Musical Effects on Agitation in Dementia

Music Intervention Effects

In the next research published in Frontiers in Psychology journal systematic review of several studies supporting the effectiveness of music on agitation in dementia was conducted. A total of 658 participants were involved in the included 12 studies (Pedersen et al., 2017). Four studies included people with vascular dementia, mixed type dementia, Alzheimer’s disease, frontotemporal dementia, and Lewy body dementia. Five of the studies included only people with Alzheimer’s disease, and the other three studies did not clarify the type of dementia. The degree of severity of the disease ranged from mild to severe, giving a broader spectrum of music therapy effectiveness. The music interventions were performed in different forms, including CD players, listening to music through headphones, and live concerts. The obtained effect size of the 12 studies for exploring the music effectiveness on agitation was d = 0.61 with a 95% confidence interval (CI) of 0.38–0.84 (Pedersen et al., 2017). The results indicate that music intervention significantly reduces agitated behaviors in demented people.

Music Therapy for Managing Neuropsychiatric Symptoms for People with Dementia

Music therapy has shown its potential effectiveness as a psychosocial intervention for people with dementia and for the prevention of agitation/aggressive behavior. Thus, the research published in BMC Geriatrics journal has shown that the music therapy program appeared to be practicable and acceptable in managing dementia symptoms (Flowerdew et al., 2015). In this research, 17 care home residents were randomized to the music therapy intervention group. The controlled trial included baseline, three months, five months, and post-intervention seven months measures of the symptoms and well-being of patients. Patients’ and carers’ feedback using semi-structured interviews, track records, and program evaluations were used as the basis to assess feasibility. 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 (Flowerdew et al., 2015). The results support the effectiveness of weekly active individual music therapy sessions.

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The Music Engagement Program for people with Alzheimer’s disease and dementia

In the research published in Evaluation and Program Planning journal, participants were 16 residents, six staff, and three family and community members (Gulliver et al., 2021). Residents were currently residing at the secure, privately owned residential aged-care nursing home. They were required to be living with advanced dementia or Alzheimer’s disease (Gulliver et al., 2021). During the session, the facilitator verbally asked the residents about any musical requests and selected these songs to be performed by the group. Residents were also encouraged to lead songs with increasing ability over time. There was a reduction in participants’ depression (Cornell scale) scores from pre- (M = 9.53, SD = 3.60) to post-intervention (M=5.27, SD = 3.61), indicating an improvement in overall depression symptoms (Gulliver et al., 2021). Findings also indicated a positive effect on dementia symptoms, preventing agitation or aggression.

Music & Memory reduces dementia and aggression

In the next research, scientists collaborated with the California Association of Health Facilities (CAHF) on the $1.4 million quality improvement initiative aimed at improving dementia care in skilled nursing facilities (Bakerjian et al., 2020). The researchers used the music program founded by Dan Cohen as a non-pharmacological intervention. The program trains nursing home staff and other healthcare professionals who care for the elderly. In addition, it included how to create and deliver personalized playlists using iPod / MP3 players and associated digital audio systems to help those battling Alzheimer’s and dementia. A three-year study of 4,107 residents found the use of antipsychotic drugs declined by 13%, and anti-anxiety medications declined by 17% each quarter for residents with dementia using the music program. (Bakerjian et al., 2020). The odds of depressive symptoms decreased 16% per quarter, and the odds of reported pain decreased 17% per quarter. In addition, the number of days on medications declined by 30%, and aggressive behaviors reduced by 20%.

Measuring Effects of Music Therapy on Patients with Alzheimer’s disease

The first summary analyses the collaborative study published in the Journal of the American Geriatrics Society (McCreedy et al., 2019). In their research, scientists discuss the effect of an individualized music program on patients with Alzheimer’s disease and related dementias. Forty-five individuals with dementia, the residents of four US nursing homes (NH), participated in the research. Their behaviors were measured in three ways; Agitation Behavior Mapping Instrument (ABMI), Cohen‐Mansfield Agitation Inventory (CMAI), and the Minimum Data Set–Aggressive Behavior Scale (MDS‐ABS) were used as measuring tools. The NHs staff systemically interviewed the participants, and their behaviors were measured throughout the research. The study reveals that listening to familiar music using a personal player contributed to decreasing aggression and agitation behaviors for all patients. It also emphasized the importance of personal interviews with patients during the individual therapy program.

Active Group Music Intervention versus Group Music Listening

The second study introduced in this research paper compares the effects of a music intervention program with group music listening on the behavior of patients with Alzheimer’s. Ninety patients with AD from six NHs participated in the research. The NHs were randomly assigned one of three options: active group music therapy (AMT), group music listening, or the usual care. In the study, active listening is combined with receptive music tasks that engage multiple brain areas, while group listening limits therapy to passive listening (Gómez-Gallego et al., 2021). Patients’ behaviors were systematically measured; Neuropsychiatric Inventory (NPI) was used to evaluate behavioral changes, and symptoms such as anxiety, aggression, and depression were measured on a scale from 1 to 3. The research concludes that active listening is significantly more effective in reducing negative behavioral symptoms in AD patients. Active music intervention is an efficient complement treatment to improve behavioral symptoms of the disease.

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Emergence of Positive Behaviors after the Onset of Dementia

While studies about AD and related dementias typically focus on the deterioration of patients’ cognitive skills and general condition, which either occurs or does not, the following article deals with positive behaviors that can develop after the onset of dementia. This study included forty-eight caregivers of patients with primary progressive aphasia (PPA), who were interviewed about positive changes in their patients’ behavior and what had influenced it (Midorikawa et al., 2017). Art therapy, music, and other activities played a crucial part in this research focusing on developing new positive behaviors. Hypersensory and Social/Emotional Scale (HSS) was used to assess positive behavioral changes. A complex survey of carers revealed that after the onset of dementia, positive behaviors and practices, such as listening to music, singing, or taking pictures or drawing can be established. The ability of a patient to develop novel positive behaviors varied primarily with relation to the duration of the disease.

The meta-analysis deals with different music therapies, evaluating which one was more effective: receptive music therapy or interactive one (Tsoi et al., 2018). The study involves 1418 patients with dementia, randomly identified through databases. With thirty-eight trials concluded, authors suggest that receptive therapy is significantly more efficient in improving patients’ mood and reducing anxiety than an interactive one. While interactive therapy did not demonstrate significant difference from usual care, receptive music therapy proved to be highly efficient in reducing patients’ depression and anxiety.

References

Bakerjian, D., Bettega, K., Cachu, A. M., Azzis, L., & Taylor, S. (2020). The impact of music and memory on resident level outcomes in California nursing homes. Original study, 21(8). Web.

Flowerdew, R., Hsu, H. H., Parker, M., Fachner, J., & Miller, H. O. (2015). Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: A cluster randomised controlled feasibility study. BMC Geriatrics, 15(84).

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Gómez-gallego, M., Gallego-mellado, M., & García-garcía, J. (2021). Comparative efficacy of active group music intervention versus group music listening in Alzheimer’s disease. International Journal of Environmental Research and Public Health, 18(15), 8067. Web.

Gulliver, A., Pike, G., Banfield, M., Morse, A. R., Katruss, N., Valerius, H., Pescud, M., Master, M., & West, S. (2021). The Music Engagement Program for people with Alzheimer’s disease and dementia: Pilot feasibility trial outcomes. Evaluation and Program Planning, 87(101930). Web.

Mccreedy, E. M., Yang, X., Baier, R. R., Rudolph, J. L., Thomas, K. S., & Mor, V. (2019). Measuring effects of nondrug interventions on behaviors: Music & memory pilot study. Journal of the American Geriatrics Society (JAGS), 67(10), 2134-2138.

Midorikawa, A., Kumfor, F., Leyton, C. E., Foxe, D., Landin-romero, R., Hodges, J. R., & Piguet, O. (2017). Characterisation of “positive” behaviours in Primary Progressive Aphasias. Dementia and Geriatric Cognitive Disorders, 44(3-4), 119-128. Web.

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Pedersen, K. A., Andersen, P. N., Lugo, R. G., Andreassen, M., & Sutterlin, S. (2017). Effects of music on agitation in dementia: A meta-analysis. Frontiers in psychology, 8(742).

Tsoi, K., Chan, J., Ng, Y. M., Lee, M., Kwok, T., & Wong, S. (2018). Receptive Music Therapy Is More Effective than Interactive Music Therapy to Relieve Behavioral and Psychological Symptoms of Dementia: A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association, 19(7), 568–576.e3. Web.

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