The use of music as an arts-based method in migrant health research: a scoping review protocol

There is increasing recognition that people’s lived experience needs to be incorporated into health decision-making. This has led to rising imperatives for involving the public in health processes, including research. While there have been significant advances in the field, patterns of exclusion still exist in some areas, including migrant participation in health research. Migration and mobility create challenges around social inclusion and this extends to social and cultural practices used in research. There is an emerging body of literature about improving meaningful, participatory spaces for migrants’ involvement in health research using creative tools and techniques that are attuned to cultural diversity. These include the use of arts-based research methods. There is strong evidence for the use of music, particularly singing, as an effective arts-based participatory tool . The goal of this scoping review is to investigate the evidence for the use of music as an arts-based method in migrant health research. Developed by an interdisciplinary team specialising in public and patient involvement; nursing and midwifery; primary health care; and the performing arts, it aims to analyse existing evidence across disciplines that are not usually studied together, identify gaps in current knowledge and use these as a foundation to build effective strategies towards increasing access to and knowledge of participatory, arts-based methods using music in migrant health research.

Methods: The protocol for this scoping review follows the guidelines and stages set out in the JBI Reviewer’s Manual ( Peters et al., 2017), and by Levac et al, (2010), which build on the methodological framework of Arksey and O’Malley (2005). This incorporates six stages: 1) Identifying the research question; 2) Identifying relevant studies; 3) Study selection; 4) Charting the data; 5) Collating, summarising, and reporting results; and 6) Consultation.

Effects of Music Therapy on Patients with Dementia-A Systematic Review

Dementia is an increasingly common syndrome and while pharmacotherapy is available, its potential benefit is limited, especially in non-cognitive outcomes. Non-pharmacotherapy such as music therapy is potentially associated with improved outcomes. We assessed the effects of music therapy on patients with dementia to evaluate its potential benefits on dementia. Two independent reviewers searched MEDLINE, EMBASE, CINAHL, CENTRAL, and ClinicalTrials.gov databases for clinical trials, using the keywords "music therapy" and "dementia". Study outcomes included cognitive function, behavioral and psychological symptoms of dementia (BPSD), and quality of life. A total of 82 studies were included, of which 43 were interventional clinical trials, and 39 were systematic reviews or meta-analyses. Significant improvements in verbal fluency occurred after music therapy, with significant reductions in anxiety, depression, and apathy. There were no significant improvements in cognition or daily functioning, and the results on quality of life and agitation were ambiguous. Limitations of studies included low patient numbers, lack of standardized music therapy, and high heterogeneity in outcomes. More large-scale clinical trials would allow for clearer conclusions on the benefits of music therapy in patients with dementia.

Sing4Health: protocol of a randomized controlled trial of the effects of a singing group intervention on the well-being, cognitive function and health of older adults

BACKGROUND

Singing is a multimodal activity that requires physical, cognitive and psychosocial performance, with benefits to various domains of well-being and health in older adults. In recent years, research has increasingly studied group singing as an important cost-effective intervention to promote active and healthy aging. However, the specific factors responsible for these benefits need further experimental support, as most studies do not allow for causal inferences. This study responds to the need for further randomized controlled trials (RCT), with follow-up measurement, on the benefits of group singing in older adults from a low socioeconomic background. Also, while most studies often focus on specific outcome measure dimensions, in this study, the conjoint effect of several physical, psychosocial, psychoemotional and cognitive dimensions are analyzed, testing mediation effects of psychosocial and psychoemotional variables on the well-being and health of the participants.

METHODS

We implement and measure the effects of a singing group program for older adults, with an RCT crossover design study, in a natural context, before and after the intervention and in a follow-up, 6 months after the intervention.

PARTICIPANTS

140 retired older adults (> 60 years) users of a social support institution, will be invited to participate in a singing group program and randomly allocated to an experimental (n = 70) and a control (n = 70) group, which will enroll in the regular activities proposed by the institution. The intervention consists of 34 bi-weekly group singing sessions, of 2 h each, for 4 months. Measures on social and emotional well-being, cognitive function, and health indicators (e.g., blood pressure, glycemia, cholesterol, c-reactive protein, sedimentation rate, respiratory function, body balance, sleep quality, medication intake, and health services attendance) will be collected. Interviews will be conducted on the motivation and perceived benefits of participation.

DISCUSSION

Significant improvements are expected in the outcome measures in the experimental group after the intervention, validating singing groups as a cost-effective intervention for healthy aging. Psychosocial and psychoemotional variables are expected to be mediators of the effects of the program in the cognitive function, well-being and health of the participants.

TRIAL REGISTRATION

NCT03985917 . Registered 14th June 2019 (retrospectively registered).

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.

Reducing Labor Pain Intensity within First Stage Active Phase through Hegu LI 4 Acupressure and Quranic Recital Method

Introduction: Labor pain is one of the greatest pains experienced by a woman in their life. The purpose of this study was to examine the effectiveness of acupressure and Quranic recital on labor pain reduction.Methods: The study design uses quasi-experiment with comparison between pretest and posttest on non-equivalent control group. Samples were as many as 30 laboring mothers in each group, totaling 60 samples who had been chosen through consecutive sampling technique. The labor pain was assessed through the NRS (Numeric Rating Scale) then analyzed univariately with mean and standard deviation, followed by independent T-sample statistical test such as bivariate analysis.Results: The average pain reduction score in the Hegu LI 4 acupressure group was higher than the Quranic recital of Surah Ar-Rahman group. The acupressure group average pain reduction was 3.03 ± 0.718 while the Quranic recital group was 2.57 ± 1.006. The difference in the average score of independent T-test was significant with the P < 0.007 and 95% C.I. -0.919-( -0.015)Conclusion: Hegu LI 4 acupressure and Quranic recital of Surah Ar-Rahman treatments were promising and may be utilized to reduce labor pain intensity within labor’s first stage active phase. Hegu LI 4 acupressure group   had a greater reduction in labor pain intensity than the Quranic recital of Surah Ar-Rahman group. This study suggests that Hegu LI 4 can be utilized to reduce labor pain as a non-pharmacological therapy.

Preservation of Musical Memory Throughout the Progression of Alzheimer's Disease? Toward a Reconciliation of Theoretical, Clinical, and Neuroimaging Evidence

Through this review of 25 clinical and experimental works on long-term musical memories in Alzheimer's disease (AD) patients, we attempt to clarify the conceptual understanding of musical memories, identify their evolution across the stages of the pathology, and propose possible explanations concerning the neural and cognitive mechanisms that underpin the preservation and impairment of certain musical memories. After clarifying the different kind of musical memories, we investigated their alterations throughout AD's progression from mild to severe stages. Both procedural and retrograde semantic memory seem relatively spared in AD, while episodic memory appears to be impaired early. Moreover, partial preservation of music encoding in AD can be revealed through paradigms that are especially designed for AD patients (relying on behavioral cues, using adapted settings, etc.). Although seldomly used, they would definitely help understanding the preserved capacities in every stage of AD. However, more research is needed to better understand this phenomenon and assess its specificity to music or other types of supports. These findings could lead to multiple applications in care settings and research designs, bringing more nuanced understanding of how long-term musical memory degrades throughout the course of AD, and should encourage us to prioritize patients' preserved cognitive abilities in current AD recreational and care programs.

How Is Quality of Life Assessed in People With Dementia? A Systematic Literature Review and a Primer for Speech-Language Pathologists

Purpose The purpose of this study was to determine how quality of life (QoL) is measured in people with dementia involved in interventions designed to improve well-being and to explore how those measures align with principles of person-centered care. Method A systematic literature review was conducted utilizing PsychInfo, CINAHL, and PubMed and combinations of the search terms: "dementia," "outcome measure," "creative engagement," "creative intervention," "TimeSlips," "art," "quality of life," and "well-being." The search was limited to studies published in peer-reviewed journals that reported outcomes for people with dementia in response to a creative intervention. Results Across the 24 reviewed studies, 30 different outcome measures were reported including eight self-reported, nine observational, and 13 proxy-reported measures. Self-report of QoL was elicited 16 times, observational measures were reported 17 times, and proxy-reported measures were used 28 times. All measures were used with participants across the dementia severity spectrum. Conclusion Current clinical practice of QoL evaluation does not align well with person-centered care principles of self-determination based on the low proportion of self-report. The previously reported limitations of proxy-report have been in part confirmed with this study. Implications of the findings for speech-language pathologists are discussed.

Playing a musical instrument is associated with slower cognitive decline in community-dwelling older adults

BACKGROUND

Elucidating behavioral protective factors for cognitive decline and dementia can have a far-reaching impact.

AIMS

To describe the association of present and past musical instrument playing with cognitive function in cognitively intact older adults.

METHOD

A post hoc observational analysis of the Zurich Disability Prevention Trial. Past and present musical instrument playing was correlated with Mini-Mental State Examination (MMSE) and EuroQol-Visual Analogue Scale (EQ-VAS) using linear regression at baseline and mixed-model linear regression over 1 year.

RESULTS

Two hundred community dwelling adults age 70 and older (mean age 77.7) were included. There were 48.5% (97/200) participants, who ever played a musical instrument; 35% (70/200) played in the past and 13.5% (27/200) played at present. At baseline, present players had a suggestively higher adjusted-MMSE than never players (28.9 vs. 28.5, p value 0.059). Over 12 months, compared to never players, ever players showed a significantly better improvement from baseline in adjusted-MMSE (0.29 vs. - 0.12, p value 0.007). The association remained significant even after restricting to participants without higher education (p value 0.03). Over time, no differences were observed for EQ-VAS (p value 0.45). However, past players had the largest decline in health-related quality of life at 12 months.

DISCUSSION

The support for a protective association in our observational study suggests the need for clinical trials to examine the effect of playing a musical instrument on cognitive function and decline. Both returning to play after an interruption and learning to play from the beginning should be examined.

CONCLUSIONS

Present and past musical instrument playing may assist in preserving cognitive function in community-dwelling older adults.

Hearing loss and cognitive function among Chinese older adults: the role of participation in leisure activities

BACKGROUND

Hearing loss, a highly prevalent sensory impairment affecting older adults, is a risk factor for cognition decline. However, there were very limited studies on this association in low-resource countries. This study aimed to assess the association between self-reported hearing loss and cognitive decline, and whether engagement in leisure activities moderated this association among older adults in China.

METHODS

Data were obtained from two waves of the nationally representative survey of China Longitudinal Healthy Longevity Survey (CLHLS) between 2011/12-2014. Eight thousand eight hundred forty-four individuals aged 65 years old or above with a dichotomized measure of self-reported hearing status were included. Modified Mini-Mental Examination (MMSE) was used to measure global cognition. Fixed-effects models were used to estimate whether leisure activity engagement moderated the association of self-perceived hearing loss with global cognitive change in the overall sample and sex subsamples.

RESULTS

Self-reported hearing loss was associated with cognitive impairment, with an odds ratio of 2.48 [1.22, 5.06]. Sex difference in the association of hearing loss and cognitive impairment was not found. Self-reported hearing loss was associated with cognitive decline, with 8% increase in risk compared with those with normal hearing. Frequent engagement in leisure activities moderated the association between hearing loss and cognitive decline for the whole and male samples.

CONCLUSION

Hearing loss was associated with cognitive decline, and leisure activities engagement moderated the association among males rather than females.

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.

Use of Music Therapy to Improve Cognition in Older Adults With Dementia: An Integrative Review

BACKGROUND AND PURPOSE

Dementia is considered a public health priority due to physical, psychological, economic, and social repercussions in older adults, their families, and caregivers. To address this issue, healthcare providers can use music therapy as a complementary therapy. This manuscript was elaborated to analyze and synthesize the current evidence of the use of music therapy to improve cognition in older adults with dementia.

METHODS

Using the Whittemore and Knafl (2005) method, databases searched were PubMed, CINAHL, Ovid, EBSCO, ProQuest, and PsycINFO, using the terms such as "Music Therapy," "Acoustic Stimulation," "Music," "Cognition," "Memory," "Attention," "Aged," and "Dementia." Studies that met the eligibility criteria were screened by title, abstract and full text. Quality of the studies were evaluated using critical appraisal tools and Cochrane "Risk of Bias" tool.

RESULTS

A total of 211 articles were screened by title and abstract, but only 28 articles met the inclusion criteria and were full text screened. Of the 28 articles, only five studies were analyzed and synthesized as they focused specifically on music therapy and cognition. Three of the studies showed that active and active-passive approaches of music therapy produce significant effect on cognition in older adults with dementia. The common characteristic was the participation of music therapists or music teachers who delivered the music therapy sessions that resulted in improved cognition.

IMPLICATIONS FOR PRACTICE

As a safe, inexpensive intervention, it should be considered as a complementary therapy to positively impact cognition in older adults with different types of dementia and levels of severity.

The effects of choral singing on communication impairments in acquired brain injury: A systematic review

BACKGROUND

Acquired brain injury (ABI), such as Parkinson's disease, dementia or stroke, can result in communication difficulties that lead to an impoverished ability to connect meaningfully with others. Choral singing is a complex task that uses multiple brain regions which are also responsible for language and communication skills. The potential therapeutic effects of group singing on communication-related outcomes across ABI aetiologies have not been systematically reviewed.

AIMS

To examine whether participation in group singing over multiple sessions improves speech, voice, language and/or communication skills in individuals with ABI-related communication disorders.

METHODS & PROCEDURES

A database search was undertaken according to the PRISMA guidelines. Search terms included: stroke OR Parkinson^* OR dementia OR 'acquired brain injury' AND choir OR choral OR singing OR sing OR 'choral sing^* ' OR group adj3 singing OR community adj3 singing AND speech OR language OR communication.

MAIN CONTRIBUTION

A total of 11 studies were included. Nine were quantitative, including one randomized and one non-randomized control trial, and two were mixed method. Nine studies were scored as level IV (uncontrolled) on the American Academy of Neurology (AAN) Classification of Evidence Matrix and two as level III (e.g., lack of blinded assessors). Eight examined speech and voice skills in Parkinson's disease, two functional communication skills in post-stroke aphasia and one communication between individuals with dementia and a significant other. One level III control trials provided evidence for a therapeutic effect of group singing on communication in individuals with Parkinson's disease.

CONCLUSIONS & IMPLICATIONS

Currently, there is only one study providing support for using group singing to improve speech and voice skills in people with Parkinson's disease, and no studies of adequate quality indicating positive effects on language and functional communication abilities in ABI. Further research using more rigorous experimental designs is required to determine whether group singing can influence communication skills in ABI. What this paper adds What is already known on the subject Music activates widespread, bilateral cortical and subcortical brain regions. Group singing is increasingly understood to have positive benefits on quality of life and health-related well-being in both healthy and clinical populations. Given the crossover in neural networks between singing, speech and language, singing activities are also thought to have positive effect of communication impairments secondary to ABI. However, to date, the research evidence supporting the application of group singing for communication impairments in ABI has not been summarized. What this paper adds to existing knowledge A total of 11 studies have looked at communication outcomes after group singing in ABI. For most of these, the quality of evidence was low (AAN level IV). It also highlights that there is a bias in the literature towards the studying individuals with Parkinson's disease (i.e., nine of the 11 studies). What are the potential or actual clinical implications of this work? This review concludes that, currently, there is emerging evidence to support positive effects of a group singing for speech and voice symptoms in individuals with Parkinson's disease, when provided using the Tamplin protocol. However, there is not yet any evidence for communication benefits for individuals with aphasia or dementia.

Music Training, Working Memory, and Neural Oscillations: A Review

This review focuses on reports that link music training to working memory and neural oscillations. Music training is increasingly associated with improvement in working memory, which is strongly related to both localized and distributed patterns of neural oscillations. Importantly, there is a small but growing number of reports of relationships between music training, working memory, and neural oscillations in adults. Taken together, these studies make important contributions to our understanding of the neural mechanisms that support effects of music training on behavioral measures of executive functions. In addition, they reveal gaps in our knowledge that hold promise for further investigation. The current review is divided into the main sections that follow: (1) discussion of behavioral measures of working memory, and effects of music training on working memory in adults; (2) relationships between music training and neural oscillations during temporal stages of working memory; (3) relationships between music training and working memory in children; (4) relationships between music training and working memory in older adults; and (5) effects of entrainment of neural oscillations on cognitive processing. We conclude that the study of neural oscillations is proving useful in elucidating the neural mechanisms of relationships between music training and the temporal stages of working memory. Moreover, a lifespan approach to these studies will likely reveal strategies to improve and maintain executive function during development and aging.

Potential benefits of music playing in stroke upper limb motor rehabilitation

Music-based interventions have emerged as a promising tool in stroke motor rehabilitation as they integrate most of the principles of motor training and multimodal stimulation. This paper aims to review the use of music in the rehabilitation of upper extremity motor function after stroke. First, we review the evidence supporting current music-based interventions including Music-supported Therapy, Music glove, group music therapy, Rhythm- and music-based intervention, and Musical sonification. Next, we describe the mechanisms that may be responsible for the effectiveness of these interventions, focusing on motor learning aspects, how multimodal stimulation may boost motor performance, and emotional and motivational aspects related to music. Then, we discuss methodological concerns in music therapy research related to modifications of therapy protocols, evaluation of patients and study designs. Finally, we highlight clinical considerations for the implementation of music-based interventions in clinical settings.

Immediate Benefit of Art on Pain and Well-Being in Community-Dwelling Patients with Mild Alzheimer's

OBJECTIVE

The present report aims to evaluate whether singing intervention can bring an immediate benefit that is greater than the one provided by painting intervention on pain and well-being.

METHODS

Fifty-nine mild patients with Alzheimer disease were randomized to a 12-week singing (n = 31) or painting group (n = 28). In the present analysis, the immediate evolution of pain and well-being was compared across sessions between the 2 groups using mixed-effects models.

RESULTS

We observed a significant improvement in well-being for both singing and painting groups immediately after sessions, compared to the assessment before the sessions. We did not observe this improvement across the sessions for pain intensity measurement.

DISCUSSION

Our results revealed that both painting and singing interventions provide an immediate benefit on the patients' well-being.

Music Training Improves Depressed Mood Symptoms in Elderly People: A Randomized Controlled Trial

The effectiveness of music training on depressed mood and general cognitive function in elderly participants is verified in this study. Music activities consisted of improvisation exercises for stimulating interpersonal skills, mood, and cognitive functions. A mixed research method was adopted, including standardized measures (Mini-Mental State Examination and Geriatric Depression Scale) and follow-up semistructured interviews. The research design included pre- and postevaluation with randomized experimental and control groups. Participants were 45 care residents aged 62 to 95, healthy and with cognitive impairment. Results revealed a significant improvement in depression index (Geriatric Depression Scale) for the experimental period (t = 1.450; p < .005; d = 0.453) while the control group had no improvement (t = 0.080; p > .1; d = 0.025). In addition, a significant improvement was found in the cognitive level (Mini-Mental State Examination) for the experimental (t = 2.300; p < .005; d = 0.668) than the control group that had a significant reduction (t = 1.240; p < .05; d = 0.273). This study provides evidence that music training has a positive impact on depressed mood and general cognitive function in elderly participants. These types of music training sessions could provide aid to control the symptoms of depression, delay the deterioration of cognitive function, and enhance social-cognitive function, especially in individuals presenting with cognitive impairment.

Short-Term Choir Singing Supports Speech-in-Noise Perception and Neural Pitch Strength in Older Adults With Age-Related Hearing Loss

Prior studies have demonstrated musicianship enhancements of various aspects of auditory and cognitive processing in older adults, but musical training has rarely been examined as an intervention for mitigating age-related declines in these abilities. The current study investigates whether 10 weeks of choir participation can improve aspects of auditory processing in older adults, particularly speech-in-noise (SIN) perception. A choir-singing group and an age- and audiometrically-matched do-nothing control group underwent pre- and post-testing over a 10-week period. Linear mixed effects modeling in a regression analysis showed that choir participants demonstrated improvements in speech-in-noise perception, pitch discrimination ability, and the strength of the neural representation of speech fundamental frequency. Choir participants' gains in SIN perception were mediated by improvements in pitch discrimination, which was in turn predicted by the strength of the neural representation of speech stimuli (FFR), suggesting improvements in pitch processing as a possible mechanism for this SIN perceptual improvement. These findings support the hypothesis that short-term choir participation is an effective intervention for mitigating age-related hearing losses.

Arts for ageing well: a propensity score matching analysis of the effects of arts engagements on holistic well-being among older Asian adults above 50 years of age

OBJECTIVE

To assess the frequency and intensity of arts engagement inclusive of active and passive engagements in arts, culture and heritage activities among Singaporean adults aged 50 and above, and examine the relationships between participatory art and holistic well-being.

DESIGN

Cross-sectional stratified household survey.

SETTING

All residential areas across Singapore's Central, East, North, North-East and West Regions.

PARTICIPANTS

1067 community-dwelling, Singaporean older adults between the ages of 50 and 95 years were recruited.

PRIMARY AND SECONDARY OUTCOME MEASURES

Respondents completed a self-reported questionnaire, consisting of standardised ad hoc items assessing the frequencies and durations of active and passive participatory arts engagement, as well as validated psychometric assessments on psychosociospiritual health including the primary outcome measure on quality of life, and the secondary outcome measures on physical, psychological, emotional, spiritual, and social well-being. sociodemographic information, as well as frequency and intensity of physical activity were also collected.

RESULTS

Passive engagement (60%) and active engagement (17%) in the arts were associated with better holistic wellness and social support. Specifically, findings from the propensity score matching and independent t-test analyses revealed that adults aged 50 and above who passively engaged in arts and culture-related events experienced higher quality of life (t(728)=3.35, p=0.0008, d=0.25), perceived health (t(728)=2.21, p=0.0277, d=0.16) and sense of belonging (t(728)=2.17, p=0.03, d=0.16), as compared with those who did not. Moreover, those who actively engaged in participatory arts experienced greater quality of life (t(442)=3.68, p=0.0003, d=0.36), self-rated health (t(442)=2.59, p=0.0099, d=0.25), spiritual well-being (t(442)=3.75, p=0.0002, d=0.37), meaning in life (t(442)=5.03, p<0.0001, d=0.50) and sense of peace (t(442)=3.72, p=0.0002, d=0.36), as compared with those who did not actively engaged in the arts.

CONCLUSION

This study provided robust evidence to support a significant causal relationship between arts engagements and holistic well-being. Recommendations for art-based public health and elderly care research, practice and policy are discussed.

HOMESIDE: home-based family caregiver-delivered music and reading interventions for people living with dementia: protocol of a randomised controlled trial

INTRODUCTION

Pharmacological interventions to address behavioural and psychological symptoms of dementia (BPSD) can have undesirable side effects, therefore non-pharmacological approaches to managing symptoms may be preferable. Past studies show that music therapy can reduce BPSD, and other studies have explored how formal caregivers use music in their caring roles. However, no randomised study has examined the effects on BPSD of music interventions delivered by informal caregivers (CGs) in the home setting. Our project aims to address the need for improved informal care by training cohabiting family CGs to implement music interventions that target BPSD, and the quality of life (QoL) and well-being of people with dementia (PwD) and CGs.

METHODS AND ANALYSIS

A large international three-arm parallel-group randomised controlled trial will recruit a sample of 495 dyads from Australia, Germany, UK, Poland and Norway. Dyads will be randomised equally to standard care (SC), a home-based music programme plus SC, or a home-based reading programme plus SC for 12 weeks. The primary outcome is BPSD of PwD (measured using the Neuropsychiatric Inventory-Questionnaire). Secondary outcomes will examine relationship quality between CG and PwD, depression, resilience, competence, QoL for CG and QoL for PwD. Outcomes will be collected at baseline, at the end of the 12-week intervention and at 6 months post randomisation. Resource Utilisation in Dementia will be used to collect economic data across the life of the intervention and at 6-month follow-up. We hypothesise that the music programme plus SC will generate better results than SC alone (primary comparison) and the reading programme plus SC (secondary comparison).

ETHICS AND DISSEMINATION

Ethical approval has been obtained for all countries. Results will be presented at national and international conferences and published in scientific journals and disseminated to consumer and caregiver representatives and the community.

TRIAL REGISTRATION NUMBERS

ACTRN12618001799246p; NCT03907748.

Effect of traditional opera on older adults with dementia

This study evaluates the effectiveness of traditional Chinese opera on older adults with dementia; those who met the inclusion criteria were categorized into intervention (n = 21) and control (n = 22) groups. Traditional Chinese opera was organized for the intervention group for 12 weeks. The Mini-Mental State Examination (MMSE), the Chinese version of the neuropsychiatric inventory (CNPI), and Quality of Life in Alzheimer's disease (QOL-AD) assessed the effectiveness at the pre-test stage and after 6 and 12 weeks of the intervention, and generalized estimated equation was used for statistical analysis. Statistically significant (P < 0.05) differences were observed between the intervention and control groups in terms of MMSE, CNPI, and QOL-AD. Traditional Chinese opera can potentially be an effective therapy for improving the cognitive function of older adults with dementia, reducing their behavioral and psychiatric symptoms and enhancing their quality of life.

Using Computer Tablets to Improve Moods for Older Adults With Dementia and Interactions With Their Caregivers: Pilot Intervention Study

BACKGROUND

Persons living with dementia represent a significant and growing segment of the older adult (aged 65 years and older) population. They are often challenged expressively and may experience difficulties with sharing their feelings or moods. Availability of, and easy access to, tablets facilitates the use of information and communication technologies (ICTs) as a delivery mechanism for nonpharmacological interventions, especially for persons living with dementia. Evidence of the impact of ICTs in different community settings on mood with older adults and the impact of engagement on their caregivers is needed to promote broader adoption and sustainment of these technologies in the United States.

OBJECTIVE

This study aimed to determine the extent of the effects of tablets on positive mood change and examine the effects of study variables on care recipients' mood changes and caregivers' daily interactions.

METHODS

The tablet intervention was developed and evaluated in five programs. The primary outcome was caregivers' assessment of care recipients' mood (n=1089) before and after a tablet engagement session using an eight-point mood visual analog scale. Session influence on caregivers' daily activities was captured for a subsample of participants (n=542). Frequency distributions were computed for each study variables. Chi-square tests of association were calculated to determine the association of the variables on mood changes for all care recipients, as well as those being treated in skilled nursing facilities and in-home, and then for those that affected caregivers' daily activities.

RESULTS

The study sample comprised 1089 care recipient and caregiver engagement sessions. Cumulatively, 50.78% (553/1089) of care recipients showed a transition from negative to positive moods, whereas another 41.78% (455/1089) maintained an already-positive mood after the caregiver engagement session. Chi-square analyses demonstrated that positive mood changes resulted from using music (χ210=72.9; P<.001), using YouTube as the sole app (χ212=64.5; P<.001), using multiple engagement strategies (χ22=42.8; P<.001), and when cared for in a skilled nursing facility (χ24=236.8; P<.001) across the entire care recipient sample. In addition, although many features of the engagement session positively influenced the caregivers' day, the largest effect was observed when care recipients' mood was considered to have improved following the session (χ24=234.7; P<.001).

CONCLUSIONS

The study is one of the first in the United States to explore the impact of ICTs, in particular managed tablets and Web-based video services that can be used on a tablet through an app, on improving mood in persons living with dementia, and enhancing caregivers' perceptions about their care recipient interactions. Importantly, these pilot data substantiate ICTs as part of a personalized engagement approach, as beneficial alternatives to pharmaceutical interventions for mood enhancement. However, a more comprehensive study that explores the ICT's impact on additional clinical outcomes is needed to confirm these preliminary findings.

A systematic review of dyadic approaches to reminiscence and life review among older adults

Objective: This paper describes a systematic review of quantitative and qualitative studies that examine the effectiveness of dyadic approaches to life review and reminiscence. Methods: The search process began with 1,056 potentially eligible articles and, after a multi-step screening process, led to 20 full-text articles for review. Results: The resulting studies (ten quantitative, nine qualitative, and one mixed-method) comprised six different kinds of dyadic approaches. There are a combination of benefits and problems associated with dyadic life review and reminiscence approaches. Conclusions: This review provides initial understanding of the impact of life review and reminiscence when care recipients and caregivers participate in the intervention together. Future clinical studies on dyadic approaches to life review and reminiscence should provide clearer descriptions of their protocols, include more consistent measures (incorporating in-the-moment measures), and involve populations of healthy older adults and their partners as well as those with cognitive impairment. The inclusion of qualitative studies helps interpret the diverse results reported in the quantitative studies and highlights key themes related to participating in dyadic interventions.

Cognitive effects of dance-movement intervention in a mixed group of seniors are not dependent on hippocampal atrophy

Dance-movement intervention (DMI) offers multi-component stimulation of cognitive functions, and it may ameliorate cognitive deficits in the elderly. We investigated the effects of intensive DMI on the cognitive performances of healthy seniors (HS) and patients with mild cognitive impairment (MCI). In addition, we evaluated whether the baseline MRI hippocampus-to-cortex volume (HV:CTV) ratio (i.e., a marker of a typical AD-specific brain atrophy and of distribution of neurofibrillary tangles in the brain) has any impact on the DMI-induced cognitive changes. The research cohort consisted of 99 subjects who were randomly assigned (in a 1:1 ratio) to a DMI group or to a control (life-as-usual) group. The DMI group consisted of 49 subjects with an average age of 69.16 years (SD = 5.36), of which 34 were HS (69.4%) and 15 had MCI (30.6%). The control group consisted of 50 subjects aged 68.37 years (SD = 6.10), of which 31 were HC (62%) and 19 (38%) had MCI. The DMI group underwent a 6-month intervention, which consisted of 60 lessons supervised by a qualified instructor. Statistical analysis yielded a significant improvement of the figural fluency task as measured by the five-point test in the DMI group as compared to the control group [t (97) = 2.72; p = 0.008]. The baseline HV:CTV ratio was not associated with cognitive changes on that task or with changes in any cognitive domain's Z scores. We observed DMI-induced effect on the test evaluating executive functions across the spectrum of HS and MCI, which was not dependent on the magnitude of AD-related brain pathology.

Music as a mnemonic strategy to mitigate verbal episodic memory in Alzheimer's disease: Does musical valence matter?

Introduction: Music is increasingly used to improve cognition in clinical settings. However, it remains unclear whether its use as a mnemonic strategy is effective in Alzheimer's disease (AD). The present study aimed at determining whether a musical mnemonic might mitigate patients' learning of new verbal information and at exploring the effect of factors such as retention delay and emotional valence of the musical excerpt used. Method: 13 patients with AD and 26 healthy comparisons (HC) with a low musical expertise were included. They learned texts about everyday life themes that were either set to familiar instrumental music, which was positively- or negatively-valenced, or spoken only. Immediate and delayed recalls (after 10 min and 24 hours) were measured. Results: Main results showed that (i) HC demonstrated better verbal episodic memory performance than participants with AD; (ii) participants with AD encoded texts paired with positively-valenced music better than texts paired with negatively-valenced music; (iii) participants with AD recalled sung texts better than spoken texts (after 10 min and 24 hours), regardless of musical valence while HC displayed better recall for texts paired with positively-valenced music. Conclusions: Musical mnemonics may help people with AD learn verbal information that relates to their daily life, regardless the musical expertise of the patients. This result gives promising clinical insights showing that music processing is robust to brain damage in AD. Possible hypotheses explaining the effectiveness of musical mnemonics in AD regardless the musical valence are discussed (e.g., different processing between musical and spoken conditions; disappearance of the positivity bias and implications with respect to the underlying socio-emotional selectivity theory).

A 'Music, Mind and Movement' Program for People With Dementia: Initial Evidence of Improved Cognition

BACKGROUND

Music is being increasingly used as a therapeutic tool for people with dementia. Research has uncovered several qualities of music that are responsible for its beneficial effects. Based on the identification of seven therapeutic capacities of music, we devised the Music, Mind, and Movement (MMM) program and evaluated whether it had therapeutic benefit for people with dementia (various types) in the areas of cognition, mood, identity, and motor fluency.

METHODS

The MMM program involved seven 45-min weekly group sessions, and individual 15-min "booster" sessions. Twenty people with mild to moderate dementia participated. Group 1 (n = 10) completed the MMM program first and Group 2 (n = 10) acted as a wait list control for 7 weeks, receiving standard care and completing the MMM program after the first group. Assessments of global cognition (Addenbrooke's Cognitive Examination, ACE-III), mood (Geriatric Depression Scale short form), identity ('I am' task), and fine motor skills (9-Hole peg task) were conducted at baseline (T1), time 2 (T2, post treatment), and time 3 (T3, 1 month post MMM program).

RESULTS

Within group comparisons were conducted with 12 participants from the MMM program and 10 participants receiving standard care. Global cognition (total ACE-III score) improved in 8/12 participants after the MMM program, whilst it decreased in 8/10 participants after the period of standard care. MMM participants showed increases in ACE-III subdomain scores of attention (p = 0.007) and verbal fluency (p = 0.056).

CONCLUSION

Our preliminary findings suggest that the MMM program may improve cognition, particularly verbal fluency and attention, in people with dementia.

Effects of music interventions on stress-related outcomes: a systematic review and two meta-analyses

Music interventions are used for stress reduction in a variety of settings because of the positive effects of music listening on both physiological arousal (e.g., heart rate, blood pressure, and hormonal levels) and psychological stress experiences (e.g., restlessness, anxiety, and nervousness). To summarize the growing body of empirical research, two multilevel meta-analyses of 104 RCTs, containing 327 effect sizes and 9,617 participants, were performed to assess the strength of the effects of music interventions on both physiological and psychological stress-related outcomes, and to test the potential moderators of the intervention effects. Results showed that music interventions had an overall significant effect on stress reduction in both physiological (d = .380) and psychological (d = .545) outcomes. Further, moderator analyses showed that the type of outcome assessment moderated the effects of music interventions on stress-related outcomes. Larger effects were found on heart rate (d = .456), compared to blood pressure (d = .343) and hormone levels (d = .349). Implications for stress-reducing music interventions are discussed.

Rehabilitation for People Living with Dementia: A Scoping Review of Processes and Outcomes

Objectives

The aim of this scoping review was to map intervention studies of rehabilitation for people living with dementia regarding processes and outcomes, with a particular focus on whether the intervention is person-centred, home-based, or organised adopting a multidisciplinary approach and measures outcomes relating to everyday functioning and well-being.

Methods

A systematic search of electronic databases was conducted in PubMed, CINAHL, PsycINFO, Embase, and Cochrane. Studies from 2005 to November 2018 were collected and screened for relevance and quality. Randomised control trials and prospective cohort trials reporting a statistically significant effect on one or more outcome measures were included. Included studies were mapped according to selected processes and outcome measures.

Results

Twenty-six intervention studies were included and mapped. Nineteen of the interventions were person-centred, nine were home-based, and 14 reported a multidisciplinary approach. Twelve of the interventions had activities of daily living as an outcome measure, and 14 had quality of life as an outcome measure.

Conclusion

Person-centredness appears in most rehabilitation interventions for people living with dementia. Other processes and outcomes are heterogeneously described in the research literature. Rehabilitation programmes can be home-based or take place at a centre. Although not exclusive, the organisation of rehabilitation can be multidisciplinary. Fewer than half of the intervention studies measure the impact on activities of daily living and quality of life. Future guidelines must take into account the weak evidence regarding these aspects.

Musical and Cognitive Abilities in Older Adults with Mild Cognitive Impairment

The objective of this cross-sectional study was to determine the extent and nature of self-reported musical abilities in persons with mild cognitive impairment (MCI). We recruited 60 older adults with a diagnosis of MCI from the Alzheimer's disease Core Center. We evaluated self-reported musical abilities using the Goldsmiths General Musical Sophistication Index. We examined correlations between musical abilities and neuropsychological measures of verbal learning and memory, processing speed, executive function, verbal fluency, naming and visuoconstructive abilities, while controlling for key demographic and participant characteristics. Older adults with MCI reported varying degrees of musical abilities. Nearly half of participants reported that they did not engage in regular, daily practice of a musical instrument. When adjusting for key demographic and participant characteristics, we found modest associations between four musical ability subfactors (active engagement, perceptual abilities, musical training and emotional engagement with music) with three cognitive abilities: verbal fluency, executive function and verbal naming. Except for the emotional engagement with music subfactor, none of the remaining musical ability subfactors correlated with any demographic or participant characteristics. While our study findings provided further support for the relationship between musical and cognitive abilities in older adults with MCI, this relationship warrants further investigation.

Principles and features to define and describe arts interventions for people with dementia: a qualitative realist study

Background: There is currently no consensus regarding the definition and description of arts interventions for people with dementia. Developing a common language of classification will encourage reflection on artistic practice, support the evaluation and improvement of arts interventions, and enable their benefits to be communicated more effectively. Methods: Using a qualitative framework derived from taxonomy and realist methodology, a literature review was undertaken to identify what key principles underpin arts interventions. This analysis was complemented by focus groups and workshops incorporating the lived experience of carers, artists, practitioners and care staff. Results: Nine principles were identified as elements present in person-centred arts interventions for people with dementia: Animation, Transcendence, Selfhood, Humanity, Expression, Connection, Possibility, Involvement and Awareness. Conclusions: It is possible to identify the component parts of arts interventions for people with dementia. These principles form an empirical basis for understanding how arts interventions work, while still respecting their individual nature.

Lincoln center moments: integrating accessibility and enhancement through expanding performing arts experiences

BACKGROUND

Exposure to the arts is vital to our quality of life, providing opportunities for social connection, engagement with past hobbies and perhaps most essentially in providing the potential for enhanced means of expression. For individuals with dementia and their care-givers, access to the arts can be challenging.

METHOD

This article describes a pilot program designed to enhance access by people with dementia and to provide deeper engagement with artists, therapist s and caregivers. Participants attended music and theater performances with caregivers, then attended workshops designed to deepen the experience. Workshops grouped participants by severity of dementia and measurements of engagement during and after the program were developed to assess the efficacy of the pilot program.

RESULTS

Enhanced quality of life was noted for people with dementia and the caregivers who attended the programs with them.

CONCLUSION

This project, the first of its kind, is a starting point. There has not been another to integrate professional musicians of varying genres, with people in the community with Alzheimer' s, and most particularly, by providing after-performance groups that assisted members' processing. Designing programs incorporating the arts as applicable to community-based institutions may expand their impact.

Activation of the Brain to Postpone Dementia: A Concept Originating from Postmortem Human Brain Studies

Alzheimer's disease (AD) is characterized by decreased neuronal activity and atrophy, while hyperactivity of neurons seems to make them resistant to aging and neurodegeneration, a phenomenon which we have paraphrased as 'use it or lose it'. Our hypothesis proposes that (1) during their functioning, neurons are damaged; (2) accumulation of damage that is not repaired is the basis of aging; (3) the vulnerability to AD is determined by the genetic background and the balance between the amount of damage and the efficiency of repair, and (4) by stimulating the brain, repair mechanisms are stimulated and cognitive reserve is increased, resulting in a decreased rate of aging and risk for AD. Environmental stimulating factors such as bilingualism/multilingualism, education, occupation, musical experience, physical exercise, and leisure activities have been reported to reduce the risk of dementia and decrease the rate of cognitive decline, although methodological problems are present.

Effects of Music Therapy in Frail Elderlies: Controlled Crossover Study

Background: Music therapy (MT) may exert beneficial preventive effects in frail elderly individuals in psychophysiological health. Objectives: One hundred and fifteen frail elderly individuals (65–89 years old) participated. Methods: Subjects were randomly divided into 2 groups for a controlled crossover trial. The MT-first group participated in group sessions of 45–50 min conducted by a certified music therapist for 12 weeks, followed by a 12-week waiting period. The waiting-first group participated in the reverse order. Cognitive function was assessed by the Verbal Fluency Test (VFT) and Yamaguchi Kanji Symbol Substitution Test (YKSST). Physical function was assessed by the Timed Up and Go test (TUG). Psychophysical health was assessed by the Geriatric Depression Scale 15-item version (GDS-15), General Health Questionnaire 12-item version (GHQ-12), Instrumental Activity of Daily Living (IADL) scale, and Life Space Assessment (LSA) scale. We also evaluated the outcome of MT using the Clinical Global Impressions of Improvement (CGI-I) scale. Results: After 12 weeks of MT, significant improvements were observed in TUG, GDS-15, and GHQ-12 scores. However, no improvements were noted in other scores. CGI-I scores revealed the significant benefits of MT. Conclusions: MT may improve physical function, depressive mood, and quality of life in frail elderly individuals.

The functional neuroanatomy of musical memory in Alzheimer's disease

Background

Memory for music has attracted much recent interest in Alzheimer's disease but the underlying brain mechanisms have not been defined in patients directly. Here we addressed this issue in an Alzheimer's disease cohort using activation fMRI of two core musical memory systems.

Methods

We studied 34 patients with younger onset Alzheimer's disease led either by episodic memory decline (typical Alzheimer's disease) or by visuospatial impairment (posterior cortical atrophy) in relation to 19 age-matched healthy individuals. We designed a novel fMRI paradigm based on passive listening to melodies that were either previously familiar or unfamiliar (musical semantic memory) and either presented singly or repeated (incidental musical episodic memory).

Results

Both syndromic groups showed significant functional neuroanatomical alterations relative to the healthy control group. For musical semantic memory, disease-associated activation group differences were localised to right inferior frontal cortex (reduced activation in the group with memory-led Alzheimer's disease); while for incidental musical episodic memory, disease-associated activation group differences were localised to precuneus and posterior cingulate cortex (abnormally enhanced activation in the syndromic groups). In post-scan behavioural testing, both patient groups had a deficit of musical episodic memory relative to healthy controls whereas musical semantic memory was unimpaired.

Conclusions

Our findings define functional neuroanatomical substrates for the differential involvement of musical semantic and incidental episodic memory in major phenotypes of Alzheimer's disease. The complex dynamic profile of brain activation group differences observed suggests that musical memory may be an informative probe of neural network function in Alzheimer's disease. These findings may guide the development of future musical interventions in dementia.

The Influence of a Multimodal Health Program with Diet, Art, and Biofield Therapy on the Quality of Life of People in Japan

Objective: To investigate whether the frequency of the practice of each of diet, art, and biofield therapy influences improvement in quality of life (QOL), and to examine whether the simultaneous practice of all three components increasingly improves QOL in a real-world setting.

Design: Pre–post-test design using convenience sampling methods.

Setting: Home setting.

Subjects: A total of 4681 individuals aged 16 years or older who answered the questionnaire appropriately.

Intervention: Participants agreed to practice the three components daily and self-evaluated the frequency of their weekly practice for three consecutive months. At the beginning and end of the study, they completed the MOA quality-of-life questionnaire (10-item MOA quality-of-life questionnaire [MQL-10]).

Outcome measures: Factors associated with the increase in MQL-10 scores for each component, and the relationship between the simultaneous practice of multiple components and the changes in MQL-10 scores were analyzed.

Results: Frequent practice of the diet and/or art components was associated with an increase in the term-end MQL-10 score (p < 0.001); however, receiving biofield therapy frequently was not. Participants' age, gender, and qualification as a practitioner of biofield therapy had no relationship with changes in scores, but the reasons for participation had a significant influence on changes in scores (p < 0.001). Participants who initially did not practice any components frequently but who subsequently increased the number of components and frequency of each practice had a higher likelihood of exhibiting an increase in the term-end score (p < 0.01). Participants who initially practiced all three components frequently but later decreased the number of components practiced frequently had a lower chance of increase and a higher risk of decrease in scores (p < 0.01).

Conclusions: The data suggest that the frequent practice of the diet and art components is associated with improvement in QOL. Simultaneous practice of diet, art, and biofield therapy is more likely to improve QOL. (ClinicalTrials.gov NCT01927250)

Sami yoik, Sami history, Sami health: a narrative review

Music as a possible health-promoting agent has attained increasing academic and scientific interest over the last decades. Nonetheless, possible connections between indigenous singing traditions and health beyond traditional ceremonial healing practices are still under-researched worldwide.

The Sami, the indigenous people living in Northern Fennoscandia, have a distinct ancient vocal music tradition called “yoik” practiced from immemorial times. The Sami share a history of assimilation with many indigenous people. During this period of nearly 400 years, yoik alongside other cultural markers was under hard pressure and even banned at times.

Compared to other indigenous people in the Arctic, Sami public health shows few significant unfavourable differences to the majority population. The potential role of yoik as a protective health and resilience factor within the Sami culture is the topic of this review. We suggest a two stage model for the health promoting effects of yoik through i) emotion regulation and stress relief on the level of the individual, and ii) as a socio-cultural resilience factors within the Sami population. This review is to be understood as theory-building review article striving for a scholarly review of the literature.

Attendance in Recreational Groups for Persons With Dementia: The Impact of Stimulus and Environmental Factors

OBJECTIVES

Participation in group activities can benefit persons with dementia, alleviating boredom, improving affect, maintaining function, and decreasing problematic behaviors.

METHODS

We describe patterns of attendance of residents with dementia at nursing home activity groups and investigate stimulus and environmental factors that may affect attendance.

RESULTS

Residents participated in 60.8% of the activities, with reasons for nonattendance including refusal (9.7%), not being on the unit (7.8%), being asleep (6.8%), and being involved in activities of daily living and other activities (8.3%). On average, 3.5 other residents not recruited for the study chose to participate in each group session. Group attendance was significantly related to group topic.

IMPLICATION

The need for activities was evident by the attendance of both invited and other residents. Understanding the factors that affect attendance is the first step toward developing procedures to maximize participation in activities in order to decrease loneliness and boredom in this population.

The Effects of Music Therapy-Singing Group on Quality of Life and Affect of Persons With Dementia: A Randomized Controlled Trial

Dementia is a clinical syndrome that is progressive and degenerative, affecting memory, behavior, emotion, and personality. Persons with dementia often experience deterioration of cognitive ability, as well as various behavioral and psychological disturbances, which significantly contribute to reduced quality of life and emotional well-being. The demand for long-term care continues to rise rapidly and it is therefore critical to develop effective strategies and evidence-based interventions to improve the quality of life for persons with dementia. Music therapy has drawn attention as a promising non-pharmacological approach for persons with dementia. A variety of music interventions including singing and listening to music have been widely applied for dementia care not only by music therapists, but also by other healthcare professionals. There are, however, little research studies that compare possible effects of music therapy interventions with those of music-based approaches on dementia care. The purpose of the current study was to compare the short-term effects of a music therapy-singing group with those of a music medicine-listening group and a control-TV group, on quality of life and affect of persons with dementia at a long-term care facility. The music therapy-singing group was facilitated by a music therapist, whereas the music medicine-listening and the control-TV group were led by nursing home activity staff. Fifty-two participants, whose ages range from 67 to 99 years old, were randomly assigned to one of the three groups, and 37 participants completed the interventions. The participants in each group were engaged for a 40-min session twice a week for four consecutive weeks. Quality of life was measured at the baseline and after the last session and only the music therapy-singing group demonstrated significant improvements when compared to the other groups. Positive and negative affect were measured at three points, including pre and post the first, fourth and eighth sessions. Only the music therapy-singing group significantly increased positive affect scores and decreased negative affect scores. The findings of the current study suggest that music therapy with active group singing may be an effective non-pharmacological intervention in improving quality of life and affect of persons with dementia at long-term care settings.

Clinical Trial Registration: http://www.germanctr.de/drks_web/, registration number DRKS00014934.

The Use of Music and Music Therapy in Ameliorating Depression Symptoms and Improving Well-Being in Nursing Home Residents With Dementia

Background: Studies have shown music therapy can improve depression symptoms in dementia and the use of music activities show promise to have positive impacts on wellbeing. However, few studies show the influence of a music intervention led by certified nursing assistants (CNAs) trained by music therapists to address depression symptoms and wellbeing in individuals with dementia.

Methods: Credentialed music therapists (1) administered 2-weeks of music therapy, (2) a 3-days training to CNAs, (3) followed by 2-weeks of music activities, singing and music-with-movement, led by CNAs for 62 nursing home residents with moderate dementia, (4) then measured depression symptoms using the Cornell Scale for Depression. We obtained video consent for 26 of the 62 residents who were video recorded receiving CNA-led music-based caregiving activities. Using the Music in Dementia Scale, over 200 h of video data was observed and raters measured changes in well-being, e.g., levels of enjoyment, mood and engagement in the residents, during the CNA facilitated music activities.

Results: A repeated measures ANOVA revealed that mean depression scores differed statistically significantly between time points, p ≤ 0.001. Residents' baseline depression symptoms significantly declined following 2 weeks of music therapy, p ≤ 0.001, increased during a 2-weeks wash-out period, p = 0.389, but appeared to stabilize following the 2-weeks music activity, p = 1.00. A video analysis and paired sampled t-test demonstrated a significant improvement in wellbeing in residents who engaged in music with movement, p = 0.003. Wellbeing improved slightly, but not significantly for residents who participated in the singing intervention, p = 0.165.

Conclusion: Findings suggest that music therapy can significantly decrease depression symptoms in nursing home residents with dementia. Music activities designed by music therapists and facilitated by CNAs may help sustain the reduction of depression symptoms and improve wellbeing in nursing home residents with moderate to severe dementia.

Golden oldies and silver brains: Deficits, preservation, learning, and rehabilitation effects of music in ageing-related neurological disorders

During the last decades, there have been major advances in mapping the brain regions that underlie our ability to perceive, experience, and produce music and how musical training can shape the structure and function of the brain. This progress has fueled and renewed clinical interest towards uncovering the neural basis for the impaired or preserved processing of music in different neurological disorders and how music-based interventions can be used in their rehabilitation and care. This article reviews our contribution to and the state-of-the-art of this field. We will provide a short overview outlining the key brain networks that participate in the processing of music and singing in the healthy brain and then present recent findings on the following key music-related research topics in neurological disorders: (i) the neural architecture underlying deficient processing of music (amusia), (ii) the preservation of singing in aphasia and music-evoked emotions and memories in Alzheimer's disease, (iii) the mnemonic impact of songs as a verbal learning tool, and (iv) the cognitive, emotional, and neural efficacy of music-based interventions and activities in the rehabilitation and care of major ageing-related neurological illnesses (stroke, Alzheimer's disease, and Parkinson's disease).

The effect of music therapy on cognitive functions in patients with dementia: a systematic review and meta-analysis

OBJECTIVES

The aim of the present study was to meta-analyze the effect of music therapy (MT) on cognitive functions in patients with dementia.

METHOD

A systematic literature search was performed in Medline, PsycINFO, Embase, CINAHL and RILM up to 8 September 2016. We included all randomized controlled trials that compared MT with standard care, or other non-musical types of intervention, evaluating cognitive outcomes in patients with dementia. Outcomes included global cognition, complex attention, executive function, learning and memory, language, and perceptual-motor skills.

RESULTS

From 1089 potentially relevant records, 110 studies were assessed for eligibility, and 7 met the inclusion criteria, of which 6 contained appropriate data for meta-analysis (330 participants, mean age range 78.8-86.3). Overall, random-effects meta-analyses suggested no significant effects of MT on all outcomes. Subgroup analysis found evidence of a beneficial effect of active MT on global cognition (SMD = 0.29, 95% CI 0.02 to 0.57, p = 0.04).

CONCLUSION

Despite the limited evidence of the present review, it is important to continue supporting MT as a complementary treatment for older adults with dementia. RCTs with larger sample sizes are needed to better elucidate the impact of MT on cognitive functions.

Remini-Sing: A Feasibility Study of Therapeutic Group Singing to Support Relationship Quality and Wellbeing for Community-Dwelling People Living With Dementia and Their Family Caregivers

Background: Living at home following a diagnosis of dementia can be difficult for both the person living with dementia (PwD) and their family caregivers (FCG). Active group music participation may provide an avenue for emotional release, offer psychosocial support to caregivers and stimulate meaningful interaction between caregivers and loved ones with dementia. Therapeutic music interventions also have the capacity to facilitate reminiscence and social engagement and can help to manage challenging symptoms associated with dementia, such as anxiety, apathy, and agitation.

Method: This feasibility study examined the acceptability of a 20-week therapeutic group singing intervention (Remini-Sing) and quantitative research assessments for PwD/FCG dyads living in the community. Quantitative measures for the following outcomes were tested for sensitivity and acceptability: relationship quality (PwD and FCG); life satisfaction, caregiver satisfaction, flourishing, and depression for FCGs; and anxiety, apathy, agitation, and quality of life for PwD. Quantitative assessments were conducted before, during (midway) and after 20 weeks of participation in a therapeutic singing group attended by the PwD and FCG together. The Remini-Sing intervention incorporated vocal warm ups, singing familiar songs, learning new songs, and opportunities for social interaction. Qualitative interviews were conducted with all dyads that completed the intervention.

Results: Twelve PWD/FCG dyads were recruited and enrolled in the study. High participation and retention rates indicated that the intervention was received favorably by participants. There were no statistically significant changes on measures from pre to post intervention. However, favorable baseline scores on relationship quality and wellbeing measures were sustained over the 20-week intervention. The testing of these measures for feasibility also revealed that some were too difficult for PwD and thus yielded questionable results, some were potentially less relevant, and there were likely floor and ceiling effects on several of the measures utilized.

Conclusions: This study demonstrated good feasibility for a research protocol and therapeutic group singing intervention for community-dwelling PwD and their FCGs. Participant reflections and researcher observations yielded useful information guiding the selection of quantitative outcome measures for future research in this area.

Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT)

OBJECTIVE

Disease-modifying treatments for OA remain elusive, and commonly used medications can have serious side effects. Although meditation and music listening (ML) have been shown to improve outcomes in certain chronic pain populations, research in OA is sparse. In this pilot RCT, we explore the effects of two mind-body practices, mantra meditation (MM) and ML, on knee pain, function, and related outcomes in adults with knee OA.

METHODS

Twenty-two older ambulatory adults diagnosed with knee OA were randomized to a MM (N=11) or ML program (N=11) and asked to practice 15-20 minutes, twice daily for 8 weeks. Core outcomes included knee pain (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Numeric Rating Scale), knee function (KOOS), and perceived OA severity (Patient Global Assessment). Additional outcomes included perceived stress (Perceived Stress Scale), mood (Profile of Mood States), sleep (Pittsburgh Sleep Quality Index), and health-related quality of life (QOL, SF-36). Participants were assessed at baseline and following completion of the program.

RESULTS

Twenty participants (91%) completed the study (9 MM, 11 ML). Compliance was excellent; participants completed an average of 12.1±0.83 sessions/week. Relative to baseline, participants in both groups demonstrated improvement post-intervention in all core outcomes, including knee pain, function, and perceived OA severity, as well as improvement in mood, perceived stress, and QOL (Physical Health) (p's≤0.05). Relative to ML, the MM group showed greater improvements in overall mood and sleep (p's≤0.04), QOL-Mental Health (p<0.07), kinesiophobia (p=0.09), and two domains of the KOOS (p's<0.09).

CONCLUSIONS

Findings of this exploratory RCT suggest that a simple MM and, possibly, ML program may be effective in reducing knee pain and dysfunction, decreasing stress, and improving mood, sleep, and QOL in adults with knee OA.