Music therapy in dementia: a narrative synthesis systematic review

Findings From a Prospective Randomized Controlled Trial of an Individualized Music Listening Program for Persons With Dementia

Music & Memory (M&M) is a passive music intervention that uses personalized music playlists delivered on digital music players. This program has been increasingly adopted in nursing homes across the United States to facilitate communication, engagement, and socialization among persons with dementia (PWDs); however, few studies have evaluated the program's effect on PWDs' outcomes. In the present study, a randomized controlled crossover design was used to examine the impact of the M&M program on 59 PWDs in 10 nursing homes over a 14-week period. Residents' evaluated outcomes included agitation, behavioral symptoms, and use of psychotropic medications. Although trends supported the positive effects of M&M, no statistically significant differences were found in any of the outcomes measured over time. Methodological limitations withstanding, these findings call into question the effectiveness of the M&M program and the ability of facility staff to implement this intervention with fidelity.

The Use of Music Playlists for People with Dementia: A Critical Synthesis

The use of pre-recorded music to ease behavioral and psychological symptoms associated with dementia is popular in health-care contexts in both formal music therapy settings and in non-therapist led interventions. However, further understanding of how non-therapist led interventions compare to therapist led interventions is needed. This paper reviews 28 studies that used pre-recorded music with people with dementia using a critical interpretive synthesis model. Results revealed that pre-recorded music can be effective in reducing a variety of affective and behavioral symptoms, in particular agitation, even where a trained music therapist is not present. However, the results are not universally positive, suggesting the need for further clarification of protocols for music use and closer investigation of variables that influence individual responseto music.

Combining music and life story to enhance participation in family interaction in semantic dementia: a longitudinal study of one family's experience

Background

Semantic dementia is a rarer dementia, classified as a type of frontotemporal dementia and a variant of primary progressive aphasia. Studies examining conversation in this condition and interventions to enhance participation in family life present as gaps in the research literature.

Methods

Working with one family on a longitudinal basis, this study used conversation analysis and narrative analysis to provide a detailed assessment of communication. This information was used to design an individually tailored life story intervention to facilitate family interaction: a co-produced life story music DVD.

Results

This intervention offered the family a resource that allowed the person with semantic dementia to display areas of retained competence and enhanced participation in interaction in a way that was not typically present in everyday conversation.

Conclusions

It is argued that fostering greater opportunities for such in-the-moment connections is an important goal for intervention, particularly when language may be significantly compromised.

The biological impact of listening to music in clinical and nonclinical settings: A systematic review

This systematic review explored the evidence base on the impact of listening to music on biological response in both clinical and nonclinical settings. Human studies exploring the effects of listening to recorded music on biological markers were included. Studies had to involve a non-music control condition. Keyword searches were carried out of five major databases (Cochrane/Wiley, PsycINFO, PubMed, Sage, and Science Direct) and bias was assessed using the Cochrane Risk of Bias Tool for Randomized Studies (RoB 2.0). Forty-four studies assessing the biological impact of music listening were identified: 27 in clinical settings and 17 in nonclinical settings. Eighty-two percent had examined the effects of short-term listening interventions, while the remainder had looked at longitudinal interventions. Thirteen of 33 biomarkers tested were reported to change in response to listening to music. The most commonly analyzed biomarker was the stress hormone cortisol, with half of clinical studies demonstrating a stress-reducing effect of music listening. Blood glucose was also found repeatedly to reduce in response to music listening. Many of the other biomarkers analyzed are also part of biological stress pathways, which suggests that the primary way by which music listening affects us biologically is via modulations of stress response. Effects were shown irrespective of genre, self-selection of the music, or duration of listening, although a majority did use classical music. The evidence base for understanding biological responses to music is still developing, but there is support for the application of listening to music, especially within clinical settings for stress reduction.

Understanding the Experience of Group Singing for Couples Where One Partner Has a Diagnosis of Dementia

Purpose of Study

There is a continuing interest around the use of group singing in dementia care. Although studies generally indicate positive outcomes, limited research has been carried out from a relational perspective, which places the couple relationship in a central position. This study aimed to better understand how group singing benefits people with dementia and their partners.

Design and Methods

Interview data from 17 couples (N = 34) with one member having dementia, who participated in a range of different types of singing groups, were analyzed using grounded theory methodology.

Results

Five key areas were identified, resulting in the development of the group singing model in dementia for couple dyads. Group singing was experienced as being both joyful and accessible. The accessibility of singing, combined with effective facilitation, created an environment for active participation and enjoyment. The group effect mediated further benefits for the person with dementia and for the caregiver which, when combined, increased benefits for the couple through participation in new experiences.

Implications

An opportunity for couples to share in-the-moment creative expression and the positive affect of artistic creation circumventing cognitive impairment is likely to contribute positively to the experience of the relationship. A more refined understanding of shared creative processes in relationship-centered models of care could inform dementia support services. Future research would benefit from longitudinally exploring the links between creativity in couples and relationship resilience.

The impact of a visual arts program on quality of life, communication, and well-being of people living with dementia: a mixed-methods longitudinal investigation

ABSTRACTBackground:Research reviews highlight methodological limitations and gaps in the evidence base for the arts in dementia care. In response, we developed a 12-week visual art program and evaluated the impact on people living with dementia through a mixed-methods longitudinal investigation.

METHODS

One hundred and twenty-five people living with mild to severe dementia were recruited across three research settings in England and Wales (residential care homes, a county hospital, and community venues). Quantitative and qualitative data on quality of life (QoL), communication and perceptions of the program were obtained through interviews and self-reports with participants and their carers. Eight domains of well-being were measured using a standardized observation tool, and data compared to an alternative activity with no art.

RESULTS

Across all sites, scores for the well-being domains of interest, attention, pleasure, self-esteem, negative affect, and sadness were significantly better in the art program than the alternative condition. Proxy-reported QoL significantly improved between baseline and 3-month follow-up, but no improvements in QoL were reported by the participants with dementia. This was contrasted by their qualitative accounts, which described a stimulating experience important for social connectedness, well-being, and inner-strength. Communication deteriorated between baseline and follow-up in the hospital setting, but improved in the residential care setting.

CONCLUSIONS

The findings highlight the potential for creative aging within dementia care, the benefits of art activities and the influence of the environment. We encourage dementia care providers and arts and cultural services to work toward embedding art activities within routine care provision.

The effects of the music-with-movement intervention on the cognitive functions of people with moderate dementia: a randomized controlled trial

OBJECTIVE

The aim of this study was to examine the effects of the six-week music-with-movement (MM) intervention, as compared with music listening (ML) and social activity (SA), on the cognitive functions of people with moderate dementia over time.

METHODS

A multi-center randomized controlled trial was conducted on 165 nursing home residents with moderate dementia. The MM intervention protocol was developed based on a critical literature review, and tested in three rounds of pilot studies before undergoing testing in this study. The participants were randomly allocated into three groups. Intervention participants (n = 58) received a 12-week MM program led by a trained health care professional, while the participants in the comparison ML group (n = 54) listened to their preferred music, and those in the SA group (n = 53) engaged in social chatting. Cognitive functions, depressive symptoms, and anxiety were measured at baseline, the sixth week, and six weeks post-intervention.

RESULTS

Greater improvements in memory and depressive symptoms for the MM group were revealed in the univariate analysis and pairwise comparisons. The effects on memory could last for at least six weeks post-intervention. However, a mixed multivariate analysis of variance (MANOVA) analysis indicated that there were no significant interactions of group by time effect Conclusion: The findings revealed that the MM intervention may be useful for enhancing the cognitive functions of people with dementia. However, there is insufficient evidence to show that the effects of the MM intervention on outcome variables over time significantly different from those observed among the comparison groups.

Assessing a cognitive music training for older participants: a randomised controlled trial

OBJECTIVES

In a randomised controlled trial, we investigated whether a cognitive training based on rhythm-music and music improvisation exercises had positive effects on executive functions in older participants.

METHODS

Thirty-five residents in a guest home with mild-moderate cognitive impairment and healthy ageing were randomly assigned to an experimental group (n = 18) featuring cognitive music training composed of 12 bi-weekly 70-min sessions, and a control group (n = 17) attended 12 bi-weekly 45-min sessions of gymnastic activities offered by the institute. A neuropsychological test battery was administered at baseline and at the end of treatment, including the Mini-Mental State Examination, verbal fluency test, Trail Making Test A, attentional matrices test and clock-drawing test.

RESULTS

Pre-test and post-test comparison showed a significant improvement for the experimental group reflected in the Mini-Mental State Examination (F(1,33) = 13.906; p < 0.001; pη²  = 0.296), verbal fluency test (VFL) (F(1,33) = 6.816; p < 0.013; pη²  = 0.171), and clock-drawing test (F(1,29) = 16.744; p < 0.001; pη²  = 0.366), while the control group did not show any significant improvements. In addition, there was a tendency towards significance for the Trail Making Test A (F(1,20) = 3.268; p < 0.086; pη²  = 0.140). Regarding the attentional matrices test, no significant differences were found for the experimental group (F(1,29) = 2.833; p < 0.103; pη²  = 0.089), while the control group had a significant performance reduction (F(1,29) = 3.947; p < 0.050; pη²  = 0.120).

CONCLUSION

The use of a cognitive protocol based on music-rhythmic exercises and music improvisation exercises is associated with improved cognitive functions in older people with mild-moderate cognitive impairment regardless of the individual's degree of cognitive reserve. Copyright © 2017 John Wiley & Sons, Ltd.

Individualized Music Program is Associated with Improved Outcomes for U.S. Nursing Home Residents with Dementia

OBJECTIVES

The objective of this study was to compare resident outcomes before and after implementation of an individualized music program, MUSIC & MEMORY (M&M), designed to address the behavioral and psychological symptoms associated with dementia (BPSD).

SETTING

98 nursing homes trained in the M&M program during 2013 and 98 matched-pair comparisons.

PARTICIPANTS

Long-stay residents with Alzheimer's disease and related dementias (ADRD) residing in M&M participating facilities (N = 12,905) and comparison facilities (N = 12,811) during 2012-2013.

INTERVENTION

M&M is a facility-level quality improvement program that provides residents with music specific to their personal histories and preferences.

MEASUREMENTS

Discontinuation of anxiolytic and antipsychotic medications, and reductions in behavioral problems and depressed mood in 2012 (pre-intervention) and 2013 (intervention), calculated using Minimum Data Set (MDS) assessments.

RESULTS

The proportion of residents who discontinued antipsychotic medication use over a 6-month period increased from 17.6% to 20.1% among M&M facilities, while remaining stable among comparison facilities (15.9% to 15.2%). The same trend was observed for anxiolytic medications: Discontinuation of anxiolytics increased in M&M facilities (23.5% to 24.4%), while decreasing among comparison facilities (24.8% to 20.0%). M&M facilities also demonstrated increased rates of reduction in behavioral problems (50.9% to 56.5%) versus comparison facilities (55.8% to 55.9%). No differences were observed for depressed mood.

CONCLUSIONS

These results offer the first evidence that the M&M individualized music program is associated with reductions in antipsychotic medication use, anxiolytic medication use, and BPSD symptoms among long-stay nursing home residents with ADRD.

Effect of wearing fingers rings on the behavioral and psychological symptoms of dementia: An exploratory study

Objective:

This study was conducted to examine the effects of an approach that wears finger rings on elderly females with behavioral and psychological symptoms of dementia.

Method:

The subjects were seven Japanese dementia patients living in elderly nursing homes. A single-case experimental design was adopted for the study. Each study subject was asked to put rings on her finger (from 9:00 to 19:00) for 7 days. The Neuropsychiatric Inventory, scenes of behavioral and psychological symptoms of dementia, interest in wearing rings, self-awareness, and overall profile were determined to assess the effect on the patients of wearing rings.

Results:

The majority of nursing care providers stated, based on their assessment, that the “irritability/lability” that was noted during the baseline period disappeared during the ring-wearing intervention period in the three patients who displayed an interest in rings. In the assessment of the self-awareness ability, these three women were aware themselves of their intellect collapsing and were capable of conjecturing their own and others’ minds. It was commonly seen that the nursing staff, even though they had not been asked to do so by the researchers, told the patients, “Mrs. XX, you look so beautiful” when they found a patient wearing rings.

Discussion/conclusion:

Individuals with low self-esteem are inclined to get angry and display aggression. In subjects with low self-esteem, anger and aggression readily arise when they are slighted by others. Self-esteem is low in those women who are aware of their own status of collapsing intellect. It is concluded that the words of conjuration, “you look so beautiful,” which the wearing of the ring per se by the patient elicited from the caregivers heightened the self-esteem and alleviated “irritability/lability” in the study subjects.

Music-based therapeutic interventions for people with dementia

BACKGROUND

Dementia is a clinical syndrome with a number of different causes which is characterised by deterioration in cognitive, behavioural, social and emotional functions. Pharmacological interventions are available but have limited effect to treat many of the syndrome's features. Less research has been directed towards non-pharmacological treatments. In this review, we examined the evidence for effects of music-based interventions as a treatment.

OBJECTIVES

To assess the effects of music-based therapeutic interventions for people with dementia on emotional well-being including quality of life, mood disturbance or negative affect, behavioural problems, social behaviour, and cognition at the end of therapy and four or more weeks after the end of treatment.

SEARCH METHODS

We searched ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG) on 14 April 2010 using the terms: music therapy, music, singing, sing, auditory stimulation. Additional searches were also carried out on 3 July 2015 in the major healthcare databases MEDLINE, Embase, psycINFO, CINAHL and LILACS; and in trial registers and grey literature sources. On 12 April 2016, we searched the major databases for new studies for future evaluation.

SELECTION CRITERIA

We included randomized controlled trials of music-based therapeutic interventions (at least five sessions) for people with dementia that measured any of our outcomes of interest. Control groups either received usual care or other activities.

DATA COLLECTION AND ANALYSIS

Two reviewers worked independently to screen the retrieved studies against the inclusion criteria and then to extract data and assess methodological quality of the included studies. If necessary, we contacted trial authors to ask for additional data, including relevant subscales, or for other missing information. We pooled data using random-effects models.

MAIN RESULTS

We included 17 studies. Sixteen studies with a total of 620 participants contributed data to meta-analyses. Participants in the studies had dementia of varying degrees of severity, but all were resident in institutions. Five studies delivered an individual music intervention; in the others, the intervention was delivered to groups of participants. Most interventions involved both active and receptive musical elements. The methodological quality of the studies varied. All were at high risk of performance bias and some were at high risk of detection or other bias. At the end of treatment, we found low-quality evidence that music-based therapeutic interventions may have little or no effect on emotional well-being and quality of life (standardized mean difference, SMD 0.32, 95% CI -0.08 to 0.71; 6 studies, 181 participants), overall behaviour problems (SMD -0.20, 95% CI -0.56 to 0.17; 6 studies, 209 participants) and cognition (SMD 0.21, 95% CI -0.04 to 0.45; 6 studies, 257 participants). We found moderate-quality evidence that they reduce depressive symptoms (SMD -0.28, 95% CI -0.48 to -0.07; 9 studies, 376 participants), but do not decrease agitation or aggression (SMD -0.08, 95% CI -0.29 to 0.14; 12 studies, 515 participants). The quality of the evidence on anxiety and social behaviour was very low, so effects were very uncertain. The evidence for all long-term outcomes was also of very low quality.

AUTHORS' CONCLUSIONS

Providing people with dementia with at least five sessions of a music-based therapeutic intervention probably reduces depressive symptoms but has little or no effect on agitation or aggression. There may also be little or no effect on emotional well-being or quality of life, overall behavioural problems and cognition. We are uncertain about effects on anxiety or social behaviour, and about any long-term effects. Future studies should employ larger sample sizes, and include all important outcomes, in particular 'positive' outcomes such as emotional well-being and social outcomes. Future studies should also examine the duration of effects in relation to the overall duration of treatment and the number of sessions.

Exploring the impact of music concerts in promoting well-being in dementia care

OBJECTIVES

This study explores the specific effects of live music concerts on the clients with dementia, their families and nursing staff/caregivers.

METHODS

Researchers attended 22 concerts in care facilities in England and Japan. Interviews were carried out with clients with dementia, nursing staff and family members. Observations were also carried out before, during and after the concerts. All observations were recorded in field notes.

RESULTS

The effect of the concerts in both countries was seen to be beneficial to all clients and nursing staff, whether or not they attended the concert. Interviews with clients with mild to mid-stage dementia noted increased levels of cooperation, interaction and conversation. Those with more advanced forms of dementia exhibited decreased levels of agitation and anti-social behaviour. Staff members reported increased levels of care, cooperation and opportunities for assessment. Family members noted an increase in the levels of well-being in their partner/parent as well as in themselves. The study also suggested that the knowledge of musical components, an awareness of the rules of music and specific musical preferences appear to remain well beyond the time when other cognitive skills and abilities have disappeared.

CONCLUSIONS

This initial study provided some further indication in terms of the uses of music as a non-pharmacological intervention for those living with all stages of dementia. These included opportunities for assessment of physical abilities as well as facilitating an increasing level of care.

Complementary medicine for treatment of agitation and delirium in older persons: a systematic review and narrative synthesis

BACKGROUND

Agitation and delirium frequently occur in cognitively impaired older people. We conducted a systematic review with narrative synthesis of the literature aiming to assess effectiveness of complementary and alternative medicine (CAM) modalities to address these conditions.

METHODS

Following preliminary search, we included 40 original researches on CAM treatment of delirium and agitation in older persons. Then, the quality of these studies was assessed using the Downs and Black Checklist and Quality Assessment Tool for Studies with Diverse Designs, and the effect sizes were calculated. We subsequently conducted a narrative synthesis of the main findings, including theory development, preliminary synthesis, exploration of relationships within and between studies, and assessment of synthesis robustness.

RESULTS

Forty articles that met the inclusion criteria were analyzed. Sixteen of these were randomized controlled trials. One article specifically addressed CAM treatment of delirium in patients without dementia, and the remaining 39 articles described treatments of agitated older persons with dementia. Thirty-five of the 40 included studies suggested that the investigated CAM therapies may ameliorate the severity of agitation and delirium. The physiological surrogates of agitation assessed in these studies included cortisol level, chromogranin A level, and heart rate variability. Very few of the studies systematically assessed safety issues, although no major adverse effects were reported.

CONCLUSION

Overall, the systematic review of the literature suggests that several CAM modalities are potentially beneficial in the treatment of agitation and delirium among older persons. We suggest that promising CAM modalities should be further explored through large-scale randomized controlled trials in different clinical settings. Copyright © 2017 John Wiley & Sons, Ltd.

Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series

OBJECTIVE

To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD).

DESIGN

Systematic overview of reviews.

DATA SOURCES

PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009-March 2015).

ELIGIBILITY CRITERIA

Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD.

DATA EXTRACTION

Eligible studies were selected and data extracted independently by 2 reviewers.The AMSTAR checklist was used to assess the quality of the SRs.

DATA ANALYSIS

Extracted data were synthesised using a narrative approach.

RESULTS

38 SRs and 129 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (25 SRs, 66 primary studies) that encompassed: shiatsu and acupressure, aromatherapy, massage/touch therapy, light therapy, sensory garden and horticultural activities, music/dance therapy, dance therapy, snoezelen multisensory stimulation therapy, transcutaneous electrical nerve stimulation; (2) cognitive/emotion-oriented interventions (13 SRs; 26 primary studies) that included cognitive stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 22 primary studies); (4) Multicomponent interventions (3 SR; four primary studies); (5) other therapies (5 SRs, 15 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions.

CONCLUSIONS

A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.

“Music in Mind” and Manchester Camerata: an exploratory qualitative evaluation of engagement in one care home in Northwest England

Purpose

The purpose of this paper is to consider the work conducted by Manchester Camerata (an internationally renowned and world-class chamber orchestra) programme for people with dementia in one care home in the north west of England. The study aim was to undertake an exploratory qualitative evaluation of experiences of those taking part in its ten week “Music in Mind” programme, namely care home staff, Manchester Camerata musicians/organisational staff, care home activity workers, the assigned music therapist and visiting family carers.

Design/methodology/approach

During July-September 2014 a sample of 11 participants was recruited and a total of 19 interviews conducted over ten weeks. All respondents were offered the opportunity to be interviewed more than once. Interview data were supplemented by information gathered at two musicians de-brief sessions and from two activity workers’ diaries. All data was organised using NVivo 10 and thematic analysis applied to the whole data set. People with dementia could not be included in the sample owing to the time limitations on starting and completing the evaluation.

Findings

This analytical process generated three overarching themes: Making it Happen, which referred to the contextual, structural and organisational considerations necessary for setting up the engagement programme; Orchestrating Person-centred Care, which addressed the importance of building relationships through person to person communication; Making Musical Connections, which identified the sensory and embodied qualities of live music and the need to capture in-the-moment experiences.

Originality/value

Whilst each of these theme headings has slightly different meanings and applications to each of the participating stakeholders, the evaluation highlights the potential power of improvised music making to equalise and harmonise the group dynamics by co-creating “in-the-moment” experiences.

Developing relationships between care staff and people with dementia through Music Therapy and Dance Movement Therapy: A preliminary phenomenological study

Background There is an increasing focus on providing effective psychosocial interventions to improve quality of life in dementia care. This study aims to explore the attitudes and perceptions of staff who participated regularly in Music Therapy (MT) and Dance Movement Therapy (DMT) groups for residents with dementia in a nursing home. Method In-depth interviews were conducted with seven members of care home staff. Data were analysed using interpretative phenomenological analysis. Results A representation modelling the impact of MT and DMT in a nursing care home. Three main themes were identified. 1) Discovering residents' skills and feelings; 2) Learning from the therapists to change approaches to care practice with subthemes: time, space and pace, choice, following the residents' lead; 3) Connection between staff and residents. Conclusion The model indicated that both interventions performed in parallel helped staff to discover residents' skills and feelings. Although it is a small sample size, this study strongly suggests that MT and DMT can have a positive influence in helping care staff to provide a meaningful care environment.

Measuring engagement with music: development of an informant-report questionnaire

OBJECTIVES

This study describes the development of the Music Engagement Questionnaire (MusEQ), a 35-item scale to measure engagement with music in daily life. Music has implications for well-being and for therapy, notably for individuals living with dementia. A number of excellent scales or questionnaires are now available to measure music engagement. Unlike these scales, the MusEQ may be completed by either the participant or an informant.

METHOD

Study 1 drew on a community-based sample of 391 participants. Exploratory factor analysis revealed six interpretable factors, which formed the basis for construction of six subscales. Study 2 applied the MusEQ to a group of participants with Alzheimer's disease (AD; n = 16) as well as a group of neurotypical older adults (OA; n = 16). Informants completed the MusEQ, and the OA group also completed the self-report version of the MusEQ. Both groups had an interview in which they described the place music had in their lives. These interviews were scored by three independent raters.

RESULTS

The MusEQ showed excellent internal consistency. Five of the factor-derived subscales showed good or excellent internal consistency. MusEQ scores were moderately correlated with a global rating of 'musicality' and with music education. There was strong agreement between self-report and informant-report data. MusEQ scores showed a significant positive relationship to independent ratings of music engagement.

CONCLUSION

The MusEQ provides a meaningful and reliable option for measuring music engagement among participants who are unable to complete a self-report questionnaire.

Music therapy and Alzheimer's disease: Cognitive, psychological, and behavioural effects

INTRODUCTION

Music therapy is one of the types of active ageing programmes which are offered to elderly people. The usefulness of this programme in the field of dementia is beginning to be recognised by the scientific community, since studies have reported physical, cognitive, and psychological benefits. Further studies detailing the changes resulting from the use of music therapy with Alzheimer patients are needed.

OBJECTIVES

Determine the clinical improvement profile of Alzheimer patients who have undergone music therapy.

PATIENTS AND METHODS

Forty-two patients with mild to moderate Alzheimer disease underwent music therapy for 6 weeks. The changes in results on the Mini-mental State Examination, Neuropsychiatric Inventory, Hospital Anxiety and Depression Scale and Barthel Index scores were studied. We also analysed whether or not these changes were influenced by the degree of dementia severity.

RESULTS

Significant improvement was observed in memory, orientation, depression and anxiety (HAD scale) in both mild and moderate cases; in anxiety (NPI scale) in mild cases; and in delirium, hallucinations, agitation, irritability, and language disorders in the group with moderate Alzheimer disease. The effect on cognitive measures was appreciable after only 4 music therapy sessions.

CONCLUSIONS

In the sample studied, music therapy improved some cognitive, psychological, and behavioural alterations in patients with Alzheimer disease. Combining music therapy with dance therapy to improve motor and functional impairment would be an interesting line of research.

[Cognitive stimulation and music intervention for people with dementia in nursing homes: A pilot study, problems and perspectives]

BACKGROUND

Nonpharmacological interventions in people with dementia are becoming an increasingly important addition to pharmacological therapy. However, the current state of research in this field is limited.

OBJECTIVES

The aim of this pilot study was to evaluate the effects of a cognitive stimulation program and a music intervention program on cognitive function, quality of life and activities of daily living in persons with dementia residing in nursing homes. In addition, specific challenges of randomized controlled trials in nursing homes should be identified to define recommendations for further studies.

METHODS

Over a period of 6 weeks, 24 individuals with mild to moderate dementia were randomly allocated to participation in a cognitive stimulation program or in a music intervention. Each program consisted of twelve group-sessions of 90 min with two sessions per week. A neuropsychological test battery was performed before and after the training period.

RESULTS

There were no significant improvements on the group level. In fact, performance declined in some domains. Nonetheless, heterogeneous results were evident in both groups after analysis on a single-case approach and some persons significantly improved their performance.

CONCLUSION

At least on a single-case approach, the study provides additional support for the potential of nonpharmacological interventions. Future studies should target logistical aspects in nursing homes, realistic planning of sample size, formulating adequate inclusion and exclusion criteria, and choosing suitable neuropsychological tests.

Effect of Active Music Therapy and Individualized Listening to Music on Dementia: A Multicenter Randomized Controlled Trial

OBJECTIVES

To assess the effects of active music therapy (MT) and individualized listening to music (LtM) on behavioral and psychological symptoms of dementia (BPSDs) in persons with dementia (PWDs).

DESIGN

Randomized controlled trial.

SETTING

Nine Italian institutions.

PARTICIPANTS

Persons with moderate to severe dementia and BPSDs (N = 120) were randomized to one of three treatments.

INTERVENTIONS

All groups received standard care (SC), and two groups attended 20 individualized MT or LtM sessions, twice a week, in addition to SC.

MEASUREMENTS

The Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), and Cornell-Brown Scale for Quality of Life in Dementia (CBS-QoL) were administered before treatment, after treatment, and at follow-up to evaluate behavioral and psychological outcomes. A specific coding scheme (Music Therapy Check List-Dementia) was used to evaluate the MT process.

RESULTS

Behavioral assessment did not show significant differences between groups. All groups showed a reduction over time in NPI global score (P ≤ .001), CSDD (P = .001), and CBS-QoL (P = .01). The NPI global score fell 28% in the MT group, 12% in the LtM group, and 21% in the SC group at the end of treatment. An exploratory post hoc analysis showed similar within-group improvements for the NPI Delusion, Anxiety, and Disinhibition subscales. In the MT group, communication and relationships between the music therapists and PWDs showed a positive albeit nonsignificant trend during treatment.

CONCLUSION

The addition of MT or LtM to standard care did not have a significant effect on BPSDs in PWDs. Further studies on the effects of the integration of standard care with different types of music interventions on BPSD in PWD are warranted.

Music-induced emotions can be predicted from a combination of brain activity and acoustic features

It is widely acknowledged that music can communicate and induce a wide range of emotions in the listener. However, music is a highly-complex audio signal composed of a wide range of complex time- and frequency-varying components. Additionally, music-induced emotions are known to differ greatly between listeners. Therefore, it is not immediately clear what emotions will be induced in a given individual by a piece of music. We attempt to predict the music-induced emotional response in a listener by measuring the activity in the listeners electroencephalogram (EEG). We combine these measures with acoustic descriptors of the music, an approach that allows us to consider music as a complex set of time-varying acoustic features, independently of any specific music theory. Regression models are found which allow us to predict the music-induced emotions of our participants with a correlation between the actual and predicted responses of up to r=0.234,p<0.001. This regression fit suggests that over 20% of the variance of the participant's music induced emotions can be predicted by their neural activity and the properties of the music. Given the large amount of noise, non-stationarity, and non-linearity in both EEG and music, this is an encouraging result. Additionally, the combination of measures of brain activity and acoustic features describing the music played to our participants allows us to predict music-induced emotions with significantly higher accuracies than either feature type alone (p<0.01).

Music Therapy Using Singing Training Improves Psychomotor Speed in Patients with Alzheimer's Disease: A Neuropsychological and fMRI Study

Background/Aims

To investigate the effect of singing training on the cognitive function in Alzheimer's disease (AD) patients.

Methods

Ten AD patients (mean age 78.1 years) participated in music therapy using singing training once a week for 6 months (music therapy group). Each session was performed with professional musicians using karaoke and a unique voice training method (the YUBA Method). Before and after the intervention period, each patient was assessed by neuropsychological batteries, and functional magnetic resonance imaging (fMRI) was performed while the patients sang familiar songs with a karaoke device. As the control group, another 10 AD patients were recruited (mean age 77.0 years), and neuropsychological assessments were performed twice with an interval of 6 months.

Results

In the music therapy group, the time for completion of the Japanese Raven's Colored Progressive Matrices was significantly reduced (p = 0.026), and the results obtained from interviewing the patients' caregivers revealed a significant decrease in the Neuropsychiatric Inventory score (p = 0.042) and a prolongation of the patients' sleep time (p = 0.039). The fMRI study revealed increased activity in the right angular gyrus and the left lingual gyrus in the before-minus-after subtraction analysis of the music therapy intervention.

Conclusion

Music therapy intervention using singing training may be useful for dementia patients by improving the neural efficacy of cognitive processing.

Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study

Background

Previous research highlights the importance of staff involvement in psychosocial interventions targeting neuropsychiatric symptoms of dementia. Music therapy has shown potential effects, but it is not clear how this intervention can be programmed to involve care staff within the delivery of patients’ care. This study reports initial feasibility and outcomes from a five month music therapy programme including weekly individual active music therapy for people with dementia and weekly post-therapy video presentations for their carers in care homes.

Methods

17 care home residents and 10 care staff were randomised to the music therapy intervention group or standard care control group. The cluster randomised, controlled trial included baseline, 3-month, 5-month and post-intervention 7-month measures of residents’ symptoms and well-being. Carer-resident interactions were also assessed. Feasibility was based on carers’ feedback through semi-structured interviews, programme evaluations and track records of the study.

Results

The music therapy programme appeared to be a practicable and acceptable intervention for care home residents and staff in managing dementia symptoms. Recruitment and retention data indicated feasibility but also challenges. Preliminary outcomes indicated differences in symptoms (13.42, 95 % CI: [4.78 to 22.07; p = 0.006]) and in levels of wellbeing (−0.74, 95 % CI: [−1.15 to −0.33; p = 0.003]) between the two groups, indicating that residents receiving music therapy improved. Staff in the intervention group reported enhanced caregiving techniques as a result of the programme.

Conclusion

The data supports the value of developing a music therapy programme involving weekly active individual music therapy sessions and music therapist-carer communication. The intervention is feasible with modifications in a more rigorous evaluation of a larger sample size.

Trial registration

Clinicaltrials.gov, number NCT01744600.

Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study

BACKGROUND

Previous research highlights the importance of staff involvement in psychosocial interventions targeting neuropsychiatric symptoms of dementia. Music therapy has shown potential effects, but it is not clear how this intervention can be programmed to involve care staff within the delivery of patients' care. This study reports initial feasibility and outcomes from a five month music therapy programme including weekly individual active music therapy for people with dementia and weekly post-therapy video presentations for their carers in care homes.

METHODS

17 care home residents and 10 care staff were randomised to the music therapy intervention group or standard care control group. The cluster randomised, controlled trial included baseline, 3-month, 5-month and post-intervention 7-month measures of residents' symptoms and well-being. Carer-resident interactions were also assessed. Feasibility was based on carers' feedback through semi-structured interviews, programme evaluations and track records of the study.

RESULTS

The music therapy programme appeared to be a practicable and acceptable intervention for care home residents and staff in managing dementia symptoms. Recruitment and retention data indicated feasibility but also challenges. Preliminary outcomes indicated differences in symptoms (13.42, 95 % CI: [4.78 to 22.07; p = 0.006]) and in levels of wellbeing (-0.74, 95 % CI: [-1.15 to -0.33; p = 0.003]) between the two groups, indicating that residents receiving music therapy improved. Staff in the intervention group reported enhanced caregiving techniques as a result of the programme.

CONCLUSION

The data supports the value of developing a music therapy programme involving weekly active individual music therapy sessions and music therapist-carer communication. The intervention is feasible with modifications in a more rigorous evaluation of a larger sample size.

TRIAL REGISTRATION

Clinicaltrials.gov, number NCT01744600.

The development of Music in Dementia Assessment Scales (MiDAS)

There is a need to develop an outcome measure specific to music therapy in dementia that reflects a holistic picture of the therapy process and outcome. This study aimed to develop a clinically relevant and scientifically robust music therapy outcome measure incorporating the values and views of people with dementia. Focus groups and interviews were conducted to obtain qualitative data on what music meant to people with dementia and the observed effects of music. Expert and peer consultations were conducted at each stage of the measure development to maximise its content validity. The new measure was field-tested by clinicians in a care home. Feedback from the clinicians and music therapy experts were incorporated during the review and refinement process of the measure. A review of the existing literature, the experiential results and the consensus process enabled the development of the new outcome measure "Music in Dementia Assessment Scales (MiDAS)". Analysis of the qualitative data identified five key areas of the impact of music on people with dementia and they were transformed as the five Visual Analogue Scale (VAS) items: levels of Interest, Response, Initiation, Involvement and Enjoyment. MiDAS comprises the five VAS items and a supplementary checklist of notable positive and negative reactions from the individual. This study demonstrates that it is possible to design and develop an easy to apply and rigorous quantitative outcome measure which has a high level of clinical relevance for people with dementia, care home staff and music therapists.

Efficacy of musical interventions in dementia: methodological requirements of nonpharmacological trials

The management of patients with Alzheimer's disease is a significant public health problem given the limited effectiveness of pharmacological therapies combined with iatrogenic effects of drug treatments in dementia. Consequently, the development of nondrug care, such as musical interventions, has become a necessity. The experimental rigor of studies in this area, however, is often lacking. It is therefore difficult to determine the impact of musical interventions on patients with dementia. As part of a series of studies, we carried out randomized controlled trials to compare the effectiveness of musical activities to other pleasant activities on various functions in patients with severe Alzheimer's disease. The data obtained in these trials are discussed in light of the methodological constraints and requirements specific to these clinical studies. Although the results demonstrate the power of music on the emotional and behavioral status of patients, they also suggest that other pleasant activities (e.g., cooking) are also effective, leaving open the question about the specific benefits of music in patients with dementia. All these findings highlight the promising potential for nonpharmacological treatments to improve the well-being of patients living in residential care and to reduce caregiver burden.

Emotional memory for musical excerpts in young and older adults

The emotions evoked by music can enhance recognition of excerpts. It has been suggested that memory is better for high than for low arousing music (Eschrich et al., 2005; Samson et al., 2009), but it remains unclear whether positively (Eschrich et al., 2008) or negatively valenced music (Aubé et al., 2013; Vieillard and Gilet, 2013) may be better recognized. Moreover, we still know very little about the influence of age on emotional memory for music. To address these issues, we tested emotional memory for music in young and older adults using musical excerpts varying in terms of arousal and valence. Participants completed immediate and 24 h delayed recognition tests. We predicted highly arousing excerpts to be better recognized by both groups in immediate recognition. We hypothesized that arousal may compensate consolidation deficits in aging, thus showing more prominent benefit of high over low arousing stimuli in older than younger adults on delayed recognition. We also hypothesized worst retention of negative excerpts for the older group, resulting in a recognition benefit for positive over negative excerpts specific to older adults. Our results suggest that although older adults had worse recognition than young adults overall, effects of emotion on memory do not seem to be modified by aging. Results on immediate recognition suggest that recognition of low arousing excerpts can be affected by valence, with better memory for positive relative to negative low arousing music. However, 24 h delayed recognition results demonstrate effects of emotion on memory consolidation regardless of age, with a recognition benefit for high arousal and for negatively valenced music. The present study highlights the role of emotion on memory consolidation. Findings are examined in light of the literature on emotional memory for music and for other stimuli. We finally discuss the implication of the present results for potential music interventions in aging and dementia.

Music and dementia

There is an increasing incidence of dementia in our aging population, and consequently an urgent need to develop treatments and activities that may alleviate the symptoms of dementia. Accumulating evidence shows that persons with dementia enjoy music, and their ability to respond to music is potentially preserved even in the late or severe stages of dementia when verbal communication may have ceased. Media interest in this topic has contributed to the public perception that music abilities are an "island of preservation" in an otherwise cognitively impaired person with dementia. In this chapter, we review the current literature on music cognition in dementia and show that there has been very scarce rigorous scientific investigation of this issue, and that various types of music memory exist and are differentially impaired in the different types of dementia. Furthermore, we discuss the recent development of music activities as a nonpharmacological treatment for dementia and highlight the methodological limitations of the current literature on this topic. While it has been reported that music activities can improve behavior, (particularly agitation), mood, and cognition in persons with dementia, recent large-scale randomized control studies have questioned the specificity of the effect of music and found that it is no more beneficial than other pleasant activities. Nevertheless, music is unique in its powerful ability to elicit both memories and emotions. This can provide an important link to individual's past and a means of nonverbal communication with carers, which make it an ideal stimulus for persons with dementia.

Time Series Analysis of Individual Music Therapy in Dementia

Abstract. This pilot study evaluated the effects of individual music therapy on communication behavior and emotional well-being in persons with advanced dementia. Contrary to more common qualitative designs in dementia-related music therapy research, we used time series analysis of videographed music therapy sessions. This quantitative statistical method for modeling and explaining time-dependent processual data has not been employed in this research area before. Based on aggregated time series data, the results showed positive and statistically significant intervention effects on participants’ communication behavior, situational well-being, and their expression of positive emotions. The study results indicate that, by choosing appropriate outcomes, video-based time series analysis is sensitive and well suited to displaying the effects of music therapy in dementia care.

Development of Six Arts, a Culturally Appropriate Multimodal Nonpharmacological Intervention in Dementia

PURPOSE

There is accumulating evidence for the efficacy of nonpharmacological multimodal stimulation interventions in maintaining cognition and improving quality of life in people with mild-to-moderate dementia. However, the complex nature of these interventions limits their application in practice and research. We report here the design and development of a culturally appropriate framework, the Six Arts, to guide delivery of multimodal interventions in a Chinese community.

DESIGN AND DEVELOPMENT

The Six Arts are a core set of Confucian philosophy comprising 6 disciplines of rites, music, archery, charioteering, literacy, and numeracy. They correspond to major mind-body functional domains of social functioning; music and rhythm; visuospatial and fine motor skills; kinesthetic and gross motor skills; language and verbal skills; and executive function. Using Six Arts as a framework, we mapped theoretical principles and evidence-based nonpharmacological interventions of cognitive stimulation, physical exercise, and social activities against the 6 functional domains. From 2011, we field-tested the use of Six Arts in structuring intervention programs in 263 people in a dementia day center in Hong Kong.

RESULTS

The Six Arts was operationalized through the development of an intervention activity database, a scoring system for intensity level, and a service delivery model for application in dementia day centers.

IMPLICATIONS

Six Arts can be used as framework for structuring nonpharmacological group intervention programs in dementia day center in a metropolitan Chinese city. Its cultural appropriateness may facilitate communication and shared decision making with families with dementia in communities influenced by Confucian philosophy.

Global music approach to persons with dementia: evidence and practice

Music is an important resource for achieving psychological, cognitive, and social goals in the field of dementia. This paper describes the different types of evidence-based music interventions that can be found in literature and proposes a structured intervention model (global music approach to persons with dementia, GMA-D). The literature concerning music and dementia was considered and analyzed. The reported studies included more recent studies and/or studies with relevant scientific characteristics. From this background, a global music approach was proposed using music and sound-music elements according to the needs, clinical characteristics, and therapeutic-rehabilitation goals that emerge in the care of persons with dementia. From the literature analysis the following evidence-based interventions emerged: active music therapy (psychological and rehabilitative approaches), active music therapy with family caregivers and persons with dementia, music-based interventions, caregivers singing, individualized listening to music, and background music. Characteristics of each type of intervention are described and discussed. Standardizing the operational methods and evaluation of the single activities and a joint practice can contribute to achieve the validation of the application model. The proposed model can be considered a low-cost nonpharmacological intervention and a therapeutic-rehabilitation method for the reduction of behavioral disturbances, for stimulation of cognitive functions, and for increasing the overall quality of life of persons with dementia.

The importance of music for people with dementia: the perspectives of people with dementia, family carers, staff and music therapists

OBJECTIVES

Despite the popularity of music-based interventions in dementia care, there is a limited knowledge of how and why people with dementia find music beneficial for their well-being. A qualitative study was conducted to develop further insights into the musical experiences of people with dementia and explore the meaning of music in their lives.

METHOD

Separate focus groups and interviews with (1) care home residents with dementia and their families, (2) day hospital clients with dementia, (3) care home staff, and (4) music therapists, were conducted. The findings of the thematic analysis were investigated further in the light of psychosocial factors with the aim of developing a theoretical model on music in dementia.

RESULTS

Six key themes were identified. The accessibility of music for people at all stages of dementia, close links between music, personal identity and life events, the importance of relationship-building through music making were particularly highlighted as valuable. The psychosocial model of music in dementia was developed. The model revealed the importance of music to support the personal psychology of people with dementia and the social psychology of the care home environment.

CONCLUSION

The effects of music go beyond the reduction of behavioural and psychological symptoms. Individual preference of music is preserved throughout the process of dementia. Sustaining musical and interpersonal connectedness would help value who the person is and maintain the quality of their life.