Effectiveness of Need-Driven Dementia-Compromised Behavior model-based interventions on behavioral and psychological symptoms of dementia: A systematic review and meta-analysis

초록

Background: Behavioral and psychological symptoms of dementia occur in most people with dementia. The Need-Driven Dementia-Compromised Behavior model interprets symptoms as expressions of unmet needs rather than problematic behaviors, explained through the interaction of background and proximal factors. Objective: This study aimed to examine the effectiveness of Need-Driven Dementia-Compromised Behavior model-based interventions on behavioral and psychological symptoms in dementia. Methods: Randomized controlled trials published up to October 3, 2025, were systematically searched in PubMed, CINAHL, EMBASE, and Web of Science. The essential criteria of model-based interventions were defined as (A) recognition of behavior as expression, (B) assessment of background and proximal factors, and (C) individualized approach based on assessment. Only interventions meeting all criteria were included. Studies not in English, not peer-reviewed, pharmacological in nature, or not exclusively targeting people with dementia were excluded. Study quality was assessed using the Revised Cochrane risk-of-bias tool, and the certainty of evidence was evaluated using the GRADE methodology. Meta-analysis was conducted using a random-effects model, with all effect sizes calculated immediately post-intervention and adjusted for baseline differences. Subgroup and meta-regression analysis were performed based on criterion A alignment (explicit vs. implicit), residence type (community vs. facility), and intervention level (individual vs. care system). Results: 39 studies were included in the systematic review, of which 22 were included in the meta-analysis. Need-Driven Dementia-Compromised Behavior model-based interventions showed statistically significant reductions in overall behavioral and psychological symptoms (SMD =-0.308, 95% CI:-0.589 to-0.027). In the analysis of individual symptoms, significant reductions were observed in agitation (SMD =-0.391, 95% CI:-0.670 to-0.111) and depression (SMD =-0.431, 95% CI:-0.792 to-0.071). Subgroup analysis revealed consistent statistically significant effects in interventions explicitly aligned with criterion A and in facility settings, with individual-level and care system-level interventions each showing statistically significant effects on different symptoms. Sensitivity analysis confirmed robust findings. Conclusions: Need-Driven Dementia-Compromised Behavior model-based interventions alleviated overall behavioral and psychological symptoms of dementia, agitation and depressive symptoms. Subgroup analysis provide evidence supporting interventions that explicitly incorporate the model's core concept and facility-based delivery while suggesting the combination of care system capacity building with individual-level interventions. This study suggests that the model is not merely a theoretical concept but a feasible, evidence-based approach capable of bringing qualitative improvements in dementia care practice. Registration: This study was registered in PROSPERO (CRD42024611259).

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