Music therapy for Alzheimer's disease

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For patients with Alzheimer's disease, music therapy provides a beneficial interaction between a patient and an individualized musical regimen and has been shown to increase cognition and slow the deterioration of memory loss. [1] Music therapy is a clinical and evidence-based intervention that involves music in some capacity and includes both a participant and a music therapist who have completed an accredited music therapy program. [2] [3] [4] [5]

Contents

The forms of music therapy are broad in nature, and can range from individual or group singing sessions, to active participation in music making, to listening to songs individually. [4] [6] Alzheimer's disease (AD) is a fatal condition that continuously deteriorates brain chemistry over time. Accounting for more than 60% of the dementia in older people, AD gradually leads to detrimental effects on cognitive function, linguistic abilities, and memory. [7] Within populations living with Alzheimer's, music therapy is sometimes used to assist in palliating the behavioral and psychological symptoms of this disease. [4] [5] [6] [8] [9] Music therapy is based in scientific findings and can elicit change in individuals as well as groups through music. [10] Personalized music therapy has been shown in some cases to be able to lessen certain symptoms, including behavioral symptoms, such as physical or verbal outbursts and hallucinations, and cognitive symptoms related to dementia. [11] [5] [12]

This personalized treatment approach has also been utilized in music therapy which, in comparison to pharmacological treatments, is a very low-cost solution to help manage aspects of the disease throughout the progression of the disease. It is also a preferable way of additional treatment over medications for behavioral symptoms (i.e. anti-depressants), as side effects are avoided. Because of the recognized decreases in behavioral outbursts, music therapy has been recognized as a care plan that is beneficial to the patient as well as the caretaker. [13] [14] However, the effects of music therapy on individuals with Alzheimer's disease have proven to be short-term, lasting a maximum of three months after the discontinuation of treatment. [7]

Recent research

Currently, there is no known cure for Alzheimer's disease, though a range of medications and alternative therapy options have shown to be effective in mitigating the progression of the disease. Medication-based treatments such as the use of low dose Leuco-Methyltioninium (LMTM) were shown to be most effective at higher doses of around 100 mg daily; unfortunately, these higher doses were shown to cause severe gastrointestinal and urinary reactions. [15] Due to the physiologically destructive nature of Alzheimer's disease, many medications that are able to slow physical deteriorations also offer many unwanted side effects because of their harsh nature. [15] While cognitive interventions such as the use of primarily computer-based training programs have shown high efficacy in improving delayed memory, recognition, clock-drawing, digit forward and digit backward tests, these programs can be expensive and present learning barriers to the senior populations who prefer the traditional pencil-and-paper methods. Aside from medication and cognition based treatments, music therapy offers a cheaper intervention that reduces the stress and side effects associated with other treatment options.

Music therapy has been studied in the psychological community and has been found to be effective in reducing behavioral symptoms as well as positively influencing emotional and cognitive well-being. In one study, Alzheimer's patients in 98 nursing homes were exposed to music therapy and the results were compared to 98 controls that were not exposed to music therapy. The results suggested that this program helped reduce the use of medication, in combination with the reduction of behavioral and physiological symptoms of dementia. [16] This is the first empirical study to show that the Music and Memory program, described below, exhibits efficacy in reducing antipsychotic and anxiolytic medicine use behavioral and psychological symptoms of dementia. [17] Additionally, another study found that music therapy demonstrated sedative and relaxing effects on patients. Certain neurotransmitter levels, such as norepinephrine and epinephrine, had significantly higher levels after four weeks of music therapy. [9] Music therapy has also been found to help slow down deterioration of linguistic ability. [6]

Similarly, a study was conducted that had Alzheimer's patients in nursing home facilities assigned to one of three activities: play puzzles, paint, or listen to music from the patients' youth. When tested six months later, those who listened to music were more alert and in better moods and had greater recall of their own personal events when compared to the groups who painted or played with puzzles. [12]

Research has even suggested that Alzheimer's patients may be capable of learning entirely new music. Alzheimer's patients were taught an original song by a group leader and over the course of three sessions, there was visible improvements and increased alertness among Alzheimer's patients. Alzheimer's patients have experienced growth in alertness, as well as, the remarkable retrieval of memories that they attach to whatever song they are being exposed to. Music makes physical and emotional connections that trigger memories that wouldn't have otherwise been retrieved if it weren't for the rhythm, melody, and melodic phrasing of the given musical piece; in many cases, music has been said to be one of the last things that an Alzheimer's patient forgets how to do (usually attributed to muscle memory). Learning new songs was possible. [18] Additionally, another study found similar results and found that Alzheimer's patients when prompted could remember new songs and tunes that were taught to them. They found that with regular practice, Alzheimer's patients could, in fact, learn new music. [19]

Additionally, a qualitative study summarized 21 studies conducted since 1985 on those with Alzheimer's disease and the effect of music therapy. These studies varied in nature, but the authors concluded that music therapy can be a successful intervention and can improve both cognitive and emotional behaviors, as well as decrease some of the behavioral issues associated with Alzheimer's disease. [5] While the methods were varied in nature, the converging evidence in the various experiments lend optimism for the validity of music therapy in this subset of the population.

One dissertation published in 2021 included 43 elderly female Americans in 3 East coast rehabilitation centers for dementia who went through a 5-week individualized singing intervention. The results of the study highlight the importance of individualization when it comes to music-based interventions (MBIs) and dementia, as high participation individuals showed much greater cognitive, functional, and narrative improvements than those that participated less. The individualized selection of familiar, nostalgic, and new songs combined with a personalized tonal key and rhythm that best fit the patient's vocal and physical abilities was vital to realizing these improvements. [20]

Constraints with research

However, some of the current research does not support the fact that all musical memory is preserved in patients with Alzheimer's disease. A paper reviewing eight case studies and three group studies, found that certain kinds of musical memory, such as remembering familiar music from one's youth, might not be preserved. However, of the Alzheimer's patients that were musicians, greater retention of musical memory was preserved compared to those without prior musical experience. This research suggests that music therapy may not be effective in the same capacity for every patient affected by Alzheimer's disease, and that differences may be highly variable in nature. While it is logical that treatment works on a case-by-case basis, it is important to remember that individuals react differently to any treatment, and results vary. [21] This study also highlights that there are huge methodological differences in the different kinds of studies, providing difficulty for synthesizing across information and study designs. This research highlights an important understanding with these studies, since most of them lack a control group so drawing causal conclusions becomes impossible. A more recent review of music training-induced neuroplasticity marks the inconsistencies as a result of varying study designs and between-subject comparisons, emphasizing the importance of longitudinal within-subject designs for future research. [22]

Future Research

Recently, new combinations of MBIs with other noninvasive methods have been proposed to bolster the efficacy of treatment. One such proposal published in 2020 presented a new clinical framework of combining MBIs with more recent Gamma-frequency sensory stimulation approaches as to noninvasively treat neurodegenerative disorders. They suggest that such a combination could enhance MBIs through the targeting of multiple biomarkers of dementia while activating auditory-reward networks. [23] They suggest that such interventions would be most effective at the mild cognitive impairment (MCI) stage for slowing/reversing cognitive decline, as the resting-state connectivity of auditory and reward systems in the brain have been shown to be heightened in MCI patients compared to AD and even healthy control patients. [23] [24]

Music & Memory program

Music programs in general have been newly investigated as a more formal and structured way to alleviate cognitive impairments associated with Alzheimer's disease and other related dementias. Providing five sessions of music-based therapy has been found to generally improve behavioral problems, reduce anxiety, and enhance the emotional well-being. [25] In contrast, however, no clear evidence about music's effect on aggression or agitation was observed. [25] The MUSIC & MEMORY® program has been recognized as the most widely used music treatment strategy and its efficacy has been studied by psychologists and noted positively in several formal studies, including a 2018 study by the University of Utah Health in Salt Lake City. [26] [17] The MUSIC & MEMORY® Program, developed by Dan Cohen, MSW, in 2006 has helped increase awareness and efficacy of music therapy in relation to Alzheimer's and other related dementias. [27] This specific program trains nursing home staff and other elder care professionals, as well as family caregivers, how to create and provide personalized playlists using iPods/mp3 players and related digital audio systems. The utilization of these technologies enable those struggling with Alzheimer's, dementia and other cognitive and physical challenges to reconnect with the world through music-triggered memories. By providing access and education, and by creating a network of MUSIC & MEMORY® Certified organizations, the institution aims to make this form of personalized therapeutic music a standard of care throughout the health care industry. [28] [27] As of 2020, Music & Memory has certified over 5,300 organizations in the United States, including state-sponsored projects in California, Texas, Ohio, and Wisconsin. [29] [17] The programs wide range of influence is estimated to have affected over 75,000 patients to date. [17]

At the Columbia Health Care Center in Wyocena, Wisconsin, the efficacy of the MUSIC & MEMORY® program was tested as a means of treating dysphagia in those with advanced dementia. Patients were instructed to listen to an individualized playlist half an hour daily before supper. They found indications of enhanced swallowing mechanism, less choking during supper, improved overall nutritional status and reduced weight loss, reduced need for speech interventions, and an enhanced quality of life. One patient had to be removed from the study due to over stimulation with the iPod, and thus these results stemmed from four participants. [30]

Power of music

Music influences many regions of the brain including those associated with emotional and creative areas. Because of this, music has the power to evoke emotion and memories from deep in the past, so it is logical that Alzheimer's patients have the ability to recall musical memories from many decades prior given the richness and vividness of these memories. [31] Music memory can be preserved for those living with Alzheimer's disease and brought forth through various techniques of music therapy. [21] Initial research has suggested that reminiscence music can be associated with daily tasks to aid in their successful completion and reduce the burden on caregivers. [32] [13] Areas of the brain that are influenced by music are one of the last regions to degenerate due to the progression of Alzheimer's disease. [33]

Music therapy has a positive effect on immediate and delayed word recall in mild AD patients. In a clinical setting, short and long-lasting stimulations by music were shown to have a positive effect on both category fluency in verbal tasks as well as fluency and speech content. Music therapy was also found to be effective in controlling the psychiatric and behavioral side-effects of AD, causing a decrease in caregiver distress as well as an increase in quality of life. [7]

Alzheimer's patients can often remember songs from their youth even when far along in the progression of their disease. Dementia facilities the use music as a means of entertainment, since it often brings joy and elicits memories. [8] Alive Inside describes that music activates more parts of the brain than any other stimulus and records itself in our motions and emotions. [34] The movie describes that these are the last parts of the brain touched by Alzheimer's. [34]

Music therapists have the capability to develop relationships and bonds with their patients, especially through repeated sessions. Music can help with an adjustment toward unfamiliar environments as well as settings that trigger memories from deep in the past. [35] These sessions can often lead to uncontrollable emotions, as evidenced in the patients Dan Cohen describes and highlights in nursing homes in Alive Inside. One patient documented in Alive Inside had used a walker for many years, and while listening to a song from her youth was able to dance without the use of her walker. [34]

Alzheimer's Disease has been discussed in popular media outlets. The 2014 film Alive Inside follows patients with Alzheimer's disease and demonstrates how music can be used as a means for music therapy to alleviate some suffering and pain. This film highlights the impact that music can have on those who can not communicate in traditional ways, and the power that music can play, particularly that from one's youth. Alive Inside won the Audience Award for U.S. Documentaries, which was screened at the Sundance Film Festival. In response to the film, the Alive Inside Foundation, founded in 2010, rose in popularity. The foundation's motto is the "Empathy Revolution" and aims to connect youth and older adults with Alzheimer's disease, specifically through music. [27] The goal of the foundation is to administer music via the form of iPods to every nursing home across the United States.

Additionally, The Alzheimer's Association gives a list of caregivers tips for people with Alzheimer's relatives and friends. They state that music therapy has been found to enhance cognition and can help caregivers better take care of those affected by Alzheimer's. [8]

Related Research Articles

<span class="mw-page-title-main">Dementia</span> Long-term brain disorders causing impaired memory, thinking and behavior

Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affects a person's ability to function and carry out everyday activities. Aside from memory impairment and a disruption in thought patterns, the most common symptoms include emotional problems, difficulties with language, and decreased motivation. The symptoms may be described as occurring in a continuum over several stages. Consciousness is not affected. Dementia ultimately has a significant effect on the individual, caregivers, and on social relationships in general. A diagnosis of dementia requires the observation of a change from a person's usual mental functioning and a greater cognitive decline than what is caused by normal aging.

<span class="mw-page-title-main">Dementia with Lewy bodies</span> Type of progressive dementia

Dementia with Lewy bodies (DLB) is a type of dementia characterized by changes in sleep, behavior, cognition, movement, and regulation of automatic bodily functions. Memory loss is not always an early symptom. The disease worsens over time and is usually diagnosed when cognitive impairment interferes with normal daily functioning. Together with Parkinson's disease dementia, DLB is one of the two Lewy body dementias. It is a common form of dementia, but the prevalence is not known accurately and many diagnoses are missed. The disease was first described by Kenji Kosaka in 1976.

Vascular dementia (VaD) is dementia caused by problems in the supply of blood to the brain, typically a series of minor strokes, leading to worsening cognitive abilities, the decline occurring piecemeal. The term refers to a syndrome consisting of a complex interaction of cerebrovascular disease and risk factors that lead to changes in brain structures due to strokes and lesions, resulting in changes in cognition. The temporal relationship between a stroke and cognitive deficits is needed to make the diagnosis.

<span class="mw-page-title-main">Donepezil</span> Medication used for dementia

Donepezil, sold under the brand name Aricept among others, is a medication used to treat dementia of the Alzheimer's type. It appears to result in a small benefit in mental function and ability to function. Use, however, has not been shown to change the progression of the disease. Treatment should be stopped if no benefit is seen. It is taken by mouth or via a transdermal patch.

<span class="mw-page-title-main">Art therapy</span> Creation of art to improve mental health

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition.

<span class="mw-page-title-main">Cognitive disorder</span> Mental health condition affecting cognitive functions

Cognitive disorders (CDs), also known as neurocognitive disorders (NCDs), are a category of mental health disorders that primarily affect cognitive abilities including learning, memory, perception, and problem solving. Neurocognitive disorders include delirium, mild neurocognitive disorders, and major neurocognitive disorder (previously known as dementia). They are defined by deficits in cognitive ability that are acquired (as opposed to developmental), typically represent decline, and may have an underlying brain pathology. The DSM-5 defines six key domains of cognitive function: executive function, learning and memory, perceptual-motor function, language, complex attention, and social cognition.

Semantic dementia (SD), also known as semantic variant primary progressive aphasia (svPPA), is a progressive neurodegenerative disorder characterized by loss of semantic memory in both the verbal and non-verbal domains. However, the most common presenting symptoms are in the verbal domain. Semantic dementia is a disorder of semantic memory that causes patients to lose the ability to match words or images to their meanings. However, it is fairly rare for patients with semantic dementia to develop category specific impairments, though there have been documented cases of it occurring. Typically, a more generalized semantic impairment results from dimmed semantic representations in the brain.

A cognitive intervention is a form of psychological intervention, a technique and therapy practised in counselling. It describes a myriad of approaches to therapy that focus on addressing psychological distress at a cognitive level. It is also associated with cognitive therapy, which focuses on the thought process and the manner by which emotions have bearing on the cognitive processes and structures. The cognitive intervention forces behavioral change. Counselors adopt different technique level to suit the characteristic of the client. For instance, when counseling adolescents, a more advanced strategy is adopted than the intervention used in children. Before the intervention, an initial cognitive assessment is also conducted to cover the concerns of the cognitive approach, which cover the whole range of human expression - thought, feeling, behavior, and environmental triggers.

Mild cognitive impairment (MCI) is a neurocognitive disorder which involves cognitive impairments beyond those expected based on an individual's age and education but which are not significant enough to interfere with instrumental activities of daily living. MCI may occur as a transitional stage between normal aging and dementia, especially Alzheimer's disease. It includes both memory and non-memory impairments. The cause of the disorder remains unclear, as well as both its prevention and treatment, with some 50 percent of people diagnosed with it going on to develop Alzheimer's disease within five years. The diagnosis can also serve as an early indicator for other types of dementia, although MCI may remain stable or even remit.

<span class="mw-page-title-main">Reminiscence therapy</span> Intervention technique with brain-injured patients

Reminiscence therapy is used to counsel and support older people, and is an intervention technique with brain-injured patients and those who appear to have "Alzheimer's and other forms of cognitive disease."

Pseudodementia is a condition where mental cognition can be temporarily decreased. The term pseudodementia is applied to the range of functional psychiatric conditions such as depression and schizophrenia, that may mimic organic dementia, but are essentially reversible on treatment. Pseudodementia typically involves three cognitive components: memory issues, deficits in executive functioning, and deficits in speech and language. Specific cognitive symptoms might include trouble recalling words or remembering things in general, decreased attentional control and concentration, difficulty completing tasks or making decisions, decreased speed and fluency of speech, and impaired processing speed. People with pseudodementia are typically very distressed about the cognitive impairment they experience. There are two specific treatments that have been found to be effective for the treatment of depression, and these treatments may also be beneficial in the treatment of pseudodementia. Cognitive behavioral therapy (CBT) involves exploring and changing thought patterns and behaviors in order to improve one's mood. Interpersonal therapy focuses on the exploration of an individual's relationships and identifying any ways in which they may be contributing to feelings of depression. Some antidepressant drugs have also been found to alleviate cognitive deficits arising from depression; in particular, the novel SSRI vortioxetine has been studied for treating pseudodementia.

<i>Musicophilia</i>

In 2007, neurologist Oliver Sacks released his book Musicophilia: Tales of Music and the Brain in which he explores a range of psychological and physiological ailments and their intriguing connections to music. It is broken down into four parts, each with a distinctive theme; part one titled Haunted by Music examines mysterious onsets of musicality and musicophilia. Part two A Range of Musicality looks at musical oddities musical synesthesia. Parts three and four are titled Memory, Movement, and Music and Emotions, Identity, and Music respectively. Each part has between six and eight chapters, each of which is in turn dedicated to a particular case study that fit the overarching theme of the section. Presenting the book in this fashion makes the reading a little disjointed if one is doing so cover to cover, however, it also means one may pick up the book and flip to any chapter for a quick read without losing any context. Four case studies from the book are featured in the NOVA program Musical Minds aired on June 30, 2009.

Psychological therapies for dementia are starting to gain some momentum. Improved clinical assessment in early stages of Alzheimer's disease and other forms of dementia, increased cognitive stimulation of the elderly, and the prescription of drugs to slow cognitive decline have resulted in increased detection in the early stages. Although the opinions of the medical community are still apprehensive to support cognitive therapies in dementia patients, recent international studies have started to create optimism.

<span class="mw-page-title-main">Alzheimer's disease</span> Progressive and terminal neurodegenerative disease characterised by memory loss

Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation, mood swings, loss of motivation, self-neglect, and behavioral issues. As a person's condition declines, they often withdraw from family and society. Gradually, bodily functions are lost, ultimately leading to death. Although the speed of progression can vary, the typical life expectancy following diagnosis is three to nine years.

Sundowning, or sundown syndrome, is a neurological phenomenon associated with increased confusion and restlessness in people with delirium or some form of dementia. It is most commonly associated with Alzheimer's disease but also found in those with other forms of dementia. The term "sundowning" was coined by nurse Lois K. Evans in 1987 due to the timing of the person's increased confusion beginning in the late afternoon and early evening. For people with sundown syndrome, a multitude of behavioral problems begin to occur and are associated with long term adverse outcomes. Sundowning seems to occur more frequently during the middle stages of Alzheimer's disease and mixed dementia and seems to subside with the progression of the person's dementia. People are generally able to understand that this behavioral pattern is abnormal. Research shows that 20–45% of people with Alzheimer's will experience some variation of sundowning confusion. However, despite lack of an official diagnosis of sundown syndrome in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there is currently a wide range of reported prevalence.

Caregiver syndrome or caregiver stress is a condition that strongly manifests exhaustion, anger, rage, or guilt resulting from unrelieved caring for a chronically ill patient. This condition is not listed in the United States' Diagnostic and Statistical Manual of Mental Disorders, although the term is often used by many healthcare professionals in that country. The equivalent used in many other countries, the ICD-11, does include the condition.

Depression is one of the most common psychiatric symptoms in Alzheimer's disease, occurring at all stages of the disease, but it often appears in a different form than other depressive disorders. In 2000, a workgroup of the U.S. National Institute of Mental Health created a set of provisional diagnostic criteria for depression of Alzheimer disease (dAD) as a separate diagnostic entity in its own right.

Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen. Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person.

<span class="mw-page-title-main">Rivastigmine</span> Chemical compound

Rivastigmine is a cholinesterase inhibitor used for the treatment of mild to moderate Alzheimer's disease. The drug can be administered orally or via a transdermal patch; the latter form reduces the prevalence of side effects, which typically include nausea and vomiting.

Steroid dementia syndrome describes the signs and symptoms of hippocampal and prefrontal cortical dysfunction, such as deficits in memory, attention, and executive function, induced by glucocorticoids. Dementia-like symptoms have been found in some individuals who have been exposed to glucocorticoid medication, often dispensed in the form of asthma, arthritis, and anti-inflammatory steroid medications. The condition reverses, but not always completely, within months after steroid treatment is stopped.

References

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  31. ↑ Alluri, Vinoo; Toiviainen, Petri; Jääskeläinen, Iiro P.; Glerean, Enrico; Sams, Mikko; Brattico, Elvira (February 15, 2012). "Large-scale brain networks emerge from dynamic processing of musical timbre, key and rhythm". NeuroImage. 59 (4): 3677–3689. doi:10.1016/j.neuroimage.2011.11.019. ISSN   1053-8119. PMID   22116038. S2CID   10296675.
  32. ↑ Cunningham, Stuart; Brill, Mark; Whalley, J. Harry; Read, Rebecca; Anderson, Gordon; Edwards, Sarah; Picking, Richard (September 5, 2019). "Assessing Wellbeing in People Living with Dementia Using Reminiscence Music with a Mobile App (Memory Tracks): A Mixed Methods Cohort Study". Journal of Healthcare Engineering. 2019: 1–10. doi: 10.1155/2019/8924273 . ISSN   2040-2309. PMC   6748176 . PMID   31583068.
  33. ↑ "Why Do the Songs from Your Past Evoke Such Vivid Memories?". Psychology Today. Retrieved February 26, 2018.
  34. 1 2 3 "nDex". Alive Inside. Retrieved February 26, 2018.
  35. ↑ Raglio, Alfredo (2010). "Music Therapy in Dementia" (PDF). Non-Pharmacological Therapies in Dementia. 1.
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