Impact of a Combined Rehabilitation and Animal-Assisted Therapy Approach on the Recovery of Motor Abilities in Patients With Dementia Hospitalized in a Medical and Rehabilitation Care Unit

1. Background and Rationale Dementia is a progressive syndrome characterized by cognitive decline beyond what is expected from normal aging, affecting memory, reasoning, orientation, comprehension, language, and judgment. According to the World Health Organization (WHO), approximately 50 million people worldwide are affected by dementia, with an estimated 10 million new cases per year. This figure is projected to reach 152 million by 2050, making dementia care a major global public health challenge.

Current pharmacological treatments for managing behavioral and psychological symptoms of dementia (BPSD) demonstrate limited efficacy and carry significant adverse effects. French health authorities (Haute Autorité de Santé, HAS) therefore recommend prioritizing non-pharmacological interventions (NPIs) as first-line approaches for symptom management. 2. Rationale for the Intervention Animal-Assisted Therapy (AAT) is a targeted, structured therapeutic intervention involving the introduction of trained animals into clinical care, delivered by qualified health professionals with documented assessment of participant progress. Based on the International Association of Human-Animal Interaction Organizations (IAHAIO) definition, AAT is a goal-directed intervention designed to promote therapeutic benefits in human health by introducing animals into care. It emphasizes improvement of physical, cognitive, behavioral, and/or socio-emotional functioning.

While AAT has been used since the 18th century, its scientific evidence base for dementia populations remains limited. A 2019 systematic review (Lai et al., Cochrane Database) identified only 9 eligible studies (6 RCTs, 2 cluster RCTs, 1 crossover RCT), showing that AAT may slightly reduce depressive symptoms in dementia patients, while evidence for effects on other outcomes (quality of life, other BPSD) remains inconclusive. Positive effects on agitation, depression, quality of life, and balance have been observed, but no study has specifically addressed the recovery of motor abilities in demented patients in a rehabilitation setting.

Since October 2021, the Institut Médical de Sologne (IMDS) has integrated AAT into the care program of elderly patients with dementia hospitalized in its geriatric medical and rehabilitation care unit (SMR). Clinical observation showed that patients resistant to or disengaged from standard rehabilitation became more accessible and demonstrated previously unseen motor capacities when in contact with trained animals. The therapeutic alliance between the nurse-animal therapist, psychomotor therapist, and nursing assistant appeared to facilitate patient engagement, improve therapeutic compliance, and unlock motor potential.

This exploratory pilot study aims to formally and objectively measure the impact of this combined approach on motor recovery. 3. Study Design RÉMÉDI-A is a prospective, single-center, cluster-randomized, open-label pilot study conducted in the geriatric SMR ward of the Institut Médical de Sologne (IMDS), 1 rue Cécile Boucher, 41600 Lamotte-Beuvron, France.