Music therapy is a potential intervention for cognition of Alzheimer's Disease: a mini-review

Current scenario and potential of music therapy in the management of diseases

Over the preceding years, music therapy has gained tremendous attention due to new findings of music in management of various conditions like Alzheimer's, depression, anxiety, insomnia, etc. Music is a non-invasive, patient-friendly and pleasant form of therapy with minimal or no side effects. It activates the reward pathway of brain by influencing several processes such as dopamine release, reduction in cortisol levels, increase in estrogen and testosterone levels. This review article focuses on advantages and disadvantages of music therapy, mechanism of action of music in brain and its effective applications in the management of different diseases. The article covers history of music therapy in America, Egypt, and India with practice of music therapy. The advanced effects of music therapy in autism, cancer, post-operative pain, Parkinson's disease, selective mutism, stroke, heart problems, pregnancy, eating disorders, bone fractures and obsessive compulsive disorders are discussed. Also the effect of music therapy on the quality of sleep and brain waves has been discussed. This is an established profession in western countries like America, UK, Australia, and Canada, but not in low-income countries like India where it needs to be standardized.

Rhythmic musical activities may strengthen connectivity between brain networks associated with aging-related deficits in timing and executive functions

Brain aging and common conditions of aging (e.g., hypertension) affect networks important in organizing information, processing speed and action programming (i.e., executive functions). Declines in these networks may affect timing and could have an impact on the ability to perceive and perform musical rhythms. There is evidence that participation in rhythmic musical activities may help to maintain and even improve executive functioning (near transfer), perhaps due to similarities in brain regions underlying timing, musical rhythm perception and production, and executive functioning. Rhythmic musical activities may present as a novel and fun activity for older adults to stimulate interacting brain regions that deteriorate with aging. However, relatively little is known about neurobehavioral interactions between aging, timing, rhythm perception and production, and executive functioning. In this review, we account for these brain-behavior interactions to suggest that deeper knowledge of overlapping brain regions associated with timing, rhythm, and cognition may assist in designing more targeted preventive and rehabilitative interventions to reduce age-related cognitive decline and improve quality of life in populations with neurodegenerative disease. Further research is needed to elucidate the functional relationships between brain regions associated with aging, timing, rhythm perception and production, and executive functioning to direct design of targeted interventions.

Treatments and regulatory mechanisms of acoustic stimuli on mood disorders and neurological diseases

Acoustic stimuli such as music or ambient noise can significantly affect physiological and psychological health in humans. We here summarize positive effects of music therapy in premature infant distress regulation, performance enhancement, sleep quality control, and treatment of mental disorders. Specifically, music therapy exhibits promising effects on treatment of neurological disorders such as Alzheimer's disease (AD) and Parkinson's disease (PD). We also highlight regulatory mechanisms by which auditory intervention affects an organism, encompassing modulation of immune responses, gene expression, neurotransmitter regulation and neural circuitry. As a safe, cost-effective and non-invasive intervention, music therapy offers substantial potential in treating a variety of neurological conditions.

Effect of Music Interventions on Cognitive Function in Older Adults With Mild Cognitive Impairment: A Systematic Review

The purpose of the current systematic review was to examine the effects of music interventions on cognitive function in older adults with mild cognitive impairment (MCI). A systematic search of CINAHL, PubMed, PsycINFO, and Web of Science databases was performed. Studies examining the effects of music interventions on cognitive function in older adults with MCI were included. Narrative synthesis for cognitive outcomes postintervention was performed. A total of 11 articles met inclusion criteria. Music interventions significantly improved global cognitive function, verbal fluency, executive function, and spatial function in older adults with MCI. Included studies were heterogeneous in terms of the type of intervention, cognitive assessment tool, and intervention duration. Six studies were at risk of bias due to missing data and confounding factors. Our findings suggest that music interventions can be an effective strategy to improve cognitive function for older adults with MCI. However, findings should be interpreted with caution. More rigorous studies with various types of music interventions investigating cognitive domain-specific effects are needed. [Research in Gerontological Nursing, 16(5), 259-268.].

Graph Theoretical Network Structures Underlie Age-Related Differences in the Functional Connectome During Rest and Music Listening

Aging is associated with decreased functional connectivity within the default mode network, as well as auditory and reward systems which are involved in music listening. Understanding how music listening affects network organization of the aging brain, both globally and specific to the brain networks, will have implications for designing lifestyle interventions that tap into distinct networks in the brain. Here we apply graph-theory metrics of modularity, global efficiency, clustering coefficients, degrees, and betweenness centrality to compare younger and older adults (YA/OA, N=24 per group) in fMRI connectivity during rest and a music listening task. Results show a less modular but more globally efficient connectome in OAs, especially during music listening, resulting in main effects of group and task, as well as group-by-task interactions. ROI analyses indicated that the posterior cingulate is more centrally located than the medial prefrontal cortex in OAs. Overall, reduced modularity and increased global efficiency with age is in keeping with previously-observed functional reorganizations, and interaction effects show that age-related differences in baseline network organization are reflected in, potentially magnified by, music listening.

Phase I cardiac rehabilitation with 5-phase music after emergency percutaneous coronary intervention for acute myocardial infarction: A prospective randomized study

BACKGROUND

Five-phase music therapy was reported to be effective in the treatment and rehabilitation of several diseases. This study explored the effect of phase I cardiac rehabilitation combined with 5-phase music in acute myocardial infarction (AMI) patients after emergency percutaneous coronary intervention.

METHODS

This prospective pilot study enrolled AMI patients who received percutaneous coronary intervention from the Traditional Chinese Medicine Hospital from July 2018 to December 2019. The participants were randomized in a 1:1:1 ratio to the control, cardiac rehabilitation, and rehabilitation-music groups. The primary endpoint was the hospital anxiety and depression scale. The secondary endpoints were the myocardial infarction dimensional assessment scale, self-rating sleep status, 6-minute walk test, and left ventricular ejection fraction.

RESULTS

The study included 150 AMI patients (n = 50/group). Hospital anxiety and depression scale showed significant time effects for both anxiety and depression (both P < .05), a treatment effect for depression (P = .02), and an interaction effect for anxiety (P = .02). A time effect was also observed for diet, sleep disorders, 6-minute walk test, and left ventricular ejection fraction (all P < .001). A difference among groups was observed for emotional reaction (P = .001). Interactions effects were observed for diet (P = .01) and sleep disorders (P = .03).

CONCLUSION

Phase I cardiac rehabilitation combined with 5-phase music could alleviate anxiety and depression and improve sleep quality.

Background Music and Memory in Mild Cognitive Impairment: The Role of Interindividual Differences

BACKGROUND

Recent research has shown that background music may improve memory consolidation and retrieval. Nevertheless, in the clinical conditions preceding dementia such as mild cognitive impairment (MCI), there is no current evidence speaking to what effect background music during memory tasks has on impaired cognition.

OBJECTIVE

Across three experiments, we investigated if background music is able to improve memory performance, the most impacted cognitive domain in amnestic MCI.

METHODS

We tested the effect of background music by using a face recognition memory task in patients with amnestic MCI. In Experiment 1, we tested the effect of background music on memory when it was played solely during an encoding phase. In Experiment 2, we explored effects of background music when played during both encoding and recognition phases. In Experiment 3, we explored the role of musically induced arousal on memory.

RESULTS

The main finding from these three experiments was that background music played during a memory task did not improve or worsen participant performance. However, when exposed to high-arousal music, memory performance was predicted by individual mood regulation. For low-arousal music conditions, there was a negative relationship between rating scores for music pleasantness and performance on the memory task.

CONCLUSION

Our results suggest that the benefits of background music on memory in individuals with MCI are modulated by interindividual preferences towards music.

A Novel Method of Teaching English to People with Mild Cognitive Impairment Using Songs: A Randomized Controlled Trial Protocol

BACKGROUND

People with mild cognitive impairment (MCI) need to prevent the further decline of their cognitive functions, and one way to do so is by learning a foreign language.

OBJECTIVE

This study describes the development of a protocol for a novel, non-pharmacological intervention for people with MCI that seeks to prevent or reduce cognitive decline by teaching English through songs.

METHODS

The development of this protocol follows a mixed-methodology approach, consisting of three stages: 1) development of the protocol of the intervention, 2) a randomized controlled trial study with two arms over six months that includes an intervention group and a control group, and 3) the evaluation of the protocol by trainers. In the second stage, we recruited a total of 128 people with MCI from the five participating countries of this study (Greece, Spain, Croatia, Slovenia, and Italy). This educational program will assess three main outcomes after 6 months of the English Lessons with the Use of Songs for People with Mild Cognitive Impairment (E.L.So.M.C.I.) workshops.

RESULTS

Our primary outcome will hopefully be an improvement in general cognition in the intervention group compared to the control group from baseline to 6 months follow-up. Secondary outcomes include a decrease in participants' anxiety and depression and an improvement in their quality of life. Development of English language skills is the last outcome.

Quality standards and recommendations for research in music and neuroplasticity

Research on how music influences brain plasticity has gained momentum in recent years. Considering, however, the nonuniform methodological standards implemented, the findings end up being nonreplicable and less generalizable. To address the need for a standardized baseline of research quality, we gathered all the studies in the music and neuroplasticity field in 2019 and appraised their methodological rigor systematically and critically. The aim was to provide a preliminary and, at the minimum, acceptable quality threshold-and, ipso facto, suggested recommendations-whereupon further discussion and development may take place. Quality appraisal was performed on 89 articles by three independent raters, following a standardized scoring system. The raters' scoring was cross-referenced following an inter-rater reliability measure, and further studied by performing multiple ratings comparisons and matrix analyses. The results for methodological quality were at a quite good level (quantitative articles: mean = 0.737, SD = 0.084; qualitative articles: mean = 0.677, SD = 0.144), following a moderate but statistically significant level of agreement between the raters (W = 0.44, χ² = 117.249, p = 0.020). We conclude that the standards for implementation and reporting are of high quality; however, certain improvements are needed to reach the stringent levels presumed for such an influential interdisciplinary scientific field.

Effects of familiar music exposure on deliberate retrieval of remote episodic and semantic memories in healthy aging adults

Familiar music facilitates memory retrieval in adults with dementia. However, mechanisms behind this effect, and its generality, are unclear because of a lack of parallel work in healthy aging. Exposure to familiar music enhances spontaneous recall of memories directly cued by the music, but it is unknown whether such effects extend to deliberate recall more generally - e.g., to memories not directly linked to the music being played. It is also unclear whether familiar music boosts recall of specific episodes versus more generalised semantic memories, or whether effects are driven by domain-general mechanisms (e.g., improved mood). In a registered report study, we examined effects of familiar music on deliberate recall in healthy adults ages 65-80 years (N = 75) by presenting familiar music from earlier in life, unfamiliar music, and non-musical audio clips across three sessions. After each clip, we assessed free recall of remote memories for pre-selected events. Contrary to our hypotheses, we found no effects of music exposure on recall of prompted events, though familiar music evoked spontaneous memories most often. These results suggest that effects of familiar music on recall may be limited to memories specifically evoked in response to the music (Preprint and registered report protocol at https://osf.io/kjnwd/).

Person-attuned musical interactions (PAMI) in dementia care. Complex intervention research for constructing a training manual

Introduction

Music is of vital importance for cognition, human care, and the formation of social communities throughout life. Dementia is a neurocognitive disorder that affects cognitive domains, and in late-stage dementia, care is needed in all aspects of daily living. Within residential care home contexts, carers play a significant role for the "caring culture" but often lack professional training in verbal and non-verbal communication skills. Thus, there is a need for training carers to respond to the multidimensional needs of persons with dementia. Music therapists use musical interactions but are not trained to train carers. Therefore, our aim was to explore person-attuned musical interactions (PAMI), and additionally, to develop and evaluate a training manual to be used by music therapists when supporting and training carers in non-verbal communication with persons with late-stage dementia in residential care home contexts.

Research process

With a realist perspective and systems thinking and within the framework for complex intervention research, the research group integrated several overlapping subprojects by applying a non-linear and iterative research process. Core elements related to person-centered dementia care as well as learning objectives were considered through the following four phases; Developing, Feasibility, Evaluation, and Implementation.

Results

The result was a training manual for qualified music therapists to use when teaching and collaborating with carers about how to implement PAMI in dementia care. The manual included comprehensive resources, a clear structure for training, defined learning objectives, and integration of theory.

Discussion

With increased knowledge about caring values and non-verbal communication, residential care home cultures may develop carer competencies and provide professional attuned care for persons with dementia. Further piloting and testing to examine the general effect on caring cultures is needed.

Dance activity interventions targeting cognitive functioning in older adults with mild cognitive impairment: A meta-analysis

Objectives

To comprehensively determine the effect of dance activities on the cognitive functions and its sub-domains of older adults with mild cognitive impairment (MCI).

Methods

We obtained data from PubMed, Web of Science, EBSCO, China national knowledge infrastructure, Wanfang data, and VIP databases from 2017/01/01 to 2022/03/01. We included trials of older adults with MCI that underwent dance activity intervention and fulfilled the inclusion criteria. Two researchers independently assessed the quality of the study using the Cochrane risk of the bias assessment tool. Meta-analysis was performed when data were available, with further subgroup analysis, using Review Manager 5.4, and sensitivity analysis was performed using Stata software 15.1.

Results

Search terms yielded 183 articles, of which 12 fulfilled the inclusion criteria. This included 7 high-quality studies and 5 medium-quality studies. A total of 820 older adults were analyzed. Results showed that dance activity had beneficial effects for global cognition [SMD_MMSE = 0.65, 95% CI_MMSE (0.20, 1.09), p_MMSE = 0.004; SMD_MoCA = 0.87, 95% CI_MoCA (0.44, 1.29), p_MoCA < 0.0001], memory [SMD = 0.61, 95% CI (0.35, 0.88), p < 0.00001], visuospatial function [SMD = −0.39, 95% CI (−0.60, −0.19), p = 0.0002], cognitive flexibility [SMD = −0.31, 95% CI (−0.52, −0.11), p = 0.003], attention [SMD = 0.34, 95% CI (0.07, 0.61), p = 0.01], and balance [SMD = 1.25, 95% CI (0.06, 2.44), p = 0.04]. Further subgroup analysis showed that open-skill dance activity (OSDA) was more effective in promoting global cognition in older adults with MCI than closed-skill dance activity (CSDA) because of the different stimulation provided by the two types of dance activities in the brain regions of the older adults (p = 0.0002). It could be speculated that dance activity improved cognitive function mainly by affecting the microstructure and function of the cingulate tract, hippocampus, cardiovascular function, and other brain areas of older adults with MCI.

Conclusion

Dance activities can significantly improve global cognition, memory, visuospatial function, cognitive flexibility, attention, and balance in older adults with MCI. However, more trials with rigorous study designs are necessary to provide more concrete evidence in the future.

Salivary Testosterone and Cortisol Levels in Tunisian Elderly Male Patients With Mild Alzheimer’s Disease. Implications of Musical Therapy And/Or Physical Rehabilitation

Changes in salivary testosterone (T) and cortisol (C) levels were assessed in elderly Tunisian male patients with mild Alzheimer’s disease (AD) subjected to music therapy and/or physical rehabilitation. Male patients with mild AD (N = 26; age = 76.23 ± 4.27 years; weight: 74.76 ± 5.36 kg) were randomly assigned into four groups for three 60-min sessions per week for 4 months; including Group1 or control group (Co) (n = 6); Group2 (n = 6), participated in physical rehabilitation (PR); Group3 (n = 7), subjected to music therapy (MT) and Group4 (n = 7), participated simultaneously in music therapy and physical rehabilitation (MT + PR). Salivary T levels increased (ηp² = 0.7) and C levels decreased (ηp² = 0.69), significantly (p < 0.001) in the PR, MT and MT + PR groups compared to the Co group respectively. Also, increases in salivary T levels and decreases in C levels in MT + PR group were greater compared to the other groups. MT increased T levels (p < 0.001) and decreased C levels (p < 0.05) to a greater extent than the PR group respectively. Changes in salivary T levels were positively (r = 0.83; p < 0.001) and C levels were negatively (r = -0.86; p < 0.001) correlated in the PR, MT and MT + PR groups with changes in MMSE in AD patients. This study highlights that combination of MT and PR holds potential to treat AD.

Comparative Analysis of Aesthetic Emotion of Dance Movement: A Deep Learning Based Approach

Dance is a unique art with the human body movement as the main means, but dance is not limited to the human body movement itself. Like any art, dance is the product of human social behavior and a romantic behavior of human thoughts and emotions in the virtual world. Dances with different characteristics will also reflect different aesthetics, different cultural psychology, different living styles, and emotional trajectories of different times and different nationalities. People rely on the image of dance artists to develop and inherit the profound ideological connotation and philosophy of life. Viewers may form their own diversified and unique aesthetic characteristics. In the new era, in order to better promote the development, communication, and dissemination of dance art, it is very necessary to analyze and explore the connotation and aesthetic characteristics of dance art. Only through specific movements can the value and ideological connotation of works be expressed. Therefore, this paper comparatively analyzes dance movement aesthetic emotion based on deep learning. Experimentations are performed to systematically analyze the models from various perspectives. Findings of the evaluation show that CAP and CNN are effective models that can successfully extract high-level emotional features. The method proposes and effectively selects the best models among the five standard models based on key features and is, therefore, suitable in predicting the dancer's emotion and for the analysis of the dance movement in the future.

Striking a chord: Utilizing music for people living with dementia

This article discusses how music therapy can be incorporated into nursing practice for people living with dementia.

Effectiveness of music intervention on cognitive function and neuropsychiatric symptoms in the elderly with dementia: a meta-analysis

Dementia is increasing dramatically with an increasing elderly population. Pharmacological interventions are proven to have limited efficacy to treat many of the features of dementia. In such a situation, non-pharmacological means become important to help people with dementia, especially music therapy. The efficacy of music intervention on cognition has been barely explored in the literature, and the few studies that are available present inconsistent results. The aim of this systematic review is to have a meta-analysis on the effect of music therapy for improvements in cognitive functions as well as neuropsychiatric symptoms in the elderly with dementia.

The forgotten role of absorption in music reward

Interindividual differences in music-related reward have been characterized as involving five main facets: musical seeking, emotion evocation, mood regulation, social reward, and sensory-motor. An interesting concept related to how humans decode music as a rewarding experience is music transcendence or absorption (i.e., music-driven states of complete immersion, including momentary loss of self-consciousness or even time-space disorientation). Here, we investigated the relation between previously characterized facets of music reward and individual differences in music absorption. A first sample of participants (N = 370) completed both the Barcelona Music Reward Questionnaire (BMRQ) and the Absorption in Music Scale (AIMS). Results showed that both constructs were highly interrelated (r = 0.78, p < 0.001), indicating that higher music reward sensitivity is associated with a greater tendency to music-related absorption states. In addition, four items from the AIMS were identified as suitable to be added to an extended version of the BMRQ (eBMRQ). A second sample (N = 550) completed the eBMRQ for a validation study. Exploratory and confirmatory factor analyses on the whole sample (N = 920) showed the reliable psychometric properties of the eBMRQ and suggested that taking into account an absorption facet could contribute to a better characterization of individual differences in the sensitivity to experience music-related reward and pleasure.

Music, Mind, Mood, and Mingling in Alzheimer’s Disease and Related Dementias: A Scoping Review

Background: Music-based interventions may help to alleviate neuropsychiatric symptoms of dementia and promote prosocial interactions between individuals living with dementia and their caregivers. However, current literature does not combine these evidence bases toward explanation of how music-based interventions may alleviate symptoms and promote prosocial interactions. Objective: We conducted a scoping review to address the following question: what do the evidence bases suggest toward how music therapy or music-based therapeutic interventions might promote prosocial interactions between individuals living with dementia and their caregivers? Methods: In this review we focused on: 1) quantitative and qualitative evidence of music-based therapies promoting prosocial behaviors in individuals living with dementia, and 2) potential neurobehavioral mechanisms associated with the processes involved with how music may promote prosocial interactions. Databases included PubMed, EBSCOhost’s CINAHL and PsycINFO, Cochrane Library (sub-search conducted using ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group), Web of Science, clinicaltrials.gov, ProQuest’s Biological Science Collection, the Journal of Music Therapy, Nordic Journal of Music Therapy, and Google Scholar. Results: Sixteen original research studies were included for evidence synthesis. This scoping review reveals the need to define and clarify mechanisms of prosocial interactions between individuals living with dementia and their caregivers considering biological and social factors. These mechanisms may include dynamic interactions between preserved brain regions associated with music-evoked autobiographical memory recall and shifts from negative to positive mood states. Conclusion: Defining and clarifying how and to what extent music may promote prosocial behaviors using well-designed and well-controlled mixed-methods studies may positively influence the design of interventions to promote prosocial interactions with caregivers.

Research Hotspots and Trends in Music Therapy Intervention for Patients With Dementia: A Bibliometrics and Visual Analysis of Papers Published From 2010 to 2021

BACKGROUND

As a serious public health problem, dementia has placed a heavy burden on society and families. Evidence suggests that the use of music therapy as a non-pharmacological intervention has certain advantages with respect to reducing the behavioral and psychological symptoms of dementia (BPSD) and improving the cognition and mental status of dementia patients. However, research trends and hotspots regarding music therapy intervention for dementia analysis have not been systematically studied via bibliometric analysis.

METHODS

We searched the Web of Science Core Collection (WoSCC) for texts published between January 1, 2010, and October 31, 2021, and visualized country, institution, journal, keyword co-occurrence, keyword emergence and keyword clustering.

RESULTS

A total of 217 articles from the WoSCC database were analyzed. In this research field, the annual number of publications has generally shown a slowly increasing trend, and the United States has the most publications and the most frequent cooperation among countries. University College London (UCL) has the most extensive influence among research institutions. Among articles, those published in the JOURNAL OF ALZHEIMER'S DISEASE were the most numerous, with 20 such articles being published, accounting for 9.22% (20/217) of the total. Comprehensive analysis of five clusters via biclustering shows that the research hotspots in this field during the past 11 years have mainly focused on the autobiographical memory, cognitive function, mental state and BPSD of dementia patients.

CONCLUSION

This study conducted a bibliometric and visual analysis of relevant studies concerning music therapy intervention for dementia patients. Psychological problems faced by dementia patients and the topics of quality of life, individualized music therapy, the mental state of caregivers and other related topics may be important research directions in the future. Therefore, the question of how to develop standardized research protocols and identify unified efficacy evaluation indicators should be a focus of and difficulty for future research.

Chronic Beneficial Effect of Makeup Therapy on Cognitive Function of Dementia and Facial Appearance Analyzed by Artificial Intelligence Software

BACKGROUND

Makeup greatly impacts normal social lives but can also be a non-pharmacological form of therapy for dementia.

OBJECTIVE

To evaluate the therapeutic effect of makeup therapy.

METHODS

We carried out a prospective interventional study on female nursing home residents with dementia, focusing on the chronic therapeutic effect of makeup therapy. Thirty-four patients who received either only skin care (control group, n = 16) or skin care plus makeup therapy (makeup therapy group, n = 18) once every 2 weeks for 3 months were assessed.

RESULTS

Three months of makeup therapy significantly improved the Mini-Mental State Examination (MMSE) score compared with control patients ( *p <  0.05). Artificial intelligence (AI) software revealed that the appearance of age decreased significantly in the makeup group compared with the control, especially among patients without depression ( *p <  0.05). Furthermore, a larger AI happiness score was significantly correlated with a greater improvement of ADL in the makeup therapy group (r = 0.43,  *p <  0.05).

CONCLUSION

Makeup therapy had a chronic beneficial effect on the cognitive function of female dementia patients, while the chronic effect of makeup therapy on facial appearance was successfully detected by the present AI software.

Benefits of Cultural Activities on People With Cognitive Impairment: A Systematic Review

Museums and cultural institutions are increasingly striving to respond to the interests and needs of the society that hosts them. This means, apart from other actions, that these institutions must be involved in the health and wellbeing of society, and the creation of cultural activities aimed at people with cognitive impairment, a group of individuals that is growing worldwide due to the aging of society and the increasing prevalence of dementia. The involved sectors are aware of the potential and benefits of activities for this population, even though there is much research to be conducted. To date, no systematic review has focused on the benefits of cultural activities for cognitively impaired people. This study aimed to explore the benefits of different modalities of cultural activities with evidence from 145 studies from various databases, which met the inclusion criteria. Significant improvements in general cognition, quality of life (QoL), emotional wellbeing, socialization, and communication were generally reported after interventions, with a reduction in depression symptoms. There was not enough evidence to prove memory, language, or daily functioning improvements attributable to cultural interventions. There were no significant reductions reported in apathy, sadness, agitation, or anxiety.

Long-Known Music Exposure Effects on Brain Imaging and Cognition in Early-Stage Cognitive Decline: A Pilot Study

BACKGROUND

Repeated exposure to long-known music has been shown to have a beneficial effect on cognitive performance in patients with AD. However, the brain mechanisms underlying improvement in cognitive performance are not yet clear.

OBJECTIVE

In this pilot study we propose to examine the effect of repeated long-known music exposure on imaging indices and corresponding changes in cognitive function in patients with early-stage cognitive decline.

METHODS

Participants with early-stage cognitive decline were assigned to three weeks of daily long-known music listening, lasting one hour in duration. A cognitive battery was administered, and brain activity was measured before and after intervention. Paired-measures tests evaluated the longitudinal changes in brain structure, function, and cognition associated with the intervention.

RESULTS

Fourteen participants completed the music-based intervention, including 6 musicians and 8 non-musicians. Post-baseline there was a reduction in brain activity in key nodes of a music-related network, including the bilateral basal ganglia and right inferior frontal gyrus, and declines in fronto-temporal functional connectivity and radial diffusivity of dorsal white matter. Musician status also significantly modified longitudinal changes in functional and structural brain measures. There was also a significant improvement in the memory subdomain of the Montreal Cognitive Assessment.

CONCLUSION

These preliminary results suggest that neuroplastic mechanisms may mediate improvements in cognitive functioning associated with exposure to long-known music listening and that these mechanisms may be different in musicians compared to non-musicians.

Neural Basis of Long-term Musical Memory in Cognitively Impaired Older Persons

OBJECTIVE

The objective of this study was to determine whether exposure to long-known music would evoke more extensive activation of brain regions minimally affected by Alzheimer disease (AD) pathology and outside traditional memory networks using a functional magnetic resonance imaging paradigm involving listening to long-known and recently-learned music in older adults with cognitive impairment to provide insight into mechanisms of long-term musical memory preservation in cognitively impaired older persons.

METHODS

Seventeen subjects with a diagnosis of mild AD or mild cognitive impairment were recruited for this study. Subjects were scanned using functional magnetic resonance imaging while they performed a music listening task, which included short clips of personally selected music from the patient's past and newly-composed music heard for the first time 60 minutes before scanning. From this task, we obtained group-level maps comparing brain areas associated with long-known and recently-heard music in all subjects.

RESULTS

Exposure to long-known music preferentially activated brain regions including the medial prefrontal cortex, precuneus, anterior insula, basal ganglia, hippocampus, amygdala, and cerebellum relative to recently-heard music. These areas are involved in autobiographical memory and associated emotional responses. In addition, they are minimally affected by early stage AD pathology, thus providing a neural basis for long-known musical memory survival.

CONCLUSIONS

Long-known music activates a bilateral network of prefrontal, emotional, motor, auditory, and subcortical regions (cerebellum, putamen, limbic structures). This extensive activation, relative to recently-heard music, may offer structural and functional clues as to why long-term musical memory appears to be relatively preserved among cognitively impaired older persons.

Effectiveness of a musical fitness programme for older adults with cognitive impairment in long-term care facilities: A quasi-experimental study

OBJECTIVE

To investigate the effectiveness of a musical fitness programme (MFP) intervention in improving neuropsychiatric symptoms, depression, upper-limb muscle strength and cognition of older adults with cognitive impairment in long-term care (LTC) facilities.

BACKGROUND

Because of population ageing, the number of older adults with cognitive impairment has been increasing. The effectiveness of medications in treating cognitive impairment is limited; therefore, the global trend has been for non-pharmacological treatments. However, intervention studies of MFPs on older LTC residents with cognitive impairment are scant.

DESIGN

This study adopted a quasi-experimental design in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist. In total, 84 older adults with cognitive impairment were recruited from seven LTC facilities. The MFP was implemented from July-November 2019.

METHODS

The intervention group received the MFP, which was 50 min per session, twice a week for 12 weeks, whereas the comparison group received usual care. Neuropsychiatric inventory nursing home version, the Cornell scale for depression in dementia Chinese version, 30-s arm curl test and Mini-Mental State Examination were the outcome measures. Data were analysed using Chi-square test, t test and repeated measure analysis of variance.

RESULTS

After the intervention, the scores of neuropsychiatric inventory and the Cornell depression exhibited significant differences over time between two groups (F = 3.6, p = .029; F = 5.96, p = .003, respectively). Nevertheless, 30-s arm curl test and Mini-Mental State Examination demonstrated non-significant between-group differences.

CONCLUSION

The MFP can effectively reduce neuropsychiatric symptoms and depression in older adults with cognitive impairment in LTC facilities. To ensure a more robust evidence base, more research is warranted.

RELEVANCE TO CLINICAL PRACTICE

The MFP is a non-pharmacological treatment that can be implemented to promote psychological well-being among older adults with cognitive impairment in LTC facilities, and to indirectly reduce nursing staff burden. To assist nursing staff in providing this intervention, on-the-job training is needed.

Mechanistic insights into the pathogenesis of neurodegenerative diseases: towards the development of effective therapy

Neurodegeneration is a prevalent and one of the emerging reasons for morbidity, mortality, and cognitive impairment in aging. Dementia is one of such conditions of neurodegeneration, partially manageable, irreversible, and worsens over time. This review is focused on biological and psychosocial risk factors associated with Alzheimer's and Parkinson's diseases, highlighting the value of cognitive decline. We further emphasized on current therapeutic strategies from pharmacological and non-pharmacological perspectives focusing on their effects on cognitive impairment, protein aggregation, tau pathology, and improving the quality of life. Deeper mechanistic insights into the multifactorial neurodegeneration could offer the design and development of promising diagnostic and therapeutic strategies.

Effect of Short-Term Metro-Rhythmic Stimulations on Gait Variability

The aim of the study was to define the effect of different short-term metro-rhythmic stimulations on the time and spatial parameters of gait. The secondary goal was to test whether prior instructions on how to respond to stimulations played a significant role in the stimulation by sound stimuli. Experimental tests of gait were conducted on a group of 36 healthy participants: group 1—subjects who were not informed how to react after hearing sound stimuli, group 2—subjects who received a clear instruction before the test to adjust the frequency of taking steps to the rhythm of the music. The gait research was carried out on a Zebris FDM-S (zebris Medical Gmbh, Isny, Germany) treadmill for various sound stimuli (arrhythmic stimulus, rhythmic stimuli at different rate). It was shown that a short-term influence of metro-rhythmic stimulations changes the time and spatial parameters of gait, i.e., gait frequency, length and duration of the gait cycle. The greatest impact on the modification of the time–space parameters of walking is exerted by rhythmic stimuli at a pace different from the frequency of gait at a preferred velocity. Providing information on how to respond to sounds heard may be important in gait therapy with RAS (rhythmic auditory stimulation).

Impacts of Music Intervention on Dementia: A Review Using Meta-Narrative Method and Agenda for Future Research

Background: Dementia, a significant cognitive impairment, is characterized by a decline in memory. It affects an individual’s mood and behavior, which can impair their quality of life and well-being. Studies show that the demand for applying music as a new therapy method for dementia has increased during the last decades. Objective: To review the studies conducted on the impacts of music on different symptoms of dementia and provide readers with a more detailed picture of the efficacy of music, and recognize gaps in the literature. Methods: Electronic searches were conducted in the Cochrane Library (1938), Embase (773), Medline and PubMed (700), PsycINFO (89), and Scopus (218) databases. The search was comprised of all the literature from 2010 to 2020. For the search, key terms including “Dementia” AND “music” OR “music intervention” OR “music therapy” and index terms “clinical trial” OR “randomized controlled trials” were used. Finally, after screening 891 citations, 30 studies were included. Results: In general, it was observed that in most cases, music could be used as one of the safe and cost-effective non-pharmacological approaches for dementia treatment. However, in some studies, no impact or short-term effect of music on some symptoms of dementia such as wandering, agitation, and cognition was detected. Conclusion: Observing no effect or even negative impact of music on people living with dementia could be due to a random selection of music, fewer individuals, and the lack of a standard protocol. High heterogeneity in outcomes did not allow for clear conclusions on the benefits of music in dementia. This demands a comprehensive non-pharmacological music treatment approach to be designed for each stage of dementia to be employed alongside pharmacological treatments. This study proposes 13 gaps in the research on the health impact of music on dementia that could be studied by future researchers.

The Mozart Effect on the Episodic Memory of Healthy Adults Is Null, but Low-Functioning Older Adults May Be an Exception

Literature on the effects of passive music listening on cognitive performance is mixed, showing negative, null or positive results depending on cognitive domain, age group, temporal relation between music and task (background music vs. music before task, the latter known as Mozart effect), or listener-dependent variables such as musical preference. Positive effects of background music on the two components of episodic memory – item and source memory - for verbal materials seem robust and age-independent, and thus deserve further attention. In the current study, we investigated two potential enhancers of music effects on episodic memory: stopping music before task performance (Mozart effect) to eliminate music-related distraction and using preferred music to maximize reward. We ran a main study on a sample of 51 healthy younger adults, along with a pilot study with 12 older adults, divided into low- vs. high functioning according to cognitive performance in a screening test. Against our expectations, Bayesian analyses showed strong evidence that music had no advantage over silence or environmental sounds in younger adults. Preferred music had no advantage either, consistent with the possibility that music-related reward had no impact on episodic memory. Among older adults, low- but not high-functioning participants’ item memory was improved by music – especially by non-preferred music - compared to silence. Our findings suggest that, in healthy adults, prior-to-task music may be less effective than background music in episodic memory enhancement despite decreased distraction, possibly because reward becomes irrelevant when music is stopped before the task begins. Our pilot findings on older adults raise the hypothesis that low-functioning older participants relate to prior-to-task auditory stimulation in deviant ways when it comes to episodic memory enhancement.

Promoting well-being among people with early-stage dementia and their family carers through community-based group singing: a phenomenological study

BACKGROUND

Dementia can negatively impact the well-being of people living with dementia and their family carers. Research suggests that music psychosocial interventions are effective, safe alternatives to pharmacological interventions for the promotion of well-being . However, evidence is limited, and research gaps remain. This study explores how a community-based group singing intervention impacts the well-being of people with early-stage dementia and their family carers.

METHODS

A phenomenological methodological approach was adopted. Participants engaged in a six-week group singing intervention facilitated by a music therapist in a community arts centre. Semi-structured interviews were conducted (n = 7).

RESULTS

Interpretative Phenomenological Analysis revealed four superordinate themes: (1) Social Connection; (2) Happiness and Rejuvenation; (3) Reconnection with the Self; and (4) Supporting the Carer-Cared-for Relationship.

CONCLUSIONS

Evidence of multidimensional enhancement of well-being, absence of adverse effects, and accessibility of this musical medium support the increased provision of community-based singing groups for these populations.

Heart Failure Self-care Associated With Brain Injury in Executive Control Regions

BACKGROUND

Inadequate self-care is linked to poor health outcomes in heart failure (HF). Self-care depends on decision-making abilities, but links between self-care and brain injury to executive decision-making regulatory areas (prefrontal cortices) are unclear.

OBJECTIVE

We investigated the relationships between HF self-care and status of prefrontal cortices.

METHODS

Magnetic resonance imaging-based diffusion tensor imaging was performed in 21 patients with HF (age, 53.8 ± 7.9 years; 15 men; left ventricular ejection fraction, 25.1% ± 6.1%), and self-care and executive function were measured with the Self-care of Heart Failure Index (SCHFI) and Trail Making Test B. Using diffusion tensor imaging data, mean diffusivity (MD) maps were calculated and region-of-interest analyses were performed on the left and right prefrontal brain areas. Statistical analyses consisted of partial correlations (covariates, age, and gender).

RESULTS

The mean ± SD SCHFI scores were 70.78 ± 11.37 for maintenance, 70 ± 17.32 for management, and 74.91 ± 15.76 for confidence. The mean ± SD Trail Making Test B score was 90.2 ± 73.3 seconds. The mean ± SD MD values (higher values indicate tissue injury) of the left and right prefrontal cortices were 1.46 ± 0.16 (×10 mm/s) and 1.44 ± 0.14 (×10 mm/s), respectively. Significant negative correlations emerged between prefrontal MD values and SCHFI maintenance (left/right, r = -0.64/-0.70; P < .003) and SCHFI management (r = -0.93/-0.86; P < .003). Significant positive correlations were observed between prefrontal MD values and Trail Making Test B (r = 0.71/0.74; P < .001). A nonsignificant correlation emerged between prefrontal MD values and SCHFI confidence scores.

CONCLUSIONS

Brain tissue integrity in executive function regulatory regions is associated with HF self-care for maintenance and management. The findings indicate that protection and brain injury repair in executive control areas may improve HF self-care.

Gender Differences in Short-term Memory Related to Music Genres

The purpose of the present research was to examine whether different music settings could influence one's cognitive function - particularly memory. The examined sample consisted of 168 college students with a male:female ratio of 1:2.2. The participants were asked to complete a short-term memory test regarding word recollection while exposed to auditory stimuli. They were divided into three groups, each experiencing very different auditory stimuli (classical music; heavy metal music; no music). The results indicated that gender (as a single parameter) played a significant role in the recall process, with female subjects achieving significantly higher scores than males (p-value = 0.006). Music as an external stimulus was also found to affect the recall process significantly (0.02 < p < 0.04). Gender did not present any statistically significant association with specific music genres although, based on the limitations of this study, findings are in need of further exploration. The results of the present study may direct forthcoming research to address this issue further by examining additional variables as well.

The Demands of Performance Generating Systems on Executive Functions: Effects and Mediating Processes

Performance generating systems (PGS) are rule- and task-based approaches to improvisation on stage in theater, dance, and music. These systems require performers to draw on predefined source materials (texts, scores, memories) while working on complex tasks within limiting rules. An interdisciplinary research team at a large Western Canadian University hypothesized that learning to sustain this praxis over the duration of a performance places high demands on executive functions; demands that may improve the performers' executive abilities. These performers need to continuously shift attention while remaining responsive to embodied and environmental stimuli in the present, they are required to inhibit automated responses and impulses using the rules of the system, and they strive toward addressing multitasking challenges with fluidity and flexibility. This study set out to test the mentioned hypothesis deductively and identify mediating processes inductively, using mixed empirical methods. In a small sample experiment with a control group (28 participants; 15 in intervention group, 13 in control group), standardized quantitative tests of executive functions (D-KEFS) were administered before and after an 8-week intervention. Participant-reported qualitative observations from the praxis were also collected throughout the intervention for grounded analysis. Within the limitations of small sample data, we found both statistically significant and trending effects on inhibition, problem-solving initiation, fluidity, and cognitive flexibility. Examining the mediating process, we found that participants experienced significant challenges sustaining the practice halfway through the intervention. The participant-reported solutions to these challenges, which emerged as the strongest behavioral patterns when coding the qualitative data to saturation, were strategies of problem-solving and of re-directing attention. These strategies support and advance our understanding of the effects measured in the standardized tests. In terms of application, our results identify characteristics of PGS that could potentially maintain and strengthen executive functions over and above less demanding performing arts interventions. The results also deliver new insight into how PGS works, which may contribute to the development and teaching of this artistic practice.

Soy flavonoids prevent cognitive deficits induced by intra-gastrointestinal administration of beta-amyloid

BACKGROUND

In Alzheimer's diseases, beta-amyloid may act as prion-like protein and migrate from the gastrointestinal tract towards the brain. Soy flavonoids have been identified as neuroprotective against cognitive loss in human. Diet with soy flavonoids may be used to slow down the progression of Alzheimer's diseases.

METHODS AND RESULTS

We performed in-vitro tissue culture experiments using myenteric plexus longitudinal muscle layers isolated from the ileum and colon of ICR mice. Beta-amyloid can be taken up into myenteric neurons and induce neuron degeneration, which is protected by flavonoids compounds, including daidzein, genistein, glycitein and luteolin. We also administered oligomeric beta-amyloid (1-42) (total dose: 8 μg) into the gastrointestinal walls of ICR mice and conducted memory tests and gastrointestinal function assessments after 6 and 12 months. Mice treated with beta-amyloid exhibited minor learning deficits in a T-maze memory test at 6 months and significant memory impairment in a novel object recognition task at 12 months. These impairments were prevented by soy flavonoids. Tracking studies performed using fluorescently tagged beta-amyloid found that, beta-amyloid injected at the stomach can aggregate within the layer of myenteric neurons and migrate to the jejunum or via the vagus nerves to the brain after 1 month. Reductions in the gastrointestinal tissue weight and the spontaneous ileal contraction frequency were also observed at 6 and 12 months, respectively.

CONCLUSION

Our findings indicate that beta-amyloid can migrate from the gastrointestinal tract to the brain to induce cognitive impairments. Furthermore, chronic soy flavonoids in drinking water have protective actions.

Music-based interventions to improve fibromyalgia syndrome: A meta-analysis

OBJECTIVE

We evaluated the effects of music therapy on pain, depression and quality of life in patients with fibromyalgia.

METHODS

Ten online databases were searched to identify randomized controlled trials that investigated the effects of music therapy on fibromyalgia patients, published up to 1st January 2019. The results were filtered and independently extracted. Statistical heterogeneity was assessed using the chi-square test. According to the outcome of the heterogeneity indices, either a fixed effect or a random effect model was used.

RESULTS

In total, seven randomized controlled trials were included. The Pain Visual Analog Scale, the McGill Pain Scale, the Beck Depression Scale and the Fibromyalgia Impact Questionnaire were used as outcome measures. Our evidence indicated that patient intervention with music therapy had lower scores on the Pain Visual Analog Scale (95% confidence interval [CI] -2.22 to -1.18, Z = 6.44, P < 0.00001, four studies) and Beck Depression Scale (95% CI -0.65 to -0.03, Z = 2.17, P = 0.03, two studies). No significant differences were observed on the McGill Pain Scale between the music intervention and control groups (95% CI -0.83 to -0.09, Z = 1.59, P = 0.11). A general qualitative description of the Fibromyalgia Impact Questionnaire results was given due to high heterogeneity (I² = 96%, P < 0.00001).

CONCLUSIONS

The music therapy is superior to non-music therapy in the treatment of pain, depression, and improvement of quality of life in fibromyalgia patients. However, due to the low quantity and quality of the included studies, a larger number and high-quality of RCTs are needed to confirm the beneficial effects of music therapy.

Music Therapy in the Treatment of Dementia: A Systematic Review and Meta-Analysis

Background: Dementia is a neurological condition characterized by deterioration in cognitive, behavioral, social, and emotional functions. Pharmacological interventions are available but have limited effect in treating many of the disease's features. Several studies have proposed therapy with music as a possible strategy to slow down cognitive decline and behavioral changes associated with aging in combination with the pharmacological therapy. Objective: We performed a systematic review and subsequent meta-analysis to check whether the application of music therapy in people living with dementia has an effect on cognitive function, quality of life, and/or depressive state. Methods: The databases used were Medline, PubMed Central, Embase, PsycINFO, and the Cochrane Library. The search was made up of all the literature until present. For the search, key terms, such as "music," "brain," "dementia," or "clinical trial," were used. Results: Finally, a total of eight studies were included. All the studies have an acceptable quality based on the score on the Physiotherapy Evidence Database (PEDro) and Critical Appraisal Skills Program (CASP) scales. After meta-analysis, it was shown that the intervention with music improves cognitive function in people living with dementia, as well as quality of life after the intervention and long-term depression. Nevertheless, no evidence was shown of improvement of quality of life in long-term and short-term depression. Conclusion: Based on our results, music could be a powerful treatment strategy. However, it is necessary to develop clinical trials aimed to design standardized protocols depending on the nature or stage of dementia so that they can be applied together with current cognitive-behavioral and pharmacological therapies.

Music Therapy in the Management of Dementia

Background:

Due to the increase in life expectancies and the number of aging population worldwide, there is a rise of aging diseases, out of which the most common is dementia. Therefore, researchers all over the world look for another alternative ways that can improve cognitive competency and neuropsychiatric disorders of these people in order to assist them in maintaining the quality of their life and reducing the overall economic burden. One of the alternative approache seems to be non-pharmacological therapies, which are non-invasive, with minimum side effects and definitely less costly, such as a music therapy (MT).

Objective:

The purpose of this review study is to discuss benefits and limitations of music therapy in the management of dementia.

Method:

This was done by conducting a literature review of available sources found in the Web of Science, Scopus and MEDLINE.

Results:

The findings show that MT may be a promising non-invasive strategy with a long history of use, relatively favorable acceptance among patients with dementia, and its efficacy especially in the treatment of psycho-behavioral symptoms of dementia.

Conclusion:

However, more research should be conducted in the area of cognitive functioning, as well as on the mechanism of MT for dementia patients.

Benzoic acid-derived nitrones: A new class of potential acetylcholinesterase inhibitors and neuroprotective agents

The discovery of new chemical entities endowed with potent and selective acetylcholinesterase (AChE) and/or butyrylcholinesterase (BChE) inhibitory activity is still a relevant subject for Alzheimer's disease therapy. Therefore, a small library of benzoic based amide nitrones (compounds 24 to 42) was synthesized and screened toward cholinesterase enzymes. SAR studies showed that the tert-butyl moiety is the most favourable nitrone pattern. In general, tert-butyl derivatives effectively inhibited AChE, being compound 33 the most potent (IC₅₀ = 8.3 ± 0.3 μM; Ki 5.2 μM). The data pointed to a non-competitive inhibition mechanism of action, which was also observed for the standard donepezil. None of compounds showed BChE inhibitory activity. Molecular modelling studies provided insights into the enzyme-inhibitor interactions and rationalised the experimental data, confirming that the binding mode of nitrones 33 and 38 towards AChE has the most favourable binding free energy. The tert-butylnitrones 33 and 38 were not cytotoxic on different cell lines (SH-SY5Y and HepG2). Moreover, compound 33 was able to prevent t-BHP-induced oxidative stress in SH-SY5Y differentiated cells. Due to its AChE selectivity and promising cytoprotective properties, as well as its appropriate drug-like profile pointing toward blood-brain barrier permeability, compound 33 is proposed as a valid lead for a further optimization step.

The New Application of UHPLC-DAD-TOF/MS in Identification of Inhibitors on β-Amyloid Fibrillation From Scutellaria baicalensis

Literary evidence depicts that aggregated β-amyloid (Aβ) leads to the pathogenesis of Alzheimer's disease (AD). Although many traditional Chinese medicines (TCMs) are effective in treating neurodegenerative diseases, there is no effective way for identifying active compounds from their complicated chemical compositions. Instead of using a traditional herbal separation method with low efficiency, we herein apply UHPLC-DAD-TOF/MS for the accurate identification of the active compounds that inhibit the fibrillation of Aβ (1-42), via an evaluation of the peak area of individual chemical components in chromatogram, after incubation with an Aβ peptide. Using the neuroprotective herbal plant Scutellaria baicalensis (SB) as a study model, the inhibitory effect on Aβ by its individual compounds, were validated using the thioflavin-T (ThT) fluorescence assay, biolayer interferometry analysis, dot immunoblotting and native gel electrophoresis after UHPLC-DAD-TOF/MS analysis. The viability of cells after Aβ (1-42) incubation was further evaluated using both the tetrazolium dye (MTT) assay and flow cytometry analysis. Thirteen major chemical components in SB were identified by UHPLC-DAD-TOF/MS after incubation with Aβ (1-42). The peak areas of two components from SB, baicalein and baicalin, were significantly reduced after incubation with Aβ (1-42), compared to compounds alone, without incubation with Aβ (1-42). Consistently, both compounds inhibited the formation of Aβ (1-42) fibrils and increased the viability of cells after Aβ (1-42) incubation. Based on the hypothesis that active chemical components have to possess binding affinity to Aβ (1-42) to inhibit its fibrillation, a new application using UHPLC-DAD-TOF/MS for accurate identification of inhibitors from herbal plants on Aβ (1-42) fibrillation was developed.

Biological clocks, some clock-related diseases, and medicinal plants

Progress in chronobiology thus far has been built on botanical field investigation records, experiments on the development of biological clocks, open questions, established rules, and molecular mechanisms. In this review, three clock-related diseases, namely cancer, Alzheimer's disease (AD), and depression, are discussed. Evidence-based mechanisms of action of active compounds, namely epigallocatechin-3-gallate (EGCG), curcumin, and melatonin, from three medicinal plants, Camellia sinensis K., Curcuma longa L., and Hypericum perforatum L., respectively, as potential therapies against cancer, AD, and depression, respectively, have been explained. Feedback loops of basic inputs and application outputs of various studies will lead to the development of chronobiology for applications in time-keeping, disease prevention, and control, and future agricultural practices.

Music therapy and dementia care practice in the United Kingdom: A British Association for Music Therapy membership survey

The place of music therapy in the spectrum of musical interventions in dementia care needs to be better understood in light of the ‘supply’ and ‘demand’ of this provision. A semi-structured, online survey of British Association for Music Therapy members and affiliates was undertaken in summer 2017. It asked respondents to report on employment practice and settings, and experience in dementia-related music therapy. It asked about training received and given, and what barriers prevent wider availability of music therapy for people with dementia in the United Kingdom. Replies came from 188 people, 142 of whom were working with people with dementia. Most respondents reported working in the public or voluntary sector, but one in five was self-employed. Most (61%) were employed in residential care or hospital settings, for an average of 20 hours per week. The main factor that would increase music therapy provision in dementia care was seen as ‘greater awareness’ of music therapy amongst the general public and within the National Health Service. Nearly one-quarter (23%) thought that training and development could help increase provision. This was the largest survey undertaken to date of dementia practice by Music Therapists in the United Kingdom. It has implications for recruitment, professional development, promotion of the specialism and research.

Music-Based Therapeutic Interventions for People with Dementia: A Mini-Review

The growing population of people with dementia worldwide calls attention to the burdens associated with age-related decline that affects physiology, psychological and cognitive status, and social/emotional wellbeing. The current standards in geriatric care recommend non-pharmacological approaches to these challenges, including safe approaches to managing pain and stress, enhancing symptom relief, and fostering independent lifestyles with the highest quality of life possible. The purpose of this article is to provide definitions of music-based interventions, music therapy applications and clinician qualifications, as well as an umbrella mini-review of meta-analyses regarding music-based interventions for individuals with dementia. Our findings indicate that most descriptions of music therapy protocols in the research lack sufficient detail to enable researchers to compare and replicate studies, and clinicians to apply techniques. Definitions of music therapy and music-based interventions are inconsistent, and practitioners vary in their professional training and preparation for implementing music-based clinical strategies. We recommend that future researchers provide thorough descriptions of music therapy and music-based interventions in their protocols.

Effect of Rhythmic Auditory Cueing on Aging Gait: A Systematic Review and Meta-Analysis

Rhythmic auditory cueing has been widely used in gait rehabilitation over the past decade. The entrainment effect has been suggested to introduce neurophysiological changes, alleviate auditory-motor coupling and reduce cognitive-motor interferences. However, a consensus as to its influence over aging gait is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal gait parameters among healthy young and elderly participants. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until May 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 2789 records, 34 studies, involving 854 (499 young/355 elderly) participants met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e. gait velocity (Hedge's g: 0.85), stride length (0.61), and cadence (1.1), amongst both age groups. This review, for the first time, evaluates the effects of auditory entrainment on aging gait and discusses its implications under higher and lower information processing constraints. Clinical implications are discussed with respect to applications of auditory entrainment in rehabilitation settings.

Comparison of multiple interventions for older adults with Alzheimer disease or mild cognitive impairment: A PRISMA-compliant network meta-analysis

BACKGROUND

The increasing prevalence of Alzheimer disease (AD) emphasizes the need for effective treatments. Both pharmacological therapies such as nutrition therapy (NT) and nonpharmacologic therapies including traditional treatment or personalized treatment (e.g., physical exercise, music therapy, computerized cognitive training) have been approved for the treatment of AD or mild cognitive impairment (MCI) in numerous areas.

METHODS

The aim of this study was to compare 4 types of interventions, physical exercise (PE), music therapy (MT), computerized cognitive training (CCT), and NT, in older adults with mild to moderate AD or MCI and identify the most effective intervention for their cognitive function. We used a system of search strategies to identify relevant studies and include randomized controlled trials (RCTs), placebo-controlled trials evaluating the efficacy and safety of 4 interventions in patients with AD or MCI. We updated the relevant studies which were published before March 2017 as a full-text article. Using Bayesian network meta-analysis (NMA), we ranked cognitive ability based objectively on Mini-Mental State Examination (MMSE), and assessed neuropsychiatric symptoms based on Neuropsychiatric Inventory (NPI). Pairwise and network meta-analyses were sequentially performed for efficacy and safety of intervention compared to control group through RCTs included.

RESULTS

We included 17 RCTs. Fifteen trials (n = 1747) were pooled for cognition and no obvious heterogeneity was found (I = 21.7%, P = .212) in NMA, the mean difference (MD) of PE (MD = 2.1, confidence interval [CI]: 0.44-3.8) revealed that PE was significantly efficacious in the treatment group in terms of MMSE. Five trials (n = 660) assessed neuropsychiatric symptoms with an obvious heterogeneity (I = 61.6%, P = .034), the MD of CCT (MD = -7.7, CI: -14 to -2.4), revealing that CCT was significantly efficacious in NPI.

CONCLUSIONS

As the first NMA comparing different interventions for AD and MCI, our study suggests that PE and CCT might have a significant improvement in cognition and neuropsychiatric symptoms respectively. Moreover, nonpharmacological therapies might be better than pharmacological therapies.

Effect of rhythmic auditory cueing on parkinsonian gait: A systematic review and meta-analysis

The use of rhythmic auditory cueing to enhance gait performance in parkinsonian patients' is an emerging area of interest. Different theories and underlying neurophysiological mechanisms have been suggested for ascertaining the enhancement in motor performance. However, a consensus as to its effects based on characteristics of effective stimuli, and training dosage is still not reached. A systematic review and meta-analysis was carried out to analyze the effects of different auditory feedbacks on gait and postural performance in patients affected by Parkinson's disease. Systematic identification of published literature was performed adhering to PRISMA guidelines, from inception until May 2017, on online databases; Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE and PROQUEST. Of 4204 records, 50 studies, involving 1892 participants met our inclusion criteria. The analysis revealed an overall positive effect on gait velocity, stride length, and a negative effect on cadence with application of auditory cueing. Neurophysiological mechanisms, training dosage, effects of higher information processing constraints, and use of cueing as an adjunct with medications are thoroughly discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance motor performance and quality of life in the parkinsonian community.

Effect of rhythmic auditory cueing on gait in cerebral palsy: a systematic review and meta-analysis

Auditory entrainment can influence gait performance in movement disorders. The entrainment can incite neurophysiological and musculoskeletal changes to enhance motor execution. However, a consensus as to its effects based on gait in people with cerebral palsy is still warranted. A systematic review and meta-analysis were carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal and kinematic parameters of gait in people with cerebral palsy. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and American Academy for Cerebral Palsy and Developmental Medicine guidelines, from inception until July 2017, on online databases: Web of Science, PEDro, EBSCO, Medline, Cochrane, Embase and ProQuest. Kinematic and spatiotemporal gait parameters were evaluated in a meta-analysis across studies. Of 547 records, nine studies involving 227 participants (108 children/119 adults) met our inclusion criteria. The qualitative review suggested beneficial effects of rhythmic auditory cueing on gait performance among all included studies. The meta-analysis revealed beneficial effects of rhythmic auditory cueing on gait dynamic index (Hedge's g=0.9), gait velocity (1.1), cadence (0.3), and stride length (0.5). This review for the first time suggests a converging evidence toward application of rhythmic auditory cueing to enhance gait performance and stability in people with cerebral palsy. This article details underlying neurophysiological mechanisms and use of cueing as an efficient home-based intervention. It bridges gaps in the literature, and suggests translational approaches on how rhythmic auditory cueing can be incorporated in rehabilitation approaches to enhance gait performance in people with cerebral palsy.