Due to global demographic changes, a notable trend of population aging has emerged, resulting in an increased prevalence of health conditions typically associated with the elderly. One such condition is cognitive impairment-dementia syndrome. Currently, 40,000 cases of dementia are registered in Lithuania (Health Information Centre), with projections estimating 81,000 cases by 2050 \[13\].
The care of individuals with dementia syndrome requires a holistic approach, incorporating both pharmacological and non-pharmacological interventions. The effectiveness of pharmacological treatment is limited: no highly effective drugs currently exist for Alzheimer's disease (available drugs have limited pathogenetic and symptomatic effects), there are no specific treatments for other forms of dementia, and the long-term use of medications to manage behavioral symptoms is associated with adverse effects. The OECD equates the routine use of neuroleptics with poor quality care \[2\]. Furthermore, even when medications are prescribed, non-pharmacological interventions should be applied concurrently \[5\].
One recommended method is arts therapy. Art therapy is a recognized psychosocial treatment that improves attention, perception, memory, and mood in people with dementia. However, there is a lack of studies evaluating the effectiveness of art therapy specifically in improving the psycho-emotional state of individuals with dementia syndrome.
Pharmacological treatments commonly used for dementia syndrome offer limited long-term benefits \[23\]. As the number of individuals affected by dementia continues to grow, increasing attention is being paid to improving their quality of life, social integration, and emotional well-being through non-pharmacological means. International guidelines recommend creative and artistic activities tailored to individual preferences, skills, and abilities, including music and dance \[19\]. One of the increasingly recognized interventions is art therapy \[5\]. Systematic review findings support the inclusion of various psychological interventions in the treatment of individuals with dementia who suffer from depression and/or anxiety disorders \[3\].
Globally, research most commonly explores the impact of art therapy on cognitive functions, quality of life, behavior, and psychological well-being in individuals with dementia \[3; 4\]. However, the FEATS scale is rarely used to assess emotional state changes. Although psycho-emotional issues are highly relevant and widely studied, relatively few studies explore these within the context of art therapy. Most existing research is qualitative, with a lack of quantitative studies.
The novelty of this planned study lies not only in the specificity of the participants but also in the application of the FEATS scale. While FEATS is widely used in research, few studies apply this instrument to explore the psycho-emotional state of people with dementia syndrome. The scale's authors and other researchers recommend expanding its use across diverse populations to assess its validity for different patient groups \[10; 21\].
This study will help reveal the effectiveness of art therapy as a non-invasive and non-pharmacological intervention for improving the psycho-emotional state of individuals with dementia syndrome. The research findings will contribute positively to patient well-being and the advancement of nursing science. Art therapy sessions are expected to improve participants' emotional state and reduce signs of anxiety, depression, and stress. This will provide scientific evidence of the effectiveness of art therapy and allow for the validation of the FEATS scale for assessing the psycho-emotional state of people with dementia syndrome.
diagnosed with dementia;
MMSE ≥11 (mild to moderate cognitive impairment);
stable somatic condition;
vision and hearing sufficient to assess cognitive function and to administer interventions;
MMSE < 11 points (severe cognitive impairment);
chronic, unstable somatic conditions;
Inability to comprehend the tasks;
Lack of knowledge of the Lithuanian language;
Single group
Art Therapy
BehavioralArt Therapy Session Plan The sessions are designed to stimulate positive feelings, satisfaction, and calmness while reducing social isolation and fostering group connections. The focus will be on pleasant experiences and positive life moments, with an emphasis on identifying current strengths and capabilities. Every session begins with a sharing activity: "Name three good things that happened this morning" or "Name three things you are grateful for today." Session Structure: Mood check-in → Warm-up task → Main task → Reflection → Mood check-out.
Depression, Anxiety, and Stress Scales (DASS-21)
The DASS-21 is intended to evaluate the severity of depression, anxiety, and stress. It consists of 21 statements divided into three subscales. Each subscale contains seven items grouped by similar content. The depression subscale measures dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia, and inertia. The anxiety subscale assesses autonomic arousal, physiological responses, situational anxiety, and subjectively experienced anxiety. The stress subscale evaluates difficulty relaxing, nervous tension, sudden sadness, irritability, and excessive reactivity or impatience. The reliability of the Lithuanian version of the DASS-21 is sufficient, making it suitable for use with the Lithuanian population. Each item is scored from 0 (no symptom) to 3 (very strong expression of the symptom). Subscale scores are calculated by summing the scores of the respective items.
Formal Elements Art Therapy Scale (FEATS)
The FEATS scale evaluates the formal elements of two-dimensional artwork (drawing and painting). It is based on the drawing "Person Picking an Apple from a Tree." Fourteen variables are assessed: color prominence, color fit, energy, space, integration of objects, logic, realism, problem-solving, developmental level, detail of objects and environment, line quality, human figure, position, rotation, and unconscious repetitive motion. Each variable is rated on a Likert scale from 0 to 5. Evaluation is based on structure rather than content, and the FEATS manual outlines specific criteria for each variable. Each drawing variable is linked to clinical symptoms, supported by three sources: * DSM symptoms that may have graphical correlates in drawings. * Literature in art therapy and psychology analyzing spontaneous and directive drawings. * Clinical observations of adult psychiatric patients' "Person Picking an Apple from a Tree" drawings.
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