Music & Alzheimer's

Am J Alzheimers Dis Other Demen. 2001 Mar-Apr; 16(2):103-8

• Kydd P.
• Sunnyside Home, Kitchener, Ontario, Canada

The purpose of this case study is to illustrate how music therapy can be used to help the elderly successfully adjust to living in a long-term care (LTC) facility. LTC residents, particularly those with Alzheimer's disease or related dementia, may exhibit behaviors such as depression, withdrawal, anxiety, emotional liability, confusion, and memory difficulties, frequently related to the disorder, but often exacerbated by difficulty in adjustment to the change in lifestyle. The subject of this case study demonstrated these symptoms. Music therapy helped him adjust to life in a LTC setting by improving his quality of life and enhancing his relationships with those around him. As chronicled in this study, music therapy may facilitate a resident's adjustment to life in a LTC facility. N.B. Names and identifying information have been changed to protect privacy.

J Music Ther. 2003 Summer; 40(2):138-50

• Brotons M, Marti P.

The purpose of this paper is to present the results of a pilot project sponsored by a private foundation in Spain ("Fundació la Caixa"), in order to demonstrate some of the applications of music therapy, and to measure more systematically some of its effects on people with a probable diagnosis of Alzheimer's Disease and Related Disorders (ADRD) in early-moderate stages of the disease, and their family caregivers. Subjects for this project were 14 patients (5 women and 9 men) with a probable diagnosis of Alzheimer's disease, and 14 family caregivers (9 women and 5 men) from a rural area outside of Barcelona. Their age range was 70 to 80 years. Prior to the beginning of the project, a neuropsychologist specialized in gerontology administered a series of standardized tests to the participants. These same tests were administered again 2 days before the end of the project and 2 months later for follow-up purposes. The results of the satisfaction questionnaire showed that the caregivers perceived an improvement in the social and emotional areas of their patients, and statistical tests showed significant differences between pre and posttest scores in the following tests: (a) Dementia Scale (X2 = 12.29, p = .002), (b) NPI (X2 = 17.72, p = .001), (c) the Cohen-Mansfield agitation scale (X2 = 11.45, p = .003), (d) Burden Interview (X2 = 9.19, p = .01), (e) Memory and Behavior Problems Checklist (frequency subscale) (X2 = 11.09, p = .004), (f) STAI-S (X2 = 14.72, p = .001), and (g) Beck's Depression Inventory (X2 = 9.38, p = .009). These results and their implications are discussed extensively.

J Gerontol Nurs. 2008 Oct; 34(10):45-52

• Witzke J, Rhone RA, Backhaus D, Shaver NA
• William Jewell College, Department of Nursing, Liberty, Missouri, USA

The purpose of this article is to provide an evidence-based synthesis of the research literature on music intervention for agitated behavior in Alzheimer's dementia. A qualitative review of the literature supported music as a low-cost, simple alternative to traditional methods of management, with minimal risk to the client. A rating system assigning levels of evidence to support these interventions was used, and implications for nursing practice innovations and further research are discussed.

J R Soc Promot Health. 2008 Mar; 128(2):73-8

• Bannan N, Montgomery-Smith C.
• University of Western Australia, School of Music, 35 Stirling Highway, Crawley WA 6009, Australia

The paper reports the activities of a pilot study of group singing for people with Alzheimer's and their carers, and presents data arising from the study. AIMS: The project aimed to answer the following questions: Would people with Alzheimer's be able to participate in group singing? Would progress be identifiable in participants' singing? Would responses to the activity be positive? Would participating carers find the activity worthwhile? Additionally, the following question was posed: Within the supportive environment of group singing, might people with Alzheimer's be able to participate in a song that they had to learn? METHODS: Songs were selected that would be familiar to participants aged over 40 years, and one original song was introduced by the group leader following a successful session. The group leader did not know which of the participants were patients with Alzheimer's and which were carers. Participants sat in a circle in a resonant hall. Sessions were filmed and a separate audio recording made and subsequently analysed, and questionnaires were completed by carers after sessions. RESULTS: Nine hours of video recording, three hours of audio recording and three collated questionnaires (one for each session) were collected. Confidence grew over the three sessions, with a traceable development in the alertness of many of the people with Alzheimer's. It proved possible to divide the group so as to sing two songs simultaneously, and also so as to perform three- and four-part rounds. It proved possible to teach an unknown song. Carers generally felt that the sessions were of value. CONCLUSIONS: People with Alzheimer's are able to participate in group singing and some longer-term benefits are perceived by their carers. In a group activity such as Singing for the Brain it is difficult to be certain how the overall effect arises from the interaction of individuals. The data assembled is difficult to submit to clinical testing, relying as it does on the judgement of participants regarding reported recall of the content of sessions on the part of people with Alzheimer's. Further research questions are raised by the success of this project.

J Music Ther. 2007 Winter; 44(4):329-43

• Ziv N, Granot A, Hai S, Dassa A, Haimov I.
• Max Stern Academic College of Emerk Yizre'el, Israel

Previous studies have demonstrated the benefits of music therapy in Alzheimer's patients, focusing either on improvement of healthy cognitive and social skills, or reduction of agitation symptoms. The present study examined the effect of background music on both positive and negative behaviors, during a time in which patients were not occupied with any structured activity. Twenty eight participants were observed both with and without stimulative, familiar background music. Results showed both a significant increase in positive social behaviors and a significant decrease in negative behaviors related to agitation when music is played. Results demonstrate the contribution of music to enhancing general positive functioning in elderly patients with dementia, and reducing negative behaviors typical of their condition.

Hu Li Za Zhi. 2006 Oct; 53(5):58-62

• Sung HC, Chang AM, Abbey J.
• Department of Nursing, Tzu Chi College of Technology

Older people with dementia may display negative emotions, memory problems, sleep disturbance, and agitated behavior. Among these symptoms, agitated behavior has been identified by families and nursing staff as the care problem that presents the greatest challenge. Several studies have found that music therapy reduced agitated behaviors in those with dementia and recommended use of music as an effective strategy in managing this behavioral problem. Music therapy represents a lower cost, effective care approach that nursing staff can easily learn and apply to those with dementia. Furthermore, reductions in agitated behavior in dementia patients that result from music therapy can also alleviate caregiver stress and burden of care, leading to improvements in the health and quality of life of both dementia patients and their caregivers. This paper aims to introduce the principles and application of music therapy in the management of agitated behavior in those with dementia.

Int Psychogeriatr. 2006 Dec; 18(4):623-30

• Holmes C, Knights A, Dean C, Hodkinson S, Hopkins V.
• School of Medicine, University of Southampton, UK

BACKGROUND: A recent Cochrane report concluded that more and better quality research is required to investigate the effectiveness of music therapy in reducing problems in behavioral, social, emotional and cognitive domains in patients with dementia. This randomized placebo-controlled trial with blinded observer rater aimed to explore whether music, live or pre-recorded, is effective in the treatment of apathy in subjects with moderate to severe dementia. METHODS: Thirty-two subjects meeting ICD-10 diagnostic criteria for moderate to severe dementia and fulfilling diagnostic criteria for apathy were exposed to live interactive music, passive pre-recorded music or silence for 30 minutes. Each subject was randomized to 30-minute music or silent periods and was video recorded and the muted recording analyzed every 3 minutes using dementia care mapping to assess the quality of engagement to the blinded music intervention. RESULTS: Compared to low baseline levels of positive engagement (12.5%) in the silent placebo period, the majority of subjects (69%), regardless of dementia severity, showed a significant and positive engagement to live music. Engagement to pre-recorded music was non-significant, with just 25% of all subjects showing positive engagement. No subjects showed any evidence of experiencing a state of ill-being during either the live or pre-recorded music sessions. CONCLUSIONS: During the intervention, live interactive music has immediate and positive engagement effects in dementia subjects with apathy, regardless of the severity of their dementia. Pre-recorded music is non-harmful but less clearly beneficial.

Dement Geriatr Cogn Disord. 2006; 22(1):108-20. Epub 2006 May 23

• Irish M, Cunningham CJ, Walsh JB, Coakley D, Lawlor BA, Robertson IH, Coen RF.
• Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland

The enhancing effect of music on autobiographical memory recall in mild Alzheimer's disease individuals (n = 10; Mini-Mental State Examination score >17/30) and healthy elderly matched individuals (n = 10; Mini-Mental State Examination score 25-30) was investigated. Using a repeated-measures design, each participant was seen on two occasions: once in music condition (Vivaldi's 'Spring' movement from 'The Four Seasons') and once in silence condition, with order counterbalanced. Considerable improvement was found for Alzheimer individuals' recall on the Autobiographical Memory Interview in the music condition, with an interaction for condition by group (p < 0.005). There were no differences in terms of overall arousal using galvanic skin response recordings or attentional errors during the Sustained Attention to Response Task. A significant reduction in state anxiety was found on the State Trait Anxiety Inventory in the music condition (p < 0.001), suggesting anxiety reduction as a potential mechanism underlying the enhancing effect of music on autobiographical memory recall.

Int Psychogeriatr. 2006 Dec; 18(4):613-21. Epub 2006 Apr 18

• Svansdottir HB, Snaedal J.
• Geriatric Department, Landspitali University Hospital, Reykjavik, Iceland

BACKGROUND: Music therapy is a potential non-pharmacological treatment for the behavioral and psychological symptoms of dementia, but although some studies have found it to be helpful, most are small and uncontrolled. METHODS: This case-control study was carried out by qualified music therapists in two nursing homes and two psychogeriatric wards. The participants were 38 patients with moderate or severe Alzheimer's disease (AD) assigned randomly to a music therapy group and a control group. RESULTS: The study showed a significant reduction in activity disturbances in the music therapy group during a 6-week period measured with the Behavior Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). There was also a significant reduction in the sum of scores of activity disturbances, aggressiveness and anxiety. Other symptoms rated by subscales of the BEHAVE-AD did not decrease significantly. Four weeks later the effects had mostly disappeared. CONCLUSIONS: Music therapy is a safe and effective method for treating agitation and anxiety in moderately severe and severe AD. This is in line with the results of some non-controlled studies on music therapy in dementia.

Zhongguo Zhen Jiu. 2005 Jun; 25(6):390-2

• Liu G, Yuan LX.
• College of Acupuncture and Massage, Guangzhou University of TCM, Guangdong 510405, China

OBJECTIVE: To find the method for increasing clinical therapeutic effect on Alzheimer disease (AD). METHODS: The patients of AD meeting American NINCDS-ADRDA Criteria were randomly divided into group A and group B. The group A (n = 21) were treated with acupuncture for 10 courses, 10 sessions constituting one course; and the group B (n = 20) were treated with combination of acupuncture and music therapy. The acupuncture method was the same as the group A and the music therapy was given for 20 sessions, once every 5 days. After treatment, their effectiveness were evaluated with the Mini-Mental State Examination (MMSE) and Activities of Daily Living (ADL). RESULTS: After treatment, the scores for MMSE increased significantly (P < 0.05) and the scores for ADL decreased significantly (P < 0.05) in the both groups, and the therapeutic effect in the group A was better than the group B (P < 0.05). CONCLUSION: Acupuncture combined with music therapy can increase the therapeutic effect on AD.

Nippon Ronen Igakkai Zasshi. 2005 Jan; 42(1):74-82

• Suzuki M, Kanamori M, Nagasawa S, Saruhara T.
• School of Nursing, Mie Prefectural College of Nursing

The purpose of this study was to clarify the efficacy of behavioral, stress and immunological evaluation methods in music therapy (MT) with elderly patients with senile dementia. The MT group consisted of 8 elderly patients with dementia and the control group included 8 similarly matched patients. A total of 25 sessions of music therapy were conducted for one hour, twice each week for three months. The Mini-Mental State Exam (MMSE), Gottfries-Brane-Steen Scale (GBS), and Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD) were used to evaluate behavioral changes. Saliva Chromogranin A (Cg A) and Immunoglobulin A (Ig A) were used to assess changes in stress and immunological status, respectively. The results of the study were as follows: 1. In GBS, the mean score of "different symptoms common in dementia" improved significantly after MT. 2. The mean Behave-AD score of "paranoid and delusional ideation" was also significantly improved (p<0.05) after the intervention. 3. In the 25th session, mean saliva Cg A was significantly decreased after MT (p<0.05). IgA was slightly increased prior to intervention. Our results suggest that a combination of behavioral, stress and immunological evaluation methods were valuable for assessing changes that occurred during MT for elderly patients with dementia.

Int Psychogeriatr. 2003 Dec; 15(4):411-30

• Götell E, Brown S, Ekman SL.
• Neurotec Department, Center for Excellence in Elderly Care Research (CECAR), Karolinska Institutet, Huddinge, Sweden

BACKGROUND AND AIM: Previous research suggested caregiver singing could influence persons with severe dementia to communicate with increased competence, to cease aggression, and to cease disruptive screaming, while at the same time they seemed to understand what was going on when being cared for during morning care sessions. The aim of this study was to illuminate the posture, body movements, and sensory awareness of patients with dementia during three types of morning care sessions with professional caregivers: (a) the usual morning care situation, (b) a caring session in which familiar background music was played, and (c) a caring session in which the caregiver sang to and/or with the patient throughout. Nine patients with late-stage dementia and 5 professional caregivers participated in this study, and 27 sessions were videotaped (9 patients x 3 caring situations). DATA COLLECTION AND METHOD: Data collection was done by means of video recording and the data were analyzed using qualitative content analysis. RESULTS: During the usual caring situation, patients demonstrated slumped posture, sluggish and asymmetric motion, listlessness, minimal awareness of both egocentric space and the physical environment, and a poor ability to perform to completion activities necessary for personal care. Both background music playing and caregiver singing had strong influences on the body and on sensory awareness. Patients had straightened posture, stronger and more symmetric movements, and a greatly increased awareness of themselves and their environment. Patients appeared to regain skills necessary for daily living, and demonstrated that they could perform tasks with intention, purpose, and competence. Caregiver singing, in particular, was very effective at drawing out capabilities that appeared to be lost in these patients. In addition, caregiver singing elicited a larger degree of mutuality in the interaction between patient and caregiver than was seen with background music. DISCUSSION: These results provide further support for the use of caregiver singing in dementia care, and the findings on how caregiver singing can be used to help in dementia caring situations are discussed.

J Music Ther. 2000 Fall; 37(3):183-95

• Brotons M, Koger SM.
• Psychology Department, Willamette University, Salem, OR 97301, USA

Dementias, such as Alzheimer's disease, include a progressive deterioration of language functioning. While some researchers have reported an increase in patients' self-expression following music therapy, it is not clear whether these changes specifically reflect improved language skills or whether simple interpersonal interaction with a therapist could account for the improvement. In this study, the effects of music therapy were compared to conversational sessions on language functioning in dementia patients. Participants were selected according to the following criteria: (a) residing in a facility specializing in Alzheimer's and related disorders; (b) possessing sufficient verbal ability to answer simple questions and to comply with requests to speak, participate, or sit down; and (c) attaining the written consent of the patient's guardian or representative. All participants had been in music therapy twice per week for at least 3 months prior to the study onset. One week prior to the beginning of the study, subjects were assessed for cognitive functioning using the Mini-Mental State Examination (MMSE), and language ability via the Western Aphasia Battery (WAB). A within-subjects design was used, with order of condition (music or group conversation first) counter-balanced between participants. Subjects participated in groups of 2 to 4, twice per week for 20-30 minutes for a total of 8 sessions (4 music therapy and 4 conversation sessions or vice-versa), and were re-tested on the WAB at the end of each 2 week (4 session) interval. Results from 20 participants revealed that music therapy significantly improved performance on both speech content and fluency dimensions of the spontaneous speech subscale of the WAB (p =.01). While the difference in overall Aphasia Quotient (AQ) for music and conversation sessions (mean AQ = 76 vs. 70, respectively) did not reach statistical significance, data were only available for 10 participants (5 per condition). Hopefully, these findings will stimulate additional research on the use of music therapy interventions with demented patients, as it may offer a noninvasive mechanism to enhance communication between victims and their caregivers.

Int Psychogeriatr. 2000 Mar; 12(1):49-65

• Gerdner LA.
• Health Services Research and Development, Center for Mental Healthcare & Outcomes Research, Veterans Administration, University of Arkansas for Medical Sciences, Little Rock, USA

Confusion and agitation in elderly patients are crucial problems. This study tested Gerdner's mid-range theory of individualized music intervention for agitation. An experimental repeated measures pretest-posttest crossover design compared the immediate and residual effects of individualized music to classical "relaxation" music relative to baseline on the frequency of agitated behaviors in elderly persons with Alzheimer's disease and related disorders (ADRD). Thirty-nine subjects were recruited from six long-term-care facilities in Iowa. The sample consisted of 30 women and 9 men (mean age 82 years) with severe cognitive impairment. Baseline data were collected for 3 weeks. Findings from the Modified Hartsock Music Preference Questionnaire guided the selection of individualized music. Group A (n = 16) received individualized music for 6 weeks followed by a 2-week "washout" period and 6 weeks of classical "relaxation" music. Group B (n = 23) received the same protocol but in reverse order. Music interventions were presented for 30 minutes, two times per week. The Modified Cohen-Mansfield Agitation Inventory measured the dependent variable. A repeated measures analysis of variance with Bonferroni post hoc test showed a significant reduction in agitation during and following individualized music compared to classical music. This study expands science by testing and supporting a theoretically based intervention for agitation in persons with ADRD.

Altern Ther Health Med. 1999 Nov; 5(6):49-57

• Kumar AM, Tims F, Cruess DG, Mintzer MJ, Ironson G, Loewenstein D, Cattan R, Fernandez JB, Eisdorfer C, Kumar M.
• Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, FL 33101, USA

CONTEXT: Music therapy is known to have healing and relaxing effects. Although these effects appear to be mediated by release of neurotransmitters and neurohormones, the specific neurohormonal systems involved have not been fully investigated. OBJECTIVE: To assess the effects of a music therapy intervention on concentrations of melatonin, norepinephrine, epinephrine, serotonin, and prolactin in the blood of a group of patients with Alzheimer's disease. DESIGN: Blood samples were obtained before initiating the therapy, immediately at the end of 4 weeks of music therapy sessions, and at 6 weeks follow-up after cessation of the sessions. SETTING: Miami Veterans Administration Medical Center, Miami, Fla. PATIENTS: 20 male inpatients with Alzheimer's disease. INTERVENTION: 30- to 40-minute morning sessions of music therapy 5 times per week for 4 weeks. MAIN OUTCOME MEASURES: Changes in melatonin, norepinephrine, epinephrine, serotonin, and prolactin following music therapy. RESULTS: Melatonin concentration in serum increased significantly after music therapy and was found to increase further at 6 weeks follow-up. A significant increase was found between baseline values and data recorded after the music therapy sessions as well as at 6 weeks follow-up. Norepinephrine and epinephrine levels increased significantly after 4 weeks of music therapy, but returned to pretherapy levels at 6 weeks follow-up. Serum concentration of prolactin and platelet serotonin levels remained unchanged after 4 weeks of music therapy and at 6 weeks follow-up. CONCLUSION: Increased levels of melatonin following music therapy may have contributed to patients' relaxed and calm mood.

J Gerontol Nurs. 1998 Jul; 24(7):10-7

• Clark ME, Lipe AW, Bilbrey M.
• Tennessee Technological University, Cookeville, USA

The purpose of this study was to examine the effects of recorded, preferred music in decreasing occurrences of aggressive behavior among individuals with Alzheimer's type dementia during bathing episodes. Eighteen older adults, age 55 to 95, with severe levels of cognitive impairment, participated in the study. They were randomly scheduled for observation during bath time under either a control (no music) condition or an experimental condition in which recorded selections of preferred music were played via audiotape recorder during the bathing episode. Following a 2-week (10 episode) observation period, conditions were reversed. A total of 20 observations were recorded for each individual. Results indicated that during the music condition, decreases occurred in 12 of 15 identified aggressive behaviors. Decreases were significant (p < 0.05) for the total number of observed behaviors and for hitting behaviors. During the music condition, caregivers frequently reported improved affect and a general increase in cooperation with the bathing task. The implications of these findings for improving the overall quality of care for severely cognitively impaired older adults are discussed.

Biomed Pharmacother. 1994; 48(7):275-81

• Aldridge D.
• Medizinische Fakultät, Universität Witten Herdecke, Germany

Active music-making provides a form of therapy for the Alzheimer's patient which may stimulate cognitive activities such that areas subject to progressive failure are maintained. Anecdotal evidence suggests that quality of life of Alzheimer's patients is significantly improved with music therapy, accompanied by the overall social benefits of acceptance and sense of belonging gained by communicating with others. Music therapy, when based on clear treatment objectives can reduce the individual prescription of tranquilizing medication, reduce the use of hypnotics and help overall goals of rehabilitation. Mood improvement and self-expression, the stimulation of speech and organisation of mental processes; and sensory stimulation and motor integration are promoted. Given that the rate of deterioration in Alzheimer's disease is not predictable, a series of single case experimental designs would generate valuable empirical data concerning treatment outcome and promote basic research into the timing functions required for the co-ordination of cognition, physiology, motor ability and the integrity of behaviour.

J Gerontol Nurs. 1992 Jan; 18(1):3-9

• Glynn NJ.

1. Empirical research is needed to evaluate immediate and sustained physiological, psychological, and psychosocial therapeutic effects, if any, of music therapy on behavioral patterns of elderly institutionalized Alzheimer's patients. 2. The Music Therapy Assessment Tool (MTAT) was specifically designed and developed to assess the effects of music therapy on behavioral patterns of Alzheimer's disease patients. 3. Preliminary testing of the MTAT suggests that it has fairly high internal consistency and inter-rater reliability and warrants consideration as a research tool. 4. Musical intervention included familiar music to facilitate communication and socialization, ethnic and nostalgic music to stimulate reminiscence, and melodies with distinctive rhythmic patterns to enhance movement and behavioral repatterning.