A growing body of international research provides evidence of the beneficial effects of personally meaningful music in the treatment of dementia.

Enjoying a playlist

The research, which we summarise below, is substantial. However, collectively it is fraught with methodological inconsistencies and limitations, and fails to identify a standardised protocol for the use of personalised music in dementia treatment and care.

This is a gap that Playlist for Life is encouraging researchers to fill, specifically through our collaboration with Glasgow Caledonian University.

 

What the research shows

Dementia is now recognised as one of the most disabling and burdensome health conditions across the world (Brookmeyera, Johnson, Ziegler-Grahamb & Arrighic, 2007). It is marked by an irreversible and progressive decline in cognitive functioning, to such an extent that it interferes with daily life and activities (Davidson & Fedele, 2011).

Yet whilst verbal communication and associated thought processes deteriorate in dementia, the brain structures involved in the processing of musical information often remain intact. This has led to the assertion that the use of music is a unique and powerful tool in dementia care (Cuddy & Duffin, 2005).

In particular, music listening with personal preferences has been suggested to be particularly efficacious in the reduction of dementia symptomology such as agitation, anxiety (Sung, Chang & Abbey, 2006) and aggression (Ragneskog, Asplund, Kihlgren & Norberg, 2001). It also enhances verbal communication and assists in the recall and eliciting of memories associated with positive feelings (Sung & Chang, 2005).

Dementia is not only chronic and progressive but, so far, remains incurable.

The strong, age-related incidence and lack of disease-modifying or preventive therapy often results in an enormous burden on individuals, their families and caregivers, and the wider society (Thyrian, Wübbeler, & Hoffmann, 2013). So there is now an urgent need for concerted worldwide interventions as a means of improving the quality of both treatment and care provided for all those affected by the disease (Wimo, 2010).

The challenge is complicated not only by the wide range of behavioural and psychological symptoms, but also by the psychiatric disorders that can present alongside the condition (Reitz, Brayne & Mayeux, 2011). All of this can lead to a significant loss in the quality of life for the patient, family and caregivers (Moretti, Torre, Antonello, & Pizzolato, 2006).

A further problem is that many of the treatments that do exist are fraught with adverse physical and psychological effects, as well as being laden with ethical considerations regarding the autonomy of the individual concerned, especially regarding the use of traditional pharmacological interventions (Mohr, Petti, & Mohr, 2003). Many patients with dementia in the latter stages are treated with sedatives, neuroleptics or antidepressants, prompting a myriad of concerns about the inappropriate use of medication in institutionalised care (Talerico, 2002). What is worse, many of those interventions quite often fail to alleviate many of the syndrome’s features (Vink, Bruinsma & Scholten, 2011).

In view of this, there has been an increased focus on the use of non-pharmacological alternatives (Douglas, James & Ballard, 2004). One alternative is music-based interventions (Gerdner, 2010).

A plethora of research extolling the virtues of music as a relatively non-invasive and cost-effective intervention in the treatment, care and even prevention of dementia has since emerged.

Many scholars have hailed not only the ‘medicalising’ properties of music to affect archetypal symptoms of dementia, such as agitation and associative pain (Jennings & Vance, 2002), but also the ostensible capacity for music to increase social interaction, verbal communication and aid memory function (Cuddy & Duffin, 2005).

It has also been posited that even modest benefits may in fact make the difference between living at home and going into institutional care (Herrmann & Black, 2000).

There are two leading strands of research on the use of ‘prescribed’ music for the alleviation of symptoms via receptive therapy (e.g. music listening) and/ or active participation, including group singing, dancing and playing instruments (c.f. Cooke, Moyle, Shum, Harrison & Murfield, 2010. This has spawned an unequivocal evidence base for the use of music in the care and treatment of individuals with dementia.

For instance, research has shown that music-based interventions result in:

A significant decrease in typical symptoms such as agitation (Gerdner, 2000)

A marked decline in both anxiety and depression (Guetin, 2009).

Increased interaction between individual patients, subsequently decreasing their sense of isolation (Pollack and Namazi, 1992).

Speech reconstruction among people with deficiencies in verbal communication – a marked symptom in the latter stages of the disease (Riecker, 2000).

Perhaps most importantly, the fostering and heightening of a sense of identity (Svansdottir & Snaedal, 2006).

Given that many life events are frequently accompanied by music, it makes intuitive sense to reason that such interventions might enable the recall of life experience and emotion. Findings outside the domain of dementia have reliably demonstrated that such ‘musical memories’ are stored for a much longer time than those not tied to any particular musical excerpt or piece (Baird 2009).

When taken together, these findings highlight the potential of music-based interventions to alleviate dementia-related symptomology and comorbid pathology. While many cognitive functions decline rapidly during the disease progression, receptivity to music can remain until the late phases of dementia (Adridge 1996). In fact, the responsiveness of patients with dementia is a remarkable phenomenon: even in the latest stage of the disease, patients may remain responsive to music where other stimuli no longer evoke a reaction (Norberg 1986).

Music, it seems, is a unique and invaluable tool as a non-pharmacological alternative in dementia care.

Accordingly, the use of music in dementia care has since been propelled to the forefront of enquiry (Gerdner, 2010), capitalising on the burgeoning advancement of music-based technologies, many of which increasingly proffer ways to tailor one’s music listening experience.

A prominent example is that of Music and Memory, a non-profit organisation pioneered by Dan Cohen in the US, which promotes the use of personalised music in dementia care. Music and Memory provides materials and support to train healthcare professionals, families and caregivers in how to create and implement personalised playlists that are delivered and supported via music technologies, with the overarching aim of integrating such methods into standardised protocol for dementia care. Playlist for Life is doing similar work in the UK.

Surprisingly, though, there is a distinct paucity of empirically validated research in support of such interventions.

Indeed, despite the anecdotal evidence that permeates the accounts of caregivers, researchers and staff (Gerdner, 2010), there currently exists no standardised or empirically validated personalised music, technology-based intervention for individuals with dementia, despite the obvious potential. Of the studies that do exist, opportunities and outcomes have largely been confined to the alleviation of specific symptoms such as agitation or aggressive behaviours (Suzuki, Kanamori, Watanabe, Nagasawa, Kojima, Ooshiro et al., 2004), despite the apparent propensity for individualised music interventions to proffer a whole host of positive health-related outcomes associated with dementia.

Such findings are further compounded by methodological inconsistencies, particularly the lack of reliable outcome measures and a tendency to overlook the impact of technology, despite its pivotal role in the delivery of such interventions.

Those studies have also tended to neglect individuals living at home (and thus those in the early stages of dementia), for whom music may be particularly efficacious in halting or stagnating the progression of the many cognitive, behavioural and social deficits seen in the latter stages of the disease (Sung, Chang & Lee, 2010).

Dementia is a complex syndrome that demands individualised care and treatment (Thyrian, Wübbeler & Hoffmann, 2013). The use of personalised music as a tailor-made, person-specific intervention presents an unparalleled opportunity to pioneer a cutting-edge contribution and also herald a more sophisticated insight into the disease itself.

(With thanks to Anna Paisley, Glasgow Caledonian University PhD student and Playlist for Life associate)

 

Follow up the academic references

Brookmeyera, R., Johnson, E., Ziegler-Grahamb, K., & Arrighic, H.M. (2007). Forecasting the global burden of Alzheimer’s disease. Alzheimer’s & Dementia, 3, 186-191.

Cahill, S., Macijauskiene, J., Nygård, A.M., Faulkner, J.P., &  Hagen, I. (2007). Technology in dementia care. Technology and Disability, 19, 55-60.

Cooke, M., Moyle, W., Shum, D., Harrison, S., & Murfield, J. (2010). A randomised controlled trial exploring the effect of music on quality of life and depression in older people with dementia. Aging & Mental Health, 14, 905-916.

Cuddy, L.L., & Duffin, J. (2005). Music, memory, and Alzheimer’s disease: is music recognition spared in dementia, and how can it be assessed? Medical Hypotheses, 64, 229-235.

Davidson, J.W., & Fedele, j. (2011). Investigating group singing activity with people with dementia and their  caregivers: problems and positive prospects. Musicae Scientiae, 15(3), 402-422.

Douglas, S., James, I., & Ballard, C. (2004). Non-pharmacological interventions in dementia. Advances in Psychiatric Treatment, 10, 171-177.

Ferri, C.P., Prince, M., Brayne, C., Brodaty, H., Fratiglioni, L., Ganguli, M., Hall, K. Hasegawa, K., Hendrie, H., Huang, Y., Jorm, A., Mathers, C., Menezes, P.R., &  Rimmer, E. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112-2117.

Gerdner, L.A. (2010). Individualized music for elders with dementia. Journal of Gerontological Nursing, 36, 7-15.

Grassel, E., Wiltfang, J., & Kornhuber, J. (2003). Non-drug therapies for dementia: an overview of the current situation with regard to proof of effectiveness. Dementia and Geriatric Cognitive Disorders, 15, 115-125.

Hampel, H., Prvulovic, D., Teipel, S., Jessen, F., Luckhaus, C., Frölich, L., & Faltraco, F. (2011). The future of Alzheimer’s disease: The next 10 years. Progress in Neurobiology, 95, 718-728.

Herrmann, N., & Black, S. E.(2000). Behavioural disturbances in dementia.  Will the real treatment stand up? Neurology, 55, 1247-1248.

Jennings, B., & Vance, D. (2002). The short-term effects of music therapy on different types of agitation in adults with Alzheimer’s. Activities, Adaptation & Aging, 26, 27-33.

Mohr, W.K., Petti, T.A., & Mohr, B.D. (2003). Adverse effects associated with physical restraint. Canadian Journal of Psychiatry, 48, 330-337.

Moretti, R., Torre, P., Antonello, R.M., & Pizzolato, G. (2006). Atypical neuroleptics as treatment of agitation and anxiety in Alzheimer’s disease: risks or benefits. Expert Reviews of Neurotherapeutics, 6. 705-710.

Music & Memory. Retrieved May 20, 2013, from http://musicandmemory.org/.

North, A. C., & Hargreaves, D. J. (2008). The social and applied psychology of music. Oxford, UK: Oxford University Press.

Raglio, A., Bellelli, G., Traficante, D., Gianotti, M., Ubezio, M.C., Villani, D., & Trabucchi, M. (2008). Efficacy of Music Therapy in the Treatment of Behavioral and Psychiatric Symptoms of Dementia. Alzheimer Disease & Associated Disorders, 22, 158-162.

Ragneskog, H., Asplund, K., Kihlgren, M., & Norberg, A. (2001) Individualized music played for agitated patients with dementia: analysis of video-recorded sessions. International Journal of Nursing Practice 7(3), 146-155.

Reitz, C., Brayne, C., & Mayeux, R. (2011). Epidemiology of Alzheimer disease. Nature Reviews Neurology, 7, 137-152.

Sherratt, K., Thornton, A., & Hatton, C. (2004). Music interventions for people with dementia: a review of the literature. Aging & Mental Health, 8(1), 3-12.

Sung, H., & Chang, A.M. (2005). Use of preferred music to decrease agitated behaviours in older people with dementia: a review of the literature. Journal of Clinical Nursing, 14(9), 1133-1140. 

Sung, H.C., Chang, A.M., & Abbey, J. (2006). The effects of preferred music on agitation of older people with dementia in Taiwan. International Journal of Geriatric Psychiatry, 21, 999-1000.

Sung, H.C., Chang, A.M., & Lee, W.L. (2010). A preferred music listening intervention to reduce  anxiety in older adults with dementia in nursing homesJournal of Clinical Nursing, 19. 1056-1064.

Suzuki, M., Kanamori, M., Watanabe, M.,  Nagasawa, S., Kojima, E., Ooshiro, H., & Nakahara, D. (2004). Behavioral and endocrinological evaluation of music  therapy for elderly patients with dementia. Nursing & Health Sciences, 6, 11-18.

Talerico, K. A.(2002). A critique of research measures used to assess inappropriate psychoactive drug use in older adults. Journal of the American Geriatrics Society, 50, 374-377.

Thyrian, J.R., Wübbeler, M., & Hoffmann, W. (2013). Interventions into the care system for dementia. Geriatric Mental Health Care, 1, 67-71.

Walworth, D.D. (2003). The effect of preferred music genre selection versus preferred song selection on experimentally induced anxiety levels. Journal of Music Therapy, 40, 2-14.

Wimo, A., Winblad, B., Aguero, T.H., & von Strauss, E. (2003). The magnitude of dementia occurrence in the world. Alzheimer Disease & Associated Disorders, 17, 63-67.

Wimo, A. (2010). The art of cost of illness. Journal of Alzheimer’s Disease, 19, 617-619.