c/strong\u003e: Positive effects were observed in communication, social engagement, and reduced disruptive behaviors.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eQuality of Life\u003c/strong\u003e: Patients reported greater well-being and increased participation in daily activities, demonstrating that relational and emotional support contributes to preserved autonomy and identity.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2. Comparative Effectiveness of PCT vs. Other Interventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe reviewed studies frequently compared PCT with other psychotherapeutic or non-pharmacological methods:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003ePCT vs. CBT\u003c/strong\u003e: While CBT was effective in reducing anxiety in early-stage dementia, its reliance on abstract thought limited its applicability in moderate-to-severe stages. Results were less sustainable compared to PCT (Martinez et al., 2022).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003ePCT vs. Behavioral Interventions (BI)\u003c/strong\u003e: Behavioral approaches targeted \u0026ldquo;problem behaviors\u0026rdquo; but often neglected patients\u0026rsquo; inner experiences. Improvements in agitation were temporary and less holistic compared to PCT (Nguyen et al., 2021).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003ePCT vs. Music Therapy\u003c/strong\u003e: Music therapy was effective in mood regulation, but its results were context-dependent and often short-lived (Kindblom et al., 2021).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003ePCT and the VIPS Model\u003c/strong\u003e: The VIPS framework (Values, Individualized, Perspective, Social environment) demonstrated robust results, with reductions of up to 40% in antipsychotic use and improvements in cooperation and psychosocial climate (Brooker et al., 2022).\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eTable \u0026Iota;. Therapeutic Approaches, Benefits, and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTherapeutic Approach\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBenefits\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eLimitations\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAdaptable to all stages of dementia, empathy, long-lasting effects\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eRequires change in care system attitudes\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCBT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePositive outcomes in early stages\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eNot applicable in middle/advanced stages\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBehavioral Interventions\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShort-term reduction of \u0026ldquo;challenging\u0026rdquo; behaviors\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDoes not incorporate emotional experience\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"1\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMusic Therapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eImmediate impact on mood\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTemporary effect, requires infrastructure\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVIPS (PCT application)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHolistic, reduction of medication, applicable in care units\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eRequires training and structural changes\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e3. Neurobiological Mechanisms of PCT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral studies highlighted potential biological underpinnings of PCT:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eStress Regulation\u003c/strong\u003e: Emotional safety in therapy was associated with better regulation of the hypothalamic\u0026ndash;pituitary\u0026ndash;adrenal (HPA) axis.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eNeurotransmitter Activity\u003c/strong\u003e: PCT environments appeared to influence neurotransmitter systems such as serotonin and dopamine (Siegel, 2012; LeDoux, 2002).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eNeuroplasticity\u003c/strong\u003e: Emotional connection and therapeutic relationships were linked to synaptic plasticity and adaptive neural pathways (Cummings et al., 2019).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eOxytocin\u003c/strong\u003e: Some studies reported increased oxytocin secretion, facilitating trust, bonding, and reduced caregiver-patient conflict.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Effects of PCT on Caregivers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCaregivers, often family members, experienced substantial benefits when engaged in PCT-based approaches:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eReduced stress, burnout, and depressive symptoms (Gallagher-Thompson et al., 2003).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eImproved communication and emotional connection with patients (Frederiksen et al., 2025).\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eGreater resilience, supported by structured training in empathy and acceptance.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThese findings confirm that PCT supports not only the patients but also their immediate care networks, contributing to a more sustainable model of dementia care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable \u0026Iota;\u0026Iota;. Summary of Selected Studies on Person-Centered Therapy (PCT) in Dementia\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tabb\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNo.\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAuthor(s)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYear\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eType of Intervention\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMain Findings\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSass et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eImprovement in mood and communication\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTerkelsen et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT\u0026thinsp;+\u0026thinsp;caregiver assessment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReduction in anxiety and depression among caregivers\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFrederiksen et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRelief for caregivers, enhanced emotional connection\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJudge et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReduction in aggression, improved cooperation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNguyen et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT vs Behavioral\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGreater acceptance by patients, less authoritarian approach\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePowers et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT\u0026thinsp;+\u0026thinsp;Reminiscence therapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIncreased emotional engagement and sense of identity\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKindblom et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMusic therapy vs PCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT provides longer-lasting effects\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLiu et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReduction of caregiver burnout, improved care relationship\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBrooker et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT \u0026ndash; VIPS framework\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCare model with reduced medication use\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMartinez et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCBT vs PCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT effective across all stages of dementia\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSiegel\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNeurobiological effect of PCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReduced cortisol, improved homeostasis\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDavidson \u0026amp; McEwen\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIncreased neuroplasticity through relationship\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUvn\u0026auml;s-Moberg et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIncreased oxytocin, reduced medication use\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKumfor et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReduction in depression index, improved mood regulation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBrooker \u0026amp; Latham\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT in long-term care\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40% reduction in antipsychotic medication\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKim \u0026amp; Park\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT \u0026ndash; Meta-analysis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eStabilization of cognitive decline, improved functionality\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSaragih et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT without pharmacological support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eImproved mood and adaptation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePanza et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT vs other psychosocial interventions\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBetter quality of life and engagement\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMoon \u0026amp; Adams\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT with cultural adaptation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIncreased effectiveness in minority groups\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCheston et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2020\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT \u0026ndash; Group therapy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eReduction in symptoms of isolation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpector et al.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2021\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePCT\u0026thinsp;+\u0026thinsp;cognitive support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCombined benefit in communication and cognition\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe findings of this systematic review highlight the therapeutic potential of Person-Centered Therapy (PCT) as a non-pharmacological intervention for individuals with dementia. Overall, the evidence demonstrates that PCT contributes significantly to emotional stability, improved quality of life, and reduction of caregiver burden. Beyond symptomatic relief, PCT appears to foster a deeper sense of identity, dignity, and interpersonal connection for patients. These results are consistent with the foundational principles of Carl Rogers\u0026rsquo; humanistic psychology, which emphasize empathy, authenticity, and unconditional positive regard as essential for personal growth and healing (Rogers, 1951).\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003ePCT and the Patient Experience\u003c/h2\u003e\u003cp\u003eOne of the most consistent findings across the reviewed studies is the enhancement of patients\u0026rsquo; emotional and behavioral functioning. Unlike cognitive\u0026ndash;behavioral therapy (CBT), which relies heavily on cognitive restructuring, PCT aligns with the preserved emotional and relational capacities in dementia. This explains why PCT remains effective even in later stages of the disease, where abstract thinking and verbal reasoning are diminished (Martinez et al., 2022). The creation of an emotionally safe environment allows patients to express themselves authentically, reducing agitation and fostering cooperation.\u003c/p\u003e\u003cp\u003eThese findings support the theoretical framework of personhood developed by Kitwood (1997), who argued that the behavior of individuals with dementia should be interpreted not merely as \u0026ldquo;symptoms\u0026rdquo; but as expressions of unmet psychological needs. By recognizing the patient as a full person with enduring dignity, PCT provides a corrective to depersonalizing tendencies in clinical care. Such recognition has profound implications: it validates patients\u0026rsquo; lived experiences, preserves their autonomy, and enhances their sense of meaning despite cognitive decline.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eComparative Effectiveness\u003c/h2\u003e\u003cp\u003eThe comparative analysis demonstrates the advantages of PCT over other non-pharmacological interventions. While CBT and behavioral interventions produce short-term benefits, they often fail to address the subjective emotional experience of dementia patients (Nguyen et al., 2021). Music therapy, though beneficial for mood regulation, shows transient effects highly dependent on context and therapist availability (Kindblom et al., 2021). By contrast, the VIPS model of PCT (Brooker et al., 2022) integrates values, individuality, perspective, and social environment, offering a more holistic and sustainable approach.\u003c/p\u003e\u003cp\u003eImportantly, the reduction in antipsychotic use observed in VIPS-based care units (up to 40%) underscores the clinical relevance of PCT. This finding has ethical as well as practical implications, given the known risks of pharmacological management in dementia, including increased mortality (Ritchie et al., 2017). PCT not only reduces reliance on medication but also enhances therapeutic alliances, suggesting it should be considered a first-line or complementary intervention in dementia care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eNeurobiological Correlates\u003c/h2\u003e\u003cp\u003eEmerging evidence suggests that the effects of PCT extend beyond psychological well-being to measurable neurobiological processes. Several studies report that therapeutic environments characterized by empathy and authenticity can regulate the hypothalamic\u0026ndash;pituitary\u0026ndash;adrenal (HPA) axis, reducing stress responses and improving homeostasis. Furthermore, neuroimaging research indicates that emotionally supportive interventions enhance activity in prefrontal and limbic regions, areas involved in emotional regulation, memory, and social cognition (Siegel, 2012; LeDoux, 2002).\u003c/p\u003e\u003cp\u003eThe association of PCT with neuroplasticity is particularly noteworthy. Even in neurodegenerative conditions, experiences of emotional connection may promote synaptic adaptability and maintain functional networks, providing a neurobiological explanation for observed behavioral improvements (Cummings et al., 2019). Additionally, the reported increase in oxytocin secretion following supportive interpersonal contact highlights a biochemical mechanism underpinning the strengthened bonds between patients and caregivers. These findings position PCT not only as a psychosocial tool but also as an intervention with tangible biological effects.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eImpact on Caregivers\u003c/h2\u003e\u003cp\u003eThe caregiver experience emerged as a critical dimension in the reviewed studies. Caregivers often face overwhelming emotional and physical demands, leading to burnout, depression, and social isolation (Brodaty \u0026amp; Donkin, 2009). Interventions grounded in PCT principles provided caregivers with skills in empathy, active listening, and unconditional acceptance. As a result, they reported reduced stress, improved coping strategies, and greater emotional resilience (Gallagher-Thompson et al., 2003; Frederiksen et al., 2025).\u003c/p\u003e\u003cp\u003eThe reciprocal benefits observed\u0026mdash;where caregivers\u0026rsquo; improved well-being translates into more effective patient care\u0026mdash;illustrate the systemic nature of PCT. Rather than isolating the patient as the sole target of intervention, PCT situates care within the broader relational network, fostering mutual support and collaboration. This aligns with contemporary public health strategies that emphasize family-centered and community-based care models.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eEthical and Practical Implications\u003c/h2\u003e\u003cp\u003eThe results also carry significant ethical weight. Dementia care often risks reducing individuals to their deficits, fostering stigmatization and disempowerment. PCT challenges this paradigm by affirming personhood and prioritizing dignity, respect, and agency. Such values resonate with the World Health Organization\u0026rsquo;s \u0026ldquo;Global Action Plan on the Public Health Response to Dementia 2017\u0026ndash;2025,\u0026rdquo; which calls for interventions that uphold human rights and quality of life (WHO, 2021).\u003c/p\u003e\u003cp\u003ePractically, PCT offers a cost-effective alternative to pharmacological interventions. Its implementation does not require advanced technologies but relies on training health professionals and caregivers in empathetic communication. The potential reduction in medication use, hospitalizations, and caregiver burnout could translate into substantial healthcare savings while enhancing patient well-being.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eLimitations and Future Directions\u003c/h2\u003e\u003cp\u003eWhile the reviewed evidence strongly supports PCT, certain limitations must be acknowledged. Many studies relied on small samples or short-term follow-ups, limiting generalizability. Additionally, the heterogeneity of PCT interventions across settings makes direct comparisons challenging. Future research should prioritize randomized controlled trials with larger sample sizes, standardized intervention protocols, and longitudinal designs to capture long-term outcomes.\u003c/p\u003e\u003cp\u003eFurthermore, integrating neuroscientific measures\u0026mdash;such as neuroimaging, biomarkers of stress regulation, and oxytocin levels\u0026mdash;could deepen our understanding of the biological mechanisms underlying PCT. Cross-cultural studies are also necessary to explore the adaptability of PCT across different healthcare systems and cultural contexts.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis systematic review demonstrates that Person-Centered Therapy (PCT) constitutes an effective, humane, and scientifically substantiated non-pharmacological intervention for individuals with dementia. By fostering emotional safety, authenticity, and unconditional acceptance, PCT improves patients\u0026rsquo; emotional stability, behavior, and overall quality of life. At the same time, it reduces caregiver burden and strengthens therapeutic alliances. In contrast to pharmacological approaches, PCT offers both clinical and ethical advantages, aligning with global health policies that prioritize dignity, personhood, and holistic care.\u003c/p\u003e\u003cp\u003eNevertheless, the current evidence base presents limitations. Many of the included studies were limited by small sample sizes, heterogeneous methodologies, and short-term follow-ups. Additionally, while the thematic synthesis highlights consistent benefits, the lack of standardized intervention protocols makes direct comparisons challenging. These constraints underscore the need for further rigorous research.\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003ePractical Implications\u003c/h2\u003e\u003cp\u003ePCT should be integrated into dementia care at both institutional and community levels. Training programs for healthcare professionals and caregivers can enhance empathy-based communication and reduce reliance on pharmacological treatments. Embedding PCT principles into long-term care facilities has the potential to lower antipsychotic use, improve psychosocial climate, and generate substantial economic benefits through reduced caregiver burnout and hospital admissions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003eDirections for Future Research\u003c/h2\u003e\u003cp\u003eFuture studies should pursue:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eRandomized Controlled Trials (RCTs)\u003c/b\u003e: Large-scale, multicenter trials are needed to establish the efficacy of PCT with greater precision and generalizability.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eLongitudinal Designs\u003c/b\u003e: Extended follow-up will clarify whether the benefits of PCT are sustained over time.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eNeurobiological Investigations\u003c/b\u003e: Incorporating neuroimaging, stress biomarkers, and oxytocin assays could provide objective evidence of the mechanisms underlying PCT.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eCross-Cultural Validation\u003c/b\u003e: Research in diverse cultural and healthcare contexts will determine the adaptability of PCT globally.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eIntegration with Digital Health Tools\u003c/b\u003e: Exploring how telehealth and artificial intelligence might support PCT delivery could expand accessibility, especially in under-resourced settings.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003eToward a Research Agenda\u003c/h2\u003e\u003cp\u003eThe convergence of psychological, relational, and neurobiological findings positions PCT at the forefront of innovative dementia care. Future doctoral research could build upon these results by systematically testing PCT within integrative models that combine clinical psychology, neuroscience, and public health. Such an agenda would not only refine theoretical understanding but also contribute directly to the development of sustainable, person-centered healthcare systems.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable ΙΙΙ Summary of Findings of the Selected Studies by Research Question\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResearch Question 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eResearch Question 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eResearch Question 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eResearch Question 4\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSaragih et al. (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReduction of disorganization, improved adaptation with consistent application of PCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePCT as an alternative in cases of pharmacological treatment failure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKim \u0026amp; Park (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSlowing of cognitive decline, strengthening of meaningful dialogue and daily functioning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReduction in antipsychotic use, enhanced cooperation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePowers et al. (2023)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional connection through reminiscence therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJudge et al. (2023)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImprovement of behavior through stable therapeutic relationship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrederiksen et al. (2023)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReduction of caregiver burnout through person-centered practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNguyen et al. (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSuperiority of PCT over behavioral intervention in free expression and emotional safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMartinez et al. (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLimitations of CBT in early stages, superiority of PCT due to emotional approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKindblom et al. (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMusic therapy provides short-term benefits, whereas PCT delivers stable and lasting effects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrooker et al. (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eApplication of the VIPS model, enhancement of cooperation and emotional stability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eImprovement of neurophysiological markers, reduced medication use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIntegration of PCT into daily care systems with measurable outcomes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiu et al. (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCaregivers with PCT: less exhaustion, more positive attitudes toward patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDavidson \u0026amp; McEwen (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStrengthening of neuroplasticity and social responsiveness through therapeutic relationship\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUvn\u0026auml;s-Moberg et al. (2023)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIncreased oxytocin levels and reduced need for pharmacological sedation in PCT environment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMaria Skotida: Conceptualization, Methodology, Literature Search, Data Curation, Formal Analysis, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing, Visualization, Project Administration.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAini, N., Chen, R., Chu, H., Chang, C. 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Neuroimaging studies of acupuncture on Alzheimer\u0026rsquo;s disease: A systematic review. \u003cem\u003eBMC Complementary Medicine and Therapies\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e, 63\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"dementia, Alzheimer’s disease, person-centered psychotherapy, Person-Centered Therapy (PCT), therapeutic relationship, empathy, caregivers, neuroplasticity, quality of life","lastPublishedDoi":"10.21203/rs.3.rs-7410026/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7410026/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis article investigates the therapeutic value of Person-Centered Therapy (PCT) in individuals diagnosed with dementia, with a focus on both patient outcomes and caregiver experiences. A systematic literature review was conducted following the PRISMA 2020 guidelines, including twenty-one studies published between 2020 and 2025. Thematic analysis was performed across four core research questions addressing: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) cognitive, emotional, and behavioral improvement; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) the caregiver\u0026ndash;patient relationship; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) comparative effectiveness of PCT against other psychotherapeutic or non-pharmacological interventions; and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) neurobiological evidence supporting PCT.\u003c/p\u003e\u003cp\u003eFindings suggest that most studies emphasized mild to moderate dementia and highlighted the role of emotional safety, authenticity, and unconditional acceptance over rigid psychotherapeutic techniques. PCT was consistently associated with improvements in emotional stability, quality of life, and reduced caregiver burden. Additionally, several studies reported neurobiological mechanisms such as enhanced neuroplasticity, regulation of the HPA axis, and increased oxytocin secretion.\u003c/p\u003e\u003cp\u003eOverall, PCT emerges as a humane, accessible, and scientifically substantiated intervention, offering both clinical and ethical advantages. It is proposed as a complementary or alternative approach to pharmacological treatment, reinforcing the need for holistic, person-centered dementia care.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e","manuscriptTitle":"Neurosciences and Person-centered Psychotherapy in Patients With Dementia: A Systematic Review of Non- Pharmacological Interventions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 10:33:17","doi":"10.21203/rs.3.rs-7410026/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4bff5a40-8283-4a87-9e79-2bc0e00acbfd","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-21T10:33:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-21 10:33:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7410026","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7410026","identity":"rs-7410026","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}