The Four-Legged Therapist

How assistance dogs help people living with dementia, their care partners and families.

This article was written by a guest contributor, and the views, thoughts and opinions expressed in this article belong solely to the author.

Assistance dogs come in all shapes and sizes. Most of us are familiar with guide dogs helping visually impaired people go about their daily lives. We may have encountered hearing dogs alerting individuals who are deaf or hard of hearing to specific sounds, or service dogs trained to help with mobility or medical issues.

ADI certified dementia dogs

However, dementia dogs are a relatively new addition to the family and are still fairly uncommon. Assistance Dogs International (ADI) — the world’s leading accreditation and standards-setting body for assistance dogs — has just four programs specializing in dementia dogs, out of more than 150 members worldwide.

ADI logo, courtesy of ADI.

Although the idea of using dogs to support people living with neurodegenerative diseases isn’t new, it wasn’t until 2011 that researchers and dog training experts came together to create the Dementia Dog Project in Glasgow, Scotland — the world’s first dementia dog pilot. A group of third-year design students from the Glasgow School of Art were commissioned by the Alzheimer Scotland charity “to create new design concepts that could help people to live well with dementia” and to lead more fulfilling and active lives at home and in their local communities.

From the start, the students realized their new service for people living with dementia had to be person-centred, take account of caregivers and include an adaptable solution which could support users as their dementia progressed. The result was a charitable collaboration between Alzheimer Scotland and ADI accredited member, Dogs for Good. In another groundbreaking innovation, the dogs are trained by inmates at an open prison in Scotland as part of their rehabilitation.

In addition to Dogs for Good in the United Kingdom, ADI also accredits dementia dogs’ programs in the United States, Germany and New Zealand. Training techniques vary from program to program, but they all adhere to the same high standards as guide dogs, hearing dogs and other types of service dogs to ensure they not only provide the best support for their users but are safe and well-behaved in public.

Dementia dog Hope with Ann and John. ©

Given the ever-increasing demand for assistance dogs of every type, there are long waiting lists for ADI certified dementia dogs — and they can cost up to US$50,000 to train. What’s more, not all dogs working with persons living with dementia are ADI certified, and they cover a wide range of support including family dogs, therapy dogs, community dogs, emotional support dogs and even online dogs!

ADI understands that such dogs are incredibly important for many people and that they play a valuable role in supporting people living with dementia, their families and caregivers — but most of them will not have been trained to ADI’s rigorous standards, which include a thorough process to ensure they are carefully matched with individuals and their families. Once a match is identified there will be many visits to build an accurate insight into individual needs, daily routine and the different environments in which the dog will live and work.

"Stroking or cuddling a dog releases endorphins and other hormones such as oxytocin, prolactin and dopamine."

– Chris Diefenthaler, Executive Director, Assistance Dogs International

How dementia dogs can provide support

Sometimes known as ‘four-legged therapists’, dementia dogs help people living with the condition in a variety of ways.

Dementia dog Lenny with Jon and Jeannette. ©

On the practical level, they can collect and deliver a medication bag or water bottle, respond to alarms to get a person to rehydrate or to take medication, and to get out of bed in the morning or remember to eat.

As people living with dementia are frequently restless or prone to wandering, the dogs are also taught to ‘anchor’ — to sit and stay next to their users and encourage them to stay sitting down too. For example, ADI member Paws4People, based in Wilmington, N.C., trains Neurological Assistance Dogs specially for individuals with developmental disabilities, including dementia. The dogs are specifically trained to convey pressure and receive pressure, to alert or distract from their handler’s vocal, movement or motor tics, and to alert someone nearby if their handler leaves a designated area.

The COVID-19 pandemic has shown how easy it is for people living with a disability — especially those who live with neurodegenerative diseases — to become lonely and isolated. Research suggests that for individuals living with dementia Animal Assisted Therapy (AAT) can boost physical activity and relieve agitation, restlessness, disorientation and aggressive behaviour. It can also improve short-term memory and communication skills, enhance eating habits and reduce loneliness.

Dementia dog Ruby with Peter and Veryan. ©

Studies have shown that stroking or cuddling a dog releases endorphins and other hormones such as oxytocin, prolactin and dopamine. In a separate study researchers found that persons in an Alzheimer’s special care unit exhibited fewer behavioural problems after a resident dog was introduced.

On an emotional level, dementia dogs are all selected for their affectionate and calming nature and are trained in methods to reduce anxiety, such as placing their head on their owner’s knees. Another ADI accredited member, VITA-Assistenzhunde, based in Hümmerich, Germany, has discovered that dogs can often find a way to connect with people who have withdrawn into their own world from which caregivers and family members may be excluded.

Dogs express their affection directly by wagging their tails or nudging gently — and they react to touch, gestures, eye contact and other non-verbal signals. They intuitively capture moods and feelings, enabling dogs and humans to communicate on a deep emotional level that transcends neurodegenerative disease.

Dementia dog Hope with Ann and family. ©

Dementia dogs can also trigger desire both to care and be cared for — a need which is deeply anchored in the memory. According to VITA-Assistenzhunde, “The experience of being needed, being important and having a meaningful task strengthens the self-esteem of those affected and encourages them to work.” Assistance dogs can awaken memories, strengthen bonds to reality and become anchors in a world that is becoming increasingly foreign. “For caregivers, such a dog can be a key to the world of dementia patients.”

Assistance dogs are not a cure for neurodegenerative diseases, but they can help ease the impact for people living with them, families, caregivers and communities. Dementia dogs don’t judge, don’t criticize, don’t get bored if a person keeps repeating the same thing or irritated with continually picking up dropped items. A dog’s affection is unbiased, honest and unconditional.

As the family of one participant puts it: “A dementia dog provides a much needed constant during a time of shifting sands. We really can’t imagine life without her, and our lives would be a lot darker.”


Discover more about ADI or search for an assistance dog near you.


As Executive Director, Chris Diefenthaler has overall responsibility for the operations and programs of Assistance Dogs International (ADI). Based in Toledo, Ohio, she joined ADI in 2017 following 25 years in the non-profit sector, which included spells with the American Red Cross and Assistance Dogs of America. Chris has a black Labrador named Tori and a bad-tempered orange tabby cat called Scout.