**5. Conclusions**

This study systematically reviewed, compared, and meta-analyzed the impact of AAI and PRI on agitation, depression, and QOL in dementia patients. Interventions involving both living and robotic animals were investigated. The meta-analysis revealed that AAI and PRI interventions significantly reduced depression but did not affect agitation or QOL. Comparison of AAI and PRI showed that each method has its benefits and shortcomings and indicated that the two methods could potentially complement each other. Interventions involving living animals had a more beneficial effect on the emotional wellbeing of dementia patients than PRI. Although robotic animals overcome some limitations of living animals, they were not shown to alleviate BPSD in this study. In the future, more research should be conducted on the impact of living and robotic animals on the emotional

wellbeing, cognitive function, and physical ability of dementia patients. Furthermore, we hope that AAI and PRI, which have been found to effectively reduce depression in dementia patients based on follow-ups, are more commonly utilized in clinical practice.

**Author Contributions:** Conceptualization, M.M. and D.-H.Y.; data curation, S.P. and A.B.; formal analysis, S.K. and Y.N.; funding acquisition, M.M. and D.-H.Y.; investigation, S.P. and A.B.; methodology S.P., A.B. and S.K.; project administration, M.M. and D.-H.Y.; resources, A.B. and S.K.; software, S.P. and D.-H.Y.; supervision, M.M. and D.-H.Y.; validation, S.K. and H.s.K.; visualization, S.K., Y.N. and H.s.K.; roles/writing—original draft, S.P., A.B., and S.K.; writing—review and editing, M.M. and D.-H.Y. All authors have read and agreed to the published version of the manuscript.

**Funding:** This work was supported by the Basic Science Research Program of the National Research Foundation of Korea (NRF), which is funded by the Ministry of Science, ICT & Future Planning (NRF-2018R1D1A3B07041059 to M.M.; NRF-2019R1G1A1004010 to D.-H.Y.) and by the Cooperative Research Program for Agriculture Science and Technology Development (Project No. PJ01319901 and PJ01428603), Rural Development Administration, Republic of Korea.

**Conflicts of Interest:** The authors declare no conflicts of interest.
