Comparative effectiveness of recreational therapies on cognition, neuropsychiatric symptoms, and psychosocial outcomes in individuals with mild cognitive impairment and dementia: A network meta-analysis

Background: Recreational therapies, including music therapy, singing therapy, dance therapy, art therapy, game therapy, creative story therapy, and combined therapy, are essential for individuals with mild cognitive impairment and dementia. However, research comparing their effectiveness is limited. Objective: This study aimed to evaluate the effectiveness of recreational therapies in improving cognitive function, neuropsychiatric symptoms, and psychosocial outcomes in individuals with mild cognitive impairment and dementia. Methods: We identified eligible randomized controlled trials of recreational therapies for individuals with mild cognitive impairment and dementia in eight electronic databases, including CINAHL, CENTRAL, Embase, EBSCOhost, Ovid MEDLINE, PubMed, Scopus, and Web of Science. A frequentist network meta-analysis with random-effects model was performed in R Software presenting standardized mean differences for data analysis. The primary outcome was cognitive function, which is classified into global cognition, fundamental processes (immediate and delayed memory, attention, and processing speed), intermediate processes (language and verbal fluency), and higher-order processes of cognitive function (executive function); while secondary outcomes were neuropsychiatric symptoms and psychosocial outcomes (depression, anxiety, and quality of life). Netrank was used to rank the interventions. Cochrane Q, I2, and τ2 statistics were used to assess heterogeneity. The quality of the evidence was graded using the Confidence in Network Meta-Analysis. Results: In total, 71 randomized controlled trials involving 6692 participants were included. Game therapy (standardized mean difference: 0.71), art therapy (0.68), and music therapy (0.29) significantly improved global cognition. Most recreational therapies enhanced fundamental processes, with the strongest effects noted for singing therapy on immediate memory (0.62), music therapy on delayed memory (0.34), creative story therapy on attention (1.08), and art therapy on processing speed (−0.28). Dance therapy (0.51) and art therapy (0.59) improved language and verbal fluency, whereas singing therapy improved executive function (0.78). Dance therapy (−0.43), music therapy (−0.38), and combined therapy (−0.35) alleviated neuropsychiatric symptoms. Regarding psychosocial outcomes, game therapy reduced depression (−0.70), music therapy reduced anxiety (−1.17), and art therapy improved quality of life (0.65). Conclusions: Recreational therapies yield domain-specific benefits across outcomes, supporting their use as effective mild cognitive impairment and dementia care strategies. These findings highlight the need to integrate recreational therapies into routine practice, offering evidence-based to enhance care and patient well-being. Registration: The protocol for this network meta-analysis was prospectively registered in International Prospective Register of Systematic Reviews (registration number: CRD 420251021190).