The effect of music therapy compared with general recreational activities in reducing agitation in people with dementia: a randomised controlled trial

A quasi-experimental mixed-method pilot study to check the efficacy of the "SOUND" active and passive music-based intervention on mental wellbeing and residual cognition of older people with dementia and dementia professionals' burnout: a research protocol

Purpose

The SOUND method offers an innovative blended intervention based on music circle-activities and cognitive stimulation approaches which was co-designed by musicians, health professionals, older people with dementia, family caregivers and researchers, for its application in dementia settings. The purpose of the paper is to describe the detailed procedure of the quasi-experimental pilot study.

Method

The experimental phase of SOUND uses a mixed-method design encompassing qualitative and quantitative observations, cognitive testing, self-report and interviewer-assisted questionnaires to investigate the effectiveness of the intervention for 45 people with dementia and 45 professionals (15 in every study country: Italy, Portugal, Romania).

Results

The pilot study will be the first implementation of the SOUND intervention aiming to investigate the feasibility and preliminary effects of the method.

Conclusion

The novelty of SOUND is its multicomponent method, including the most evidenced features for improving the wellbeing of participants.

An Individual Music Intervention for Adults With Intellectual Disabilities and Challenging Behavior: Protocol for a Randomized Controlled Trial

BACKGROUND

Individuals with intellectual disabilities (ID) are more likely to have problems with executive functioning (EF) and challenging behavior (CB), which are negatively linked to well-being. Among clinical populations, music interventions have been shown to improve various outcome measures, such as CB and EF. Until now, no randomized controlled trials (RCTs) have been conducted to examine the effectiveness of an individual music intervention for adults with ID and CB.

OBJECTIVE

The study aims to identify the effect and feasibility of an individual music intervention compared with care-as-usual for people with ID and CB.

METHODS

In this study, a 2-group RCT with a pretest, posttest, and follow-up assessment after 8 weeks is presented. Participants of the music intervention condition will receive 16 individual music sessions within 8 to 10 weeks. The music intervention will be guided by a manual for music workers, in which every session will have a different focus (introduction, emotions, different EF, and end performance). Participants receiving care as usual will function as a control group. After the research is finished, they will be offered a budget, which they can spend on musical activities or musical instruments as they wish. Assessments will include caregiver rating scales and self-report questionnaires and tests, which will assess outcome measures of CB, well-being, depression, anxiety, self-esteem, and 4 domains of EF. A process evaluation will be conducted after the completion of the study, which entails the analysis of data on multiple aspects of the intervention and the study overall.

RESULTS

Enrollment commenced in July 2021, and data collection ended in May 2023. A total of 97 participants were recruited, with 44 participants allocated to the intervention group and 53 allocated to the control group. Data will be analyzed after this protocol has been accepted for publication.

CONCLUSIONS

Because there are currently no published RCTs of an individual music intervention for adults with ID and CB, this study will provide insight into the effectiveness and experiences of an individual music intervention for this target group.

TRIAL REGISTRATION

International Clinical Trials Registry Platform NL8482; http://tinyurl.com/4565s5pd.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52497.

Investigating the Readability and Linguistic, Psychological, and Emotional Characteristics of Digital Dementia Information Written in the English Language: Multitrait-Multimethod Text Analysis

BACKGROUND

Past research in the Western context found that people with dementia search for digital dementia information in peer-reviewed medical research articles, dementia advocacy and medical organizations, and blogs written by other people with dementia. This past work also demonstrated that people with dementia do not perceive English digital dementia information as emotionally or cognitively accessible.

OBJECTIVE

In this study, we sought to investigate the readability; linguistic, psychological, and emotional characteristics; and target audiences of digital dementia information. We conducted a textual analysis of 3 different types of text-based digital dementia information written in English: 300 medical articles, 35 websites, and 50 blogs.

METHODS

We assessed the text's readability using the Flesch Reading Ease and Flesch-Kincaid Grade Level measurements, as well as tone, analytical thinking, clout, authenticity, and word frequencies using a natural language processing tool, Linguistic Inquiry and Word Count Generator. We also conducted a thematic analysis to categorize the target audiences for each information source and used these categorizations for further statistical analysis.

RESULTS

The median Flesch-Kincaid Grade Level readability score and Flesch Reading Ease score for all types of information (N=1139) were 12.1 and 38.6, respectively, revealing that the readability scores of all 3 information types were higher than the minimum requirement. We found that medical articles had significantly (P=.05) higher word count and analytical thinking scores as well as significantly lower clout, authenticity, and emotional tone scores than websites and blogs. Further, blogs had significantly (P=.48) higher word count and authenticity scores but lower analytical scores than websites. Using thematic analysis, we found that most of the blogs (156/227, 68.7%) and web pages (399/612, 65.2%) were targeted at people with dementia. Website information targeted at a general audience had significantly lower readability scores. In addition, website information targeted at people with dementia had higher word count and lower emotional tone ratings. The information on websites targeted at caregivers had significantly higher clout and lower authenticity scores.

CONCLUSIONS

Our findings indicate that there is an abundance of digital dementia information written in English that is targeted at people with dementia, but this information is not readable by a general audience. This is problematic considering that people with <12 years of education are at a higher risk of developing dementia. Further, our findings demonstrate that digital dementia information written in English has a negative tone, which may be a contributing factor to the mental health crisis many people with dementia face after receiving a diagnosis. Therefore, we call for content creators to lower readability scores to make the information more accessible to a general audience and to focus their efforts on providing information in a way that does not perpetuate overly negative narratives of dementia.

Tourism experiences reduce the risk of cognitive impairment in the Chinese older adult: a prospective cohort study

Background

Given the etiological complexity of cognitive impairment, no effective cure currently exists for precise treatment of dementia. Although scholars have noted tourism's potential role in managing cognitive impairment and mild dementia, more robust empirical investigation is needed in this area. This study aimed to examine the associations between tourism and cognitive impairment and dementia in older Chinese adults.

Method

From a nationwide community-based cohort, 6,717 individuals aged ≥60 were recruited from 2011 to 2014, of whom 669 (9.96%) had had at least one tourism experience in the 2 years prior to enrollment. All the participants were then prospectively followed up until 2018. The association between tourism and cognitive impairment was examined by the Cox proportional hazards regression model. The adjusted hazard ratio (aHR) and its 95% confidence interval (CI) were calculated to evaluate the effect of tourism experience on cognitive impairment and dementia.

Results

A total of 1,416 individuals were newly diagnosed with cognitive impairment and 139 individuals with dementia onset during follow-up. The incidence of cognitive impairment was significantly lower among participants with tourism experiences (316.94 per 10,000 person-years) than those without such experiences (552.38 per 10,000 person-years). Cox regression showed that tourism decreased the risk of cognitive impairment (aHR = 0.69, 95% CI: 0.41-0.62) when adjusted for behavioral covariates and characteristics. Compared with participants without tourism experiences, those with 1, 2, and ≥3 tourism experiences had a lower risk of cognitive impairment with the aHRs of 0.72 (95% CI: 0.52-0.99), 0.65 (0.42-1.01), and 0.68 (0.44-0.98), respectively. Tourism experiences also reduced participants' risk of dementia (aHR = 0.41, 95% CI: 0.19-0.89).

Conclusion

Our findings demonstrated associations between tourism and reduced risks of cognitive impairment and dementia in older Chinese adults. Thus, tourism could serve as a novel approach to dementia prevention.

Effect of internet-based vs. in-person multimodal interventions on patients with mild to moderate Alzheimer's disease: a randomized, cross-over, open-label trial

Objective

We aimed to investigate the effect of internet-based and in-person cognitive interventions on cognition, mood, and activities of daily living (ADL) on patients with mild to moderate Alzheimer's disease (AD) and examine whether internet-based intervention is as effective as the in-person intervention.

Methods

We recruited 52 patients with probable mild AD, of whom 42 completed the trial. We randomly divided participants into intervention and control groups at a 1:1 ratio and statistically compared the neuropsychological test results of the two groups. In addition, patients in the intervention group were randomly assigned to a 4 weeks internet-based or in-person intervention, with subsequent crossover to the other group for 4 weeks. We statistically analyzed and compared the neuropsychological test scores between internet-based and in-person interventions.

Results

Compared with the control group, the intervention group (internet-based and in-person) showed significantly improved profile in cognition (p < 0.001), depression (p < 0.001), anxiety (p < 0.001) and ADL (p < 0.001). In addition, the effect of the internet-based intervention on cognition (p = 0.918) and depression (p = 0.282) was not significantly different from that of the in-person intervention. However, in the Beck anxiety inventory (p = 0.009) and Seoul instrumental activity of daily living (p = 0.023), in-person intervention was more effective than internet-based intervention.

Conclusion

This study suggests that both types of cognitive intervention (in-person and internet-based) may be viable supplementary treatments along with approved pharmacological therapy. In terms of anxiety and ADL, the effect of the in-person interventions may be more effective than the-internet based interventions.

Sensogenomics of music and Alzheimer's disease: An interdisciplinary view from neuroscience, transcriptomics, and epigenomics

Introduction

The relationship between music and Alzheimer's disease (AD) has been approached by different disciplines, but most of our outstanding comes from neuroscience.

Methods

First, we systematically reviewed the state-of-the-art of neuroscience and cognitive sciences research on music and AD (>100 studies), and the progress made on the therapeutic impact of music stimuli in memory. Next, we meta-analyzed transcriptomic and epigenomic data of AD patients to search for commonalities with genes and pathways previously connected to music in genome association, epigenetic, and gene expression studies.

Results

Our findings indicate that >93% of the neuroscience/ cognitive sciences studies indicate at least one beneficial effect of music on patients with neurodegenerative diseases, being improvements on memory and cognition the most frequent outcomes; other common benefits were on social behavior, mood and emotion, anxiety and agitation, quality of life, and depression. Out of the 334 music-related genes, 127 (38%) were found to be linked to epigenome/transcriptome analysis in AD (vs. healthy controls); some of them (SNCA, SLC6A4, ASCC2, FTH1, PLAUR and ARHGAP26) have been reported to be associated e.g. with musical aptitude and music effect on the transcriptome. Other music-related genes (GMPR, SELENBP1 and ADIPOR1) associated to neuropsychiatric, neurodegenerative diseases and music performance, emerged as hub genes in consensus co-expression modules detected between AD and music estimulated transcriptomes. In addition, we found connections between music, AD and dopamine related genes, with SCNA being the most remarkable - a gene previously associated with learning and memory, and neurodegenerative disorders (e.g., Parkinson's disease and AD).

Discussion

The present study indicate that the vast majority of neuroscientific studies unambiguously show that music has a beneficial effect on health, being the most common benefits relevant to Alzheimer's disease. These findings illuminate a new roadmap for genetic research in neurosciences, and musical interventions in AD and other neurodegenerative conditions.

James A, Dupuis K, Cohen D. Developing a music-based digital therapeutic to help manage the neuropsychiatric symptoms of dementia

The greying of the world is leading to a rapid acceleration in both the healthcare costs and caregiver burden that are associated with dementia. There is an urgent need to develop new, easily scalable modalities of support. This perspective paper presents the theoretical background, rationale, and development plans for a music-based digital therapeutic to manage the neuropsychiatric symptoms of dementia, particularly agitation and anxiety. We begin by presenting the findings of a survey we conducted with key opinion leaders. The findings highlight the value of a music-based digital therapeutic for treating neuropsychiatric symptoms, particularly agitation and anxiety. We then consider the neural substrates of these neuropsychiatric symptoms before going on to evaluate randomized control trials on the efficacy of music-based interventions in their treatment. Finally, we present our development plans for the adaptation of an existing music-based digital therapeutic that was previously shown to be efficacious in the treatment of adult anxiety symptoms.

A scoping review: Sensory interventions for older adults living with dementia

This scoping review focused on the existing scholarly literature exploring sensory interventions and immersive environments developed for, and used by, older adults living with dementia. The purpose of the scoping review is 1) to understand the various sensory interventions that have been developed, used, and have provided data to show how such interventions are expected to impact the lives of individuals living with dementia; and 2) to understand how the field is moving forward. We chose to map the literature to understand the types of interventions, the types of outcomes measured, and the contexts of their implementation. Our search was constrained to references from 1990 to 1 June 2019 in the following databases: Academic Search Complete, CINAHL Complete, MEDLINE, PsycINFO databases, and Summon Search discovery layer. We screened 2305 articles based on their titles and abstracts, and 465 were sent to full text review, of which 170 were included in our full text extraction. Once the data were extracted, we created emic categories, which emerged from the data, for data that were amenable to categorization (e.g., study setting, intervention type, and outcome type). We developed ten different categories of interventions: art, aromatics, light, multi-component interventions, multisensory rooms, multisensory, music, nature, touch, and taste. Sensory interventions are a standard psychosocial approach to managing the personal expressions commonly experienced by people living with dementia. Our findings can help providers, caregivers, and researchers better design interventions for those living with dementia, to help them selectively choose interventions for particular outcomes and settings. Two areas emerging in the field are nature interventions (replacing traditional "multisensory rooms" with natural environments that are inherently multisensory and engaging) and multi-component interventions (where cognitive training programs are enhanced by adding sensory components).

Active music therapy in dementia: results from an open-label trial

ABSTRACT Objective: Cognitive, neuropsychiatric and functional deficits are core symptoms of dementia. Non-pharmacological interventions, such as music therapy, when used in conjunction with pharmacological treatment, have the potential to alleviate these symptoms. The purpose of this preliminary study is to examine the active music therapy on cognition and neuropsychiatric symptoms in the elderly with mild and moderate dementia. Methods: The initial sample consisted of outpatients with dementia (N = 15) and their family members or caregivers (N = 15). Two dyads did not complete the assessments before intervention and were excluded from the analysis. Thirteen females (N = 13) comprised the final sampled and were diagnosed with Alzheimer’s disease (N = 10), vascular dementia (N = 2) and mixed dementia (N = 1), at mild (N = 11) and moderate (N = 2) dementia stage. Participants were enrolled in an open-label trial of active music therapy group, set to take place once weekly for 60 minutes over a period of 12 weeks. Results: Participants experienced a slight improvement on cognition measured with Mini-Mental State Examination (p = 0.41), although without statistical significance and a statistically significant decrease in anxiety (p = 0.042) in post-intervention. There were no significant effects on quality of life and caregiver burden. Conclusions: Active music therapy is a promising intervention with good acceptance among participants. More studies with larger sample sizes are needed to confirm its effects and efficacy in cognitive and neuropsychiatric symptoms in dementia.

The Rationale and Design of Behavioral Interventions for Management of Agitation in Dementia in a Multi-Site Clinical Trial

BACKGROUND

Agitation and aggression are common in patients with Alzheimer's disease and related dementias and pose a significant burden on patients, caregivers, and the healthcare systems. Guidelines recommend personalized behavioral interventions as the first-line treatment; however, these interventions are often underutilized. The Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov Identifier # NCT0367220) is a multisite randomized controlled trial comparing an Integrated Care Pathway, that includes a sequential pharmacological algorithm and structured behavioral interventions, with treatment-as-usual to treat agitation in dementia in long-term care and inpatient settings.

OBJECTIVE

To describe the rationale and design of structured behavioral interventions in the StaN study.

METHODS

Structured behavioral interventions are designed and implemented based on the following considerations: 1) personalization, 2) evidence base, 3) dose and duration, 4) measurement-based care, and 5) environmental factors and feasibility.

RESULTS

The process to design behavioral interventions for each individual starts with a comprehensive assessment, followed by personalized, evidence-based interventions delivered in a standardized manner with ongoing monitoring of global clinical status. Measurement-based care is used to tailor the interventions and to integrate them with pharmacotherapy.

CONCLUSION

Individualized behavioral interventions in patients with dementia may be challenging to design and implement. Here we describe a process to design and implement individualized and structured behavioral interventions in the context of a multisite trial in long-term care and inpatient settings. This process can inform the design of behavioral interventions in future trials and in clinical settings for the treatment of agitation in dementia.

Effects of Nonpharmacological Interventions on Disruptive Vocalisation in Nursing Home Patients With Dementia—A Systematic Review

Background

Vocally disruptive behaviour is a common and difficult to treat condition in older residents with dementia. The aim of this systematic review is to evaluate the efficacy of nonpharmacological interventions in its management in persons with dementia residing in a nursing home.

Methodology

A systematic search was conducted using Ovid MEDLINE, CINAHL, and Cochrane databases and reference lists from relevant publications on various nonpharmacological approaches to manage vocally disruptive behaviour in nursing home residents. The method of appraisal was through the National Institutes of Health scoring for the Quality Assessment of controlled intervention studies. Inclusion criteria included residents of nursing homes over the age of 65 with dementia and disruptive vocalisation. Only randomised controlled trials published in English were included.

Results

A total of 5,606 articles were identified, which cover 501 trials, of which 23 were selected. There were fourteen studies observed to have an impact of clinical and statistical significance with interventions including (i) a multidimensional approach with different nonpharmacological interventions, (ii) multisensory stimulation, (iii) staff education and training, (iv) personalised bathing, and (v) pain recognition and appropriate management. Seven studies demonstrated no observable effect whereas two showed worsening in vocally disruptive behaviour.

Conclusions

Many aspects of vocally disruptive behaviour management are poorly understood. Limited empirical evidence supports the use of several nonpharmacological interventions to reduce it. There is more robust evidence to support the use of a tailored approach to management over the universal approach.

The Assessments of Music Therapy for Dementia Based on the Cochrane Review

Background

Research on music therapy for dementia has taken a variety of measures and has been slow to consolidate evidence. Examining the outcomes that are currently being investigated and the measures that have been used can be useful for future research on music therapy for dementia.

Objectives

This study used cited original papers from a review in the Cochrane Database of Systematic Reviews to determine if there are items that should be measured or scales that should be used in conducting research on music therapy for dementia. The rating scales used and the outcomes examined were extracted.

Method

We used Dodd's criteria to identify (1) the outcome domains examined in music therapy for dementia, (2) the measures used, and (3) the measures capable of detecting significant intervention effects.

Result

A search for reviews was conducted, and 7 systematic reviews (78 articles) were identified. Among them, 30 articles met the inclusion criteria. The 30 articles examined 18 of the 38 items in Dodd's outcome categories, while 20 items were not examined, and 78 different survey methods were used. The items most frequently surveyed in the studies were psychiatric outcomes, cognitive functioning, and global quality of life general outcomes.

Conclusions

We found that many studies investigated cognitive function, behavioral and psychological symptoms of dementia (BPSD), and quality of life; compared to BPSD, various types of rating scales were used for cognitive function. By standardizing the rating scales, we can contribute to the accumulation of evidence for music therapy for dementia.

Understanding How Sensory Changes Experienced by Individuals with a Range of Age-Related Cognitive Changes Can Effect Technology Use

Clinical researchers have identified sensory changes people with age-related cognitive changes, such as dementia and mild cognitive impairment, experience that are different from typical age-related sensory changes. Technology designers and researchers do not yet have an understanding of how these unique sensory changes affect technology use. This work begins to bridge the gap between the clinical knowledge of sensory changes and technology research and design through interviews with people with mild to moderate dementia, mild cognitive impairment, subjective cognitive decline, and healthcare professionals. This extended version of our ASSETS conference paper includes people with a range of age-related cognitive changes describing changes in vision, hearing, speech, dexterity, proprioception, and smell. We discuss each of these sensory changes and ways to leverage optimal modes of sensory interaction for accessible technology use with existing and emerging technologies. Finally, we discuss how accessible sensory stimulation may change across the spectrum of age-related cognitive changes.

Emerging Perspectives in the Management of Agitation in Alzheimer's Disease and Patients with Dementia

While Alzheimer's disease, the most common cause of dementia, is perhaps best characterized by cognitive decline, more than 90% of patients exhibit behavioural and psychological symptoms of dementia. Agitation in patients with dementia is often difficult to manage, and is associated with increased morbidity and mortality in patients and a heightened caregiver burden. Thus, effective management of dementia-related agitation (DRA) is vital. Care should first be taken to consider and address causes of agitation and aggression, after which non-pharmacological interventions should be employed. If non-pharmacological measures are unsuccessful in reducing DRA then medications should be considered, although none are approved by the Food and Drug Administration for this indication. Electroconvulsive therapy may be a promising option for patients with treatment-refractory DRA, although more studies are needed. While there are several drugs in the pipeline for DRA treatment, results from robust randomized clinical trials are necessary before they can be administered to patients. Thus, clinicians should employ current strategies to manage DRA to ensure holistic care for patients with Alzheimer's disease.

Benefits of Cultural Activities on People With Cognitive Impairment: A Systematic Review

Museums and cultural institutions are increasingly striving to respond to the interests and needs of the society that hosts them. This means, apart from other actions, that these institutions must be involved in the health and wellbeing of society, and the creation of cultural activities aimed at people with cognitive impairment, a group of individuals that is growing worldwide due to the aging of society and the increasing prevalence of dementia. The involved sectors are aware of the potential and benefits of activities for this population, even though there is much research to be conducted. To date, no systematic review has focused on the benefits of cultural activities for cognitively impaired people. This study aimed to explore the benefits of different modalities of cultural activities with evidence from 145 studies from various databases, which met the inclusion criteria. Significant improvements in general cognition, quality of life (QoL), emotional wellbeing, socialization, and communication were generally reported after interventions, with a reduction in depression symptoms. There was not enough evidence to prove memory, language, or daily functioning improvements attributable to cultural interventions. There were no significant reductions reported in apathy, sadness, agitation, or anxiety.

Choral Singing Enriches Everyday Life for People With Mild to Moderate Dementia and Their Family Caregivers

Dementia causes substantial suffering for affected persons and their family caregivers. Because no cure is available, it is important to investigate how alternative therapies can improve life for these individuals. For the current study, persons with dementia (PwD) were recruited from a specialized Memory Clinic in Sweden to engage in a choral singing intervention for 1 hour per week for four semesters. PwD were encouraged to bring a family caregiver to the sessions; both were interviewed and data were analyzed using qualitative content analysis. The choral singing intervention appeared to become an important social context for PwD and family caregivers and had a positive impact on relationship, mental well-being, mood, and memory. The intervention appeared to act as an enriched environment for all participants. Choral singing interventions for PwD and their family caregivers is a simple means to create a social context and improve general well-being. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Comparative Efficacy of Active Group Music Intervention versus Group Music Listening in Alzheimer's Disease

BACKGROUND

Music interventions are promising therapies for the management of symptoms in Alzheimer's disease (AD). Globally, music interventions can be classified as active or receptive depending on the participation of the subjects. Active and receptive music tasks engage different brain areas that might result in distinctive clinical effects. This study aims to compare the clinical effects of two types of music interventions and a control activity.

METHODS

Ninety AD patients from six nursing homes participated in the study. Nursing homes were randomly and blindly assigned to receive either active music intervention, receptive music intervention, or the usual care. Effects on cognition, behaviour, daily living activities, and motor function were assessed.

RESULTS

Active music intervention improved cognition, behaviour, and functional state in a higher extent than both receptive music intervention and usual care. The effect size of active music intervention for cognitive deficits and behavioural symptoms was large (η2 = 0.62 and 0.61, respectively), while for functional state, it was small-to-medium sized (η2 = 0.18). Receptive music intervention had a stabilizing effect on behavioural symptoms compared to control intervention (mean change from baseline ± standard deviation = -0.76 ± 3.66 and 3.35 ± 3.29, respectively). In the active music intervention, the percentage of patients who showed improvement in cognitive deficits (85.7), behavioural symptoms (92.9), and functional state (46.4) was higher than in both receptive listening (11.8, 42.9, and 14.3, respectively) and control group (6.3, 12.2, and 17.1, respectively).

CONCLUSIONS

Active music intervention is useful to improve symptoms of AD and should be prescribed as a complement to the usual treatment.

Impact of Alzheimer's Dementia on Caregivers and Quality Improvement through Art and Music Therapy

Dementia is a general term for a series of medical conditions that affect the brain and evolve progressively. According to the literature, there are over 200 subtypes and causes of dementia, with Alzheimer's disease (AD) being the most common in elderly people. AD is an irreversible progressive neurodegenerative condition that leads to a decline in mental function, enough to disrupt daily life. Thinking skills slowly deteriorate, which, in advanced stages, makes it impossible to perform simple tasks. Besides the change in the quality of life of AD patients and their families, there is a considerable alteration in the quality of life of their caregivers, whose health can be negatively affected by the development of mental and somatic disorders. This article reviews the literature in order to reveal the benefits of applying non-pharmacological interventions such as music and art therapy to improve quality of life. This article also aims to shed light on the impact of this disease on the caregiver's life. Music and art therapy have produced reliable results in the treatment of patients with AD, and the best effects are related to increased socialization and the maintenance of social status.

Impacts of Music Intervention on Dementia: A Review Using Meta-Narrative Method and Agenda for Future Research

Background: Dementia, a significant cognitive impairment, is characterized by a decline in memory. It affects an individual’s mood and behavior, which can impair their quality of life and well-being. Studies show that the demand for applying music as a new therapy method for dementia has increased during the last decades. Objective: To review the studies conducted on the impacts of music on different symptoms of dementia and provide readers with a more detailed picture of the efficacy of music, and recognize gaps in the literature. Methods: Electronic searches were conducted in the Cochrane Library (1938), Embase (773), Medline and PubMed (700), PsycINFO (89), and Scopus (218) databases. The search was comprised of all the literature from 2010 to 2020. For the search, key terms including “Dementia” AND “music” OR “music intervention” OR “music therapy” and index terms “clinical trial” OR “randomized controlled trials” were used. Finally, after screening 891 citations, 30 studies were included. Results: In general, it was observed that in most cases, music could be used as one of the safe and cost-effective non-pharmacological approaches for dementia treatment. However, in some studies, no impact or short-term effect of music on some symptoms of dementia such as wandering, agitation, and cognition was detected. Conclusion: Observing no effect or even negative impact of music on people living with dementia could be due to a random selection of music, fewer individuals, and the lack of a standard protocol. High heterogeneity in outcomes did not allow for clear conclusions on the benefits of music in dementia. This demands a comprehensive non-pharmacological music treatment approach to be designed for each stage of dementia to be employed alongside pharmacological treatments. This study proposes 13 gaps in the research on the health impact of music on dementia that could be studied by future researchers.

The Role of Sensory Changes in Everyday Technology use by People with Mild to Moderate Dementia

Technology design for dementia primarily focuses on cognitive needs. This includes providing task support, accommodating memory changes, and simplifying interfaces by reducing complexity. However, research has demonstrated that dementia affects not only the cognitive abilities of people with dementia, but also their sensory and motor abilities. This work provides a first step towards understanding the interaction between sensory changes and technology use by people with dementia through interviews with people with mild to moderate dementia and practitioners. Our analysis yields an understanding of strategies to use technology to overcome sensory changes associated with dementia as well as barriers to using certain technologies. We present new directions for the design of technologies for people with mild to moderate dementia, including intentional sensory stimulation to facilitate comprehension, as well as opportunities to leverage advances in technology design from other disabilities for dementia.

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.

Effect of Integrated Cognitive Intervention Therapy in Patients with Mild to Moderate Alzheimer's Disease

Background and Purpose

The effect of the integrated program comprising cognitive training, art therapy, and music therapy has not been extensively studied in patients with Alzheimer's disease (AD). The present study investigated the effect of integrated cognitive intervention therapy on cognition, and activity of daily life (ADL), and mood in patients with mild to moderate AD.

Methods

In this study, the data of 59 patients who met the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer disease and Related Disorders Association (NINCDS-ADRDS) criteria of probable AD among those who registered at the Centenarian's Good Memory Program in Goyang from September 2014 to August 2019 were collected. We statistically analyzed the scores of Korean version of a Mini-Mental Status Examination (K-MMSE), Korean Dementia Screening Questionnaire-Cognition (KDSQ-C), Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), and Seoul-Instrumental Activities of Daily Living (S-IADL) of the same patients before and after the use of integrated cognitive intervention therapy.

Results

K-MMSE slightly increased from 18.7±4.5 to 19.7±5.0 (p<0.001) and KDSQ-C improved from 14.5±7.6 before therapy to 12.6±7.2 after therapy (p=0.001). Mean S-IADL score improved from 17.6±7.6 before therapy to 15.7±9.5 after therapy (p<0.001). Additionally, mean GDS score before the therapy was 5.6±3.5 that improved to 4.2±3.0 after the therapy (p<0.001). Mean BAI score decreased from 8.4±10.3 before therapy to 5.9±8.4 after therapy (p=0.001).

Conclusions

In conclusion, this study demonstrated the possibility that the use of an integrated cognitive therapy improved cognition, ADL, and mood (depression and anxiety) in patients with mild to moderate ADs.

A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT

BACKGROUND

People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision.

OBJECTIVES

To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes.

DESIGN

The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible.

SETTING

Nursing homes in England providing care for people with dementia.

PARTICIPANTS

Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff.

INTERVENTION

Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement.

MAIN OUTCOME MEASURES

The two contender primary outcome measures were Comfort Assessment in Dying - End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data - health economic outcomes, medication/service use and intervention activity.

RESULTS

Phase 1 (realist review; 86 papers) identified that a key intervention component was the activities enabling the development of moments of connection. In phase 2, refinement of the intervention enabled the production of a user-friendly 16-page A4 booklet. In phase 3, eight nursing homes were recruited. Two homes withdrew before the intervention commenced; four intervention and two control homes completed the study. Residents with advanced dementia (n = 32) were recruited in intervention (n = 18) and control (n = 14) homes. Informal carers (total, n = 12: intervention, n = 5; control, n = 7) and 97 staff from eight sites (intervention, n = 75; control, n = 22) were recruited over a 6-month period. Recruitment is feasible. Completion rates of the primary outcome questionnaires were high at baseline (100%) and at 4 weeks (96.8%). The Quality of Life in Late Stage Dementia was more responsive to change over 24 weeks. Even where economic data were missing, these could be collected in a full trial. The intervention was acceptable; the dose varied depending on the staffing and physical environment of each care home. Staff and informal carers reported changes for the person with dementia in two ways: increased social engagement and greater calm. No adverse events related to the intervention were reported.

CONCLUSIONS

A subsequent definitive trial is feasible if there are amendments to the recruitment process, outcome measure choice and intervention specification.

FUTURE WORK

In a full trial, consideration is needed of the appropriate outcome measure that is sensitive to different participant responses, and of clear implementation principles for this person-centred intervention in a nursing home context.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN14948133.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 6. See the NIHR Journals Library website for further project information.

The Positive Effects of Viewing Gardens for Persons with Dementia

Dementia is highly prevalent among the worldwide elderly population. Only a small number of the currently marketed drugs are effective in controlling its symptoms, and none has any effect on its progression. Further, as the condition advances, even these pharmaceuticals lose their efficiency, and new research into interventions that might improve the life quality of patients at the end stage of dementia and their families is increasingly rare. In our previous studies, we explored the benefits of exposure to nature, in the form of a Japanese garden, for persons with advanced dementia. In the current work, we extended our observations to two new locations and a new set of subjects with a different ethnic composition with the goal of identifying interventions that might improve their quality of life. We found that, even in these new settings, garden observation not only relieved physiological stress, it improved qualitative measures such as verbalization and memory retrieval. We present data that viewing the garden is a holistic experience rather a solely visual stimulus. Our new data further support the conclusion that garden observation is worth including in the care planning schedule of advanced dementia patients. Its low cost and easy availability make it an economical adjunct to current pharmacological methods that has the potential to improve the quality of life of people with dementia.

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.

Multisensory Stimulation and Individualized Music Sessions on Older Adults with Severe Dementia: Effects on Mood, Behavior, and Biomedical Parameters

BACKGROUND

Multisensory stimulation and individualized music have shown to be good in handling the psychological and behavioral symptoms in people with severe dementia.

OBJECTIVE

Explore the effects of two nonpharmacological interventions, multisensory stimulation environment (MSSE) in a Snoezelen room and individualized music sessions, on mood, behavior, and biomedical parameters of institutionalized elderly patients with severe dementia.

METHODS

Randomized trial of 21 patients aged ≥65 years randomly assigned to two groups (MSSE and individualized music). Interventions administered in two-weekly sessions lasted 30 minutes for a period of 12 weeks. Main outcomes were recorded before, during, and at the end of the intervention.

RESULTS

Both groups had immediate positive effects on mood and behavior. Participants were more happy/more content (p < 0.001), talked more spontaneously (p = 0.009), related to people better (p = 0.002), were more attentive to/focused on their environment (p < 0.001), enjoyed themselves (p = 0.003), were less bored/inactive (p = 0.004), and more relaxed/content (p = 0.003). The MSSE group performed a better visual follow-up of the stimuli (p = 0.044), and the music group were more relaxed and happy (p = 0.003). A decrease in heart rate (p = 0.013) and an increase in oxygen saturation (p = 0.011) were observed from before to after interventions in both groups, with no significant differences between them.

CONCLUSIONS

Both interventions seem to be effective at managing mood and behavioral disturbances in the short term and at improving physiological rates, highlighting the efficacy of nonpharmacological treatments in patients with severe dementia.

Mindsong, music therapy and dementia care: collaborative working to support people with dementia and family carers at home

Mindsong brings music therapy to people with dementia across Gloucestershire. In 2016, it was part of an innovative co-production project funded by NHS Gloucestershire Clinical Commissioning Group that offered music therapy to people with advanced dementia and ‘challenging’ behaviour. Music therapy was used at times of crisis with couples in the domiciliary setting and the hardest to reach residents at a dementia specialist care home. Positive outcomes included improvements in well-being, mood, engagement and behaviours. Working with client and carer together resulted in increased carer resilience despite complex challenges. Collaborative working maximised results to the benefit of clients and those who care for them. This article focuses on work in the domiciliary setting.

Evaluating the Impact of Music & Memory's Personalized Music and Tablet Engagement Program in Wisconsin Assisted Living Communities: Pilot Study

BACKGROUND

Individuals with Alzheimer disease or related dementia represent a significant and growing segment of the older adult (aged 65 years and above) population. In addition to physical health concerns, including comorbid medical conditions, these individuals often exhibit behavioral and psychological symptoms of dementia (BPSD). The presence of BPSD in long-term care residential facilities can disrupt resident's care and impact staff. Nonpharmacological interventions such as personalized music and tablet engagement maintain cognitive function, improve quality of life (QOL), and mitigate BPSD for older adults with dementia. Evidence of the impact of such interventions in assisted living communities (ALCs) is needed for widespread adoption and sustainment of these technologies.

OBJECTIVE

The aim of this study was to assess the impact of Music & Memory's personalized music and tablet engagement (PMATE) program on QOL, agitation, and medication use for residents living in 6 Wisconsin ALCs.

METHODS

The data collected were on the utilization of iPods and iPads by the residents. Residents' outcomes were assessed using the Pittsburgh Agitation Scale, the Quality of Life in Late Stage Dementia scale, and self-reported medication use. A mixed-methods approach was utilized to examine the impact of the PMATE program on these outcomes. Descriptive statistics were calculated. A paired t test explored changes in residents' QOL. A 1-way analysis of variance was utilized to examine changes in resident's agitation and QOL based on the resident's utilization of the PMATE program. Qualitative interviews were conducted with the individuals responsible for PMATE implementation in the ALC. Residents excluded from the analysis were those who passed away, were discharged, or refused to participate.

RESULTS

A total of 5 apps, based on average times used by residents, were identified. In all, 4 of the 5 apps were rated as being useful to promote residents' engagement. PMATE utilization was not associated with changes in the residents' agitation levels or antipsychotic medication use over time. Over a 3-month period, the change in residents' QOL was significant (P=.047), and the differences across ALCs were also significant (F₂₅=3.76, P=.02). High utilizers of the PMATE program (>2500 min over 3 months) showed greater improvements in QOL as compared with low utilizers (a change of -5.90 points vs an increase of 0.43 points). The difference was significant (P=.03). Similar significant findings were found between the high- and midutilizers.

CONCLUSIONS

The study is one of the first to explore the impact of Music & Memory's PMATE program on residents living in ALCs. Findings suggest that higher utilization over time improves residents' QOL. However, a more comprehensive study with improved data collection efforts across multiple ALCs is needed to confirm these preliminary findings.

Spring EngAGEment: An Interprofessional Collaboration to Enhance Community Interaction and University Education

Purpose

Interprofessional education and practices are increasingly recognized as vital to addressing complex health needs, including individuals living with Alzheimer's disease or other associated dementias (AD/OAD). An innovative approach to meet this need is to create a meaningful engagement experience, Spring EngAGEment, following a multidisciplinary patient-centered model to serve individuals with AD/OAD and their care partners in the community and to offer new interprofessional collaboration opportunities for college students and faculty across disciplines in nursing, recreation, and speech-language pathology. The Spring EngAGEment program was developed by lead undergraduate students in an outcome-based program planning course from the Department of Recreation, Parks & Leisure Services and implemented by student volunteers and faculty across the disciplines with ongoing mentorship from the author team and feedback from the local ACT on Alzheimer's team. The program offered community resource booths, gardening, music therapy, and physical activity education as a way to inform individuals with AD/OAD and their care partners on available community resources, increase their mental outlook, and help reduce their isolation and stress.

Conclusions

This interprofessional practice/interprofessional education experience not only allowed college students to facilitate collaboration with future health care professionals from a variety of disciplines but also provided the participants living with AD/OAD and their care partners with new ideas and strategies to help adjust to their life changes. Program outcomes from event participants with AD/OAD and student volunteers were reported. Lessons identified by the author team are discussed.

Improving living and dying for people with advanced dementia living in care homes: a realist review of Namaste Care and other multisensory interventions

BACKGROUND

Seventy percent of people with advanced dementia live and die in care homes. Multisensory approaches, such as Namaste Care, have been developed to improve the quality of life and dying for people with advanced dementia but little is known about effectiveness or optimum delivery. The aim of this review was to develop an explanatory account of how the Namaste Care intervention might work, on what outcomes, and in what circumstances.

METHODS

This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories, and their validation with a purposive sample of stakeholders. Twenty stakeholders - user/patient representatives, dementia care providers, care home staff, researchers -took part in interviews and/or workshops.

RESULTS

We included 85 papers. Eight focused on Namaste Care and the remainder on other types of sensory interventions such as music therapy or massage. We identified three context-mechanism-outcome configurations which together provide an explanatory account of what needs to be in place for Namaste Care to work for people living with advanced dementia. This includes: providing structured access to social and physical stimulation, equipping care home staff to cope effectively with complex behaviours and variable responses, and providing a framework for person-centred care. A key overarching theme concerned the importance of activities that enabled the development of moments of connection for people with advanced dementia.

CONCLUSIONS

This realist review provides a coherent account of how Namaste Care, and other multisensory interventions might work. It provides practitioners and researchers with a framework to judge the feasibility and likely success of Namaste Care in long term settings. Key for staff and residents is that the intervention triggers feelings of familiarity, reassurance, engagement and connection.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42016047512.

Systematic review of the impact of arts for health activities on health, wellbeing and quality of life of older people living in care homes

Care home populations frequently feature older people who often experience poor physical health and cognitive difficulties, along with vulnerability to psychological and social stressors. To date there has been no systematic review which focuses on the impact of arts for health activities to the care home population. Evidence was sourced from several databases and 71 studies were deemed eligible for inclusion in this review. These studies underwent data extraction and quality appraisal and the findings associated with health, wellbeing and quality of life are presented within this paper.

Implementation of personalized music listening for assisted living residents with dementia

Personalized music listening (PML) has been touted as a safe and inexpensive means of improving the quality of life, mood, and behavior of persons with dementia. A PML program was implemented in an assisted living facility and evaluated across the five dimensions of the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance. The first 17 residents invited to participate were enrolled and followed over eight months. Effectiveness was evident in staff-reported mood improvement in 62% of encounters. Adoption was evident in qualitative feedback collected from medication technicians. Implementation was facilitated by low costs, engagement of external volunteers, highlighting outcomes that are relevant to staff, and attention to playlists over time. Maintenance required continued engagement of volunteers, ongoing fundraising, attention to facility staff engagement, and iterative adjustments to the program framework as staffing changes occurred. PML was found to be a meaningful intervention that is possible at a reasonable cost.

Music-based therapeutic interventions for people with dementia

BACKGROUND

Dementia is a clinical syndrome with a number of different causes which is characterised by deterioration in cognitive, behavioural, social and emotional functions. Pharmacological interventions are available but have limited effect to treat many of the syndrome's features. Less research has been directed towards non-pharmacological treatments. In this review, we examined the evidence for effects of music-based interventions.

OBJECTIVES

To assess the effects of music-based therapeutic interventions for people with dementia on emotional well-being including quality of life, mood disturbance or negative affect, behavioural problems, social behaviour and cognition at the end of therapy and four or more weeks after the end of treatment.

SEARCH METHODS

We searched ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG) on 19 June 2017 using the terms: music therapy, music, singing, sing, auditory stimulation. Additional searches were carried out on 19 June 2017 in the major healthcare databases MEDLINE, Embase, PsycINFO, CINAHL and LILACS; and in trial registers and grey literature sources.

SELECTION CRITERIA

We included randomised controlled trials of music-based therapeutic interventions (at least five sessions) for people with dementia that measured any of our outcomes of interest. Control groups either received usual care or other activities with or without music.

DATA COLLECTION AND ANALYSIS

Two review authors worked independently to screen the retrieved studies against the inclusion criteria and then to extract data and assess methodological quality of the included studies. If necessary, we contacted trial authors to ask for additional data, including relevant subscales, or for other missing information. We pooled data using random-effects models.

MAIN RESULTS

We included 22 studies with 1097 randomised participants. Twenty-one studies with 890 participants contributed data to meta-analyses. Participants in the studies had dementia of varying degrees of severity, and all were resident in institutions. Seven studies delivered an individual music intervention; the other studies delivered the intervention to groups of participants. Most interventions involved both active and receptive musical elements. The methodological quality of the studies varied. All were at high risk of performance bias and some were at high risk of detection or other bias.At the end of treatment, we found low-quality evidence that the interventions may improve emotional well-being and quality of life (standardised mean difference (SMD) 0.32, 95% confidence interval (CI) 0.02 to 0.62; 9 studies, 348 participants) and reduce anxiety (SMD -0.43, 95% CI -0.72 to -0.14; 13 studies, 478 participants). We found low-quality evidence that music-based therapeutic interventions may have little or no effect on cognition (SMD 0.15, 95% CI -0.06 to 0.36; 7 studies, 350 participants). There was moderate-quality evidence that the interventions reduce depressive symptoms (SMD -0.27, 95% CI -0.45 to -0.09; 11 studies, 503 participants) and overall behaviour problems (SMD -0.23, 95% CI -0.46 to -0.01; 10 studies, 442 participants), but do not decrease agitation or aggression (SMD -0.07, 95% CI -0.24 to 0.10; 14 studies, 626 participants). The quality of the evidence on social behaviour was very low, so effects were very uncertain.The evidence for long-term outcomes measured four or more weeks after the end of treatment was of very low quality for anxiety and social behaviour, and for the other outcomes, it was of low quality for little or no effect (with small SMDs, between 0.03 and 0.34).

AUTHORS' CONCLUSIONS

Providing people with dementia who are in institutional care with at least five sessions of a music-based therapeutic intervention probably reduces depressive symptoms and improves overall behavioural problems at the end of treatment. It may also improve emotional well-being and quality of life and reduce anxiety, but may have little or no effect on agitation or aggression or on cognition. We are uncertain about effects on social behaviour and about long-term effects. Future studies should examine the duration of effects in relation to the overall duration of treatment and the number of sessions.

Reporting quality of music intervention research in healthcare: A systematic review

INTRODUCTION

Concomitant with the growth of music intervention research, are concerns about inadequate intervention reporting and inconsistent terminology, which limits validity, replicability, and clinical application of findings.

OBJECTIVE

Examine reporting quality of music intervention research, in chronic and acute medical settings, using the Checklist for Reporting Music-based Interventions. In addition, describe patient populations and primary outcomes, intervention content and corresponding interventionist qualifications, and terminology.

METHODS

Searching MEDLINE, PubMed, CINAHL, HealthSTAR, and PsycINFO we identified articles meeting inclusion/exclusion criteria for a five-year period (2010-2015) and extracted relevant data. Coded material included reporting quality across seven areas (theory, content, delivery schedule, interventionist qualifications, treatment fidelity, setting, unit of delivery), author/journal information, patient population/outcomes, and terminology.

RESULTS

Of 860 articles, 187 met review criteria (128 experimental; 59 quasi-experimental), with 121 publishing journals, and authors from 31 countries. Overall reporting quality was poor with <50% providing information for four of the seven checklist components (theory, interventionist qualifications, treatment fidelity, setting). Intervention content reporting was also poor with <50% providing information about the music used, decibel levels/volume controls, or materials. Credentialed music therapists and registered nurses delivered most interventions, with clear differences in content and delivery. Terminology was varied and inconsistent.

CONCLUSIONS

Problems with reporting quality impedes meaningful interpretation and cross-study comparisons. Inconsistent and misapplied terminology also create barriers to interprofessional communication and translation of findings to patient care. Improved reporting quality and creation of shared language will advance scientific rigor and clinical relevance of music intervention research.

The impact of group activities and their content on persons with dementia attending them

BACKGROUND

Individuals suffering from dementia and residing in nursing homes often feel lonely and bored. This study examined the engagement and mood of people with dementia in group activities, and how personal characteristics, such as cognitive function, may impact on an individual's responses to group activities.

METHODS

The study included 102 participants, who took part in group activities while their mood and engagement levels were observed. Participants were invited to attend 10 different types of group activities, each of which was offered twice.

RESULTS

Results found improved engagement and mood during group activities as compared to control no-group times. Significant relationships between the type of activity and ratings of engagement and mood were also found. Although participants with higher levels of cognitive functioning manifested greater responsiveness to groups, the pattern of response to different contents did not differ by cognitive function.

CONCLUSIONS

This study shows the potential utility of group activities for improving quality of life of persons with dementia and demonstrates a methodology that can be used for quality improvement to optimize group contents. Future research should expand the range of contents of group activities in order to enhance the options for improving mood and engagement of individuals with dementia.

Dementia-related agitation: a review of non-pharmacological interventions and analysis of risks and benefits of pharmacotherapy

Unsurprisingly, the subject of dementia has been a rising matter of public health concerns as people now live longer. World Alzheimer Report 2015, estimate that about 46.8 million people worldwide have dementia. These numbers are projected to almost double every 20 years, reaching 74.7 million in 2030 and 131.5 million in 2050. The modality for treating agitation and other behavioral symptoms in dementia patients has been a challenge. Many years on, there has been no FDA-approved pharmacotherapy in treating dementia-related agitation. This review discusses the current knowledge of non-pharmacological interventions, and analyzes the risks and benefits of pharmacotherapy in the management of dementia-related agitation, as well as providing an anecdotal of the author's clinical experience. This article aims to provide opportunity for increase awareness for clinicians, particularly those with no specialty training in geriatrics medicine but see dementia patients with agitation and other behavioral symptoms from time to time. Likewise, it hopefully will benefit the readers of medical journals to update their existing knowledge on matters relating to the management of dementia-related agitation.

The Effect of Music Therapy in Patients with Huntington's Disease: A Randomized Controlled Trial

BACKGROUND

Music therapy may have beneficial effects on improving communication and expressive skills in patients with Huntington's disease (HD). Most studies are, however, small observational studies and methodologically limited. Therefore we conducted a multi-center randomized controlled trial.

OBJECTIVE

To determine the efficacy of music therapy in comparison with recreational therapy in improving quality of life of patients with advanced Huntington's disease by means of improving communication.

METHOD

Sixty-three HD-patients with a Total Functional Capacity (TFC) score of ≤7, admitted to four long-term care facilities in The Netherlands, were randomized to receive either group music therapy or group recreational therapy in 16 weekly sessions. They were assessed at baseline, after 8, 16 and 28 weeks using the Behaviour Observation Scale for Huntington (BOSH) and the Problem Behaviour Assessment-short version (PBA-s). A linear mixed model with repeated measures was used to compare the scores between the two groups.

RESULTS

Group music therapy offered once weekly for 16 weeks to patients with Huntington's disease had no additional beneficial effect on communication or behavior compared to group recreational therapy.

CONCLUSION

This was the first study to assess the effect of group music therapy on HD patients in the advanced stages of the disease. The beneficial effects of music therapy, recorded in many, mainly qualitative case reports and studies, could not be confirmed with the design (i.e. group therapy vs individual therapy) and outcome measures that have been used in the present study. A comprehensive process-evaluation alongside the present effect evaluation is therefore performed.

Music-based interventions in neurological rehabilitation

During the past ten years, an increasing number of controlled studies have assessed the potential rehabilitative effects of music-based interventions, such as music listening, singing, or playing an instrument, in several neurological diseases. Although the number of studies and extent of available evidence is greatest in stroke and dementia, there is also evidence for the effects of music-based interventions on supporting cognition, motor function, or emotional wellbeing in people with Parkinson's disease, epilepsy, or multiple sclerosis. Music-based interventions can affect divergent functions such as motor performance, speech, or cognition in these patient groups. However, the psychological effects and neurobiological mechanisms underlying the effects of music interventions are likely to share common neural systems for reward, arousal, affect regulation, learning, and activity-driven plasticity. Although further controlled studies are needed to establish the efficacy of music in neurological recovery, music-based interventions are emerging as promising rehabilitation strategies.

Music-based therapeutic interventions for people with dementia

BACKGROUND

Dementia is a clinical syndrome with a number of different causes which is characterised by deterioration in cognitive, behavioural, social and emotional functions. Pharmacological interventions are available but have limited effect to treat many of the syndrome's features. Less research has been directed towards non-pharmacological treatments. In this review, we examined the evidence for effects of music-based interventions as a treatment.

OBJECTIVES

To assess the effects of music-based therapeutic interventions for people with dementia on emotional well-being including quality of life, mood disturbance or negative affect, behavioural problems, social behaviour, and cognition at the end of therapy and four or more weeks after the end of treatment.

SEARCH METHODS

We searched ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG) on 14 April 2010 using the terms: music therapy, music, singing, sing, auditory stimulation. Additional searches were also carried out on 3 July 2015 in the major healthcare databases MEDLINE, Embase, psycINFO, CINAHL and LILACS; and in trial registers and grey literature sources. On 12 April 2016, we searched the major databases for new studies for future evaluation.

SELECTION CRITERIA

We included randomized controlled trials of music-based therapeutic interventions (at least five sessions) for people with dementia that measured any of our outcomes of interest. Control groups either received usual care or other activities.

DATA COLLECTION AND ANALYSIS

Two reviewers worked independently to screen the retrieved studies against the inclusion criteria and then to extract data and assess methodological quality of the included studies. If necessary, we contacted trial authors to ask for additional data, including relevant subscales, or for other missing information. We pooled data using random-effects models.

MAIN RESULTS

We included 17 studies. Sixteen studies with a total of 620 participants contributed data to meta-analyses. Participants in the studies had dementia of varying degrees of severity, but all were resident in institutions. Five studies delivered an individual music intervention; in the others, the intervention was delivered to groups of participants. Most interventions involved both active and receptive musical elements. The methodological quality of the studies varied. All were at high risk of performance bias and some were at high risk of detection or other bias. At the end of treatment, we found low-quality evidence that music-based therapeutic interventions may have little or no effect on emotional well-being and quality of life (standardized mean difference, SMD 0.32, 95% CI -0.08 to 0.71; 6 studies, 181 participants), overall behaviour problems (SMD -0.20, 95% CI -0.56 to 0.17; 6 studies, 209 participants) and cognition (SMD 0.21, 95% CI -0.04 to 0.45; 6 studies, 257 participants). We found moderate-quality evidence that they reduce depressive symptoms (SMD -0.28, 95% CI -0.48 to -0.07; 9 studies, 376 participants), but do not decrease agitation or aggression (SMD -0.08, 95% CI -0.29 to 0.14; 12 studies, 515 participants). The quality of the evidence on anxiety and social behaviour was very low, so effects were very uncertain. The evidence for all long-term outcomes was also of very low quality.

AUTHORS' CONCLUSIONS

Providing people with dementia with at least five sessions of a music-based therapeutic intervention probably reduces depressive symptoms but has little or no effect on agitation or aggression. There may also be little or no effect on emotional well-being or quality of life, overall behavioural problems and cognition. We are uncertain about effects on anxiety or social behaviour, and about any long-term effects. Future studies should employ larger sample sizes, and include all important outcomes, in particular 'positive' outcomes such as emotional well-being and social outcomes. Future studies should also examine the duration of effects in relation to the overall duration of treatment and the number of sessions.

Exploring the impact of music concerts in promoting well-being in dementia care

OBJECTIVES

This study explores the specific effects of live music concerts on the clients with dementia, their families and nursing staff/caregivers.

METHODS

Researchers attended 22 concerts in care facilities in England and Japan. Interviews were carried out with clients with dementia, nursing staff and family members. Observations were also carried out before, during and after the concerts. All observations were recorded in field notes.

RESULTS

The effect of the concerts in both countries was seen to be beneficial to all clients and nursing staff, whether or not they attended the concert. Interviews with clients with mild to mid-stage dementia noted increased levels of cooperation, interaction and conversation. Those with more advanced forms of dementia exhibited decreased levels of agitation and anti-social behaviour. Staff members reported increased levels of care, cooperation and opportunities for assessment. Family members noted an increase in the levels of well-being in their partner/parent as well as in themselves. The study also suggested that the knowledge of musical components, an awareness of the rules of music and specific musical preferences appear to remain well beyond the time when other cognitive skills and abilities have disappeared.

CONCLUSIONS

This initial study provided some further indication in terms of the uses of music as a non-pharmacological intervention for those living with all stages of dementia. These included opportunities for assessment of physical abilities as well as facilitating an increasing level of care.

Does music therapy enhance behavioral and cognitive function in elderly dementia patients? A systematic review and meta-analysis

Demographic aging is a worldwide phenomenon, cognitive and behavioral impairment is becoming global burden of nerve damage. However, the effect of pharmacological treatment is not satisfying. Therefore, we analyzed the efficacy of music therapy in elderly dementia patients, and if so, whether music therapy can be used as first-line non-pharmacological treatment. A comprehensive literature search was performed on PubMed, EMbase and the Cochrane Library from inception to September 2016. A total of 34 studies (42 analyses, 1757 subjects) were included; all of them had an acceptable quality based on the PEDro and CASP scale scores. Studies based on any type of dementia patient were combined and analyzed by subgroup. The standardized mean difference was -0.42 (-0.74 to -0.11) for disruptive behavior and 0.20 (-0.09 to 0.49) for cognitive function as primary outcomes in random effect models using controls as the comparator; the secondary outcomes were depressive score, anxiety and quality of life. No evidence of publication bias was found based on Begg's and Egger's test. The meta-analysis confirmed that the baseline differences between the two groups were balanced. Subgroup analyses showed that disease sub-type, intervention method, comparator, subject location, trial design, trial period and outcome measure instrument made little difference in outcomes. The meta-regression may have identified the causes of heterogeneity as the intervention method, comparator and trial design. Music therapy was effective when patients received interactive therapy with a compared group. There was positive evidence to support the use of music therapy to treat disruptive behavior and anxiety; there were positive trends supporting the use of music therapy for the treatment of cognitive function, depression and quality of life. This study is registered with PROSPERO, number CRD42016036153.

Group engagement in persons with dementia: The concept and its measurement

Although a few papers documented benefits of group therapeutic activities for individuals with dementia, there is a dearth of studies that have investigated the effects of group activities on persons with dementia. This paper introduces a theoretical framework of studying group therapeutic recreational activity, the Comprehensive Process Model of Group Engagement, and an assessment tool, the Group Observational Measurement of Engagement (GOME). We also report the psychometric properties of this assessment. One hundred and four persons with dementia took part in ten different group activities, with each activity conducted twice at random order so that 20 activities were observed for each group of participants. Following each group activity, research and therapeutic recreation staff members used the GOME assessment to independently rate participants on individual-level measures of attendance duration and engagement, and group level measures (e.g., positive and negative interactions among group members). Reliability and validity analyses comparing observer ratings for each group activity on the individual-level measures of attendance and engagement showed good psychometric properties. Different measures collected on a group level differed with respect to their psychometric quality. We present a theoretical framework to understand group engagement and present measures that could be used in future research and practice.

Efficacy of music therapy in the neuropsychiatric symptoms of dementia: systematic review

ABSTRACT Objective A large number of psychosocial interventions in dementia are based on music activities and music therapy interventions. We aim at assessing the efficacy of music therapy in the neuropsychiatric symptoms of people with dementia. Methods This systematic review is according to the methodology suggested by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched for articles in PubMed, Web of Knowledge Cross Search, Cochrane Library, Scopus and Lilacs/Bireme databases published from 2005 to 2016. The search keywords included “early onset” and “late onset” combined with “dementia”, “Alzheimer”, “vascular dementia”, “mixed dementia”, “frontotemporal dementia”, “neuropsychiatric symptoms”, “behavioral disturbances”, “behavioral and psychological symptoms of dementia” and “music therapy”. The studies were categorized according to its efficacy on the decline of neuropsychiatric symptoms and improvement of cognitive function, quality of life and well-being. Results We selected 12 out of 257 papers. Music therapy interventions were applied individually or in group setting, using active or receptive technique. In general, studies indicated the efficacy of music therapy on the decline of depression, agitation and anxiety. There were heterogeneity of interventions, methodological design and instruments of evaluation among the studies. Conclusions Although there are reports of the efficacy of music therapy on the decline of neuropsychiatric symptoms of dementia, the area still needs randomized studies aimed at the solution of important methodological problems like the lack of standardized approaches.

Effectiveness of group music therapy versus recreational group singing for depressive symptoms of elderly nursing home residents: pragmatic trial

OBJECTIVES

Several studies have suggested positive effects of music therapy in dementia, but research on age-related depression has been limited and of insufficient quality. The aim of this study was to examine the effect of interactive group music therapy versus recreational group singing on depressive symptoms in elderly nursing home residents.

METHOD

Residents of two German nursing homes with sufficient length of stay who were not bedridden were invited to participate in a pragmatic trial. A total of 117 participants, grouped into four clusters (based on their wards), were randomised to interactive group music therapy (n = 62; 20 units of 40 minutes, 2×/week) or recreational group singing (n = 55; 10 units of 90 minutes, 1×/week). The level of depressive symptoms was assessed using the Montgomery-Åsberg Depression Rating Scale at baseline (47% with at least mild depression) and follow-up in the 6th and 12th weeks. There was no blinding of assessors.

RESULTS

The level of depressive symptoms improved significantly more in those assigned to music therapy (n = 60) than in recreational singing (n = 53), both in 6th week (mean difference 3.0 scores, 95% CI 1.21 to 4.79, p = 0.001) and 12th week (mean difference 4.50 scores, 95% CI 2.51 to 6.50, p < 0.001).

CONCLUSION

The results suggest that music therapy decreases depressive symptoms in elderly people in nursing homes more effectively than recreational singing.

[Non-pharmacological treatment of dementia in geriatric psychiatry care units : Scoping review]

BACKGROUND

The number of persons suffering from dementia will continuously increase in the coming years; therefore, evidence-based interventions are needed in geriatric psychiatric care. When evidence is poor scoping reviews may help to identify knowledge gaps and needs for research.

AIM OF THE ARTICLE

To present an overview of clinical trials on non-pharmacological treatment for elderly with dementia in hospitals, wards and nursing homes, specializing in gerontopsychiatric care.

MATERIAL AND METHODS

A systematic search was carried out by one of the authors for clinical trials (randomized controlled, controlled and single group pre-post design, English and German, 1998-2014) in PsycINFO, PubMED, PSYNDEX and the Cochrane Library as well as a manual search in two relevant German peer-reviewed journals. Two authors included studies according to a priori defined inclusion criteria. One author extracted data after consulting the second author in cases of ambiguity. The risk of bias of the studies was not assessed.

RESULTS AND DISCUSSION

A total of 77 studies were identified, 29 studies on restructured treatment pathways or settings, 14 trials on environmental changes and 34 studies on therapeutic single or group interventions. Both the methodological quality of the studies and the evidence for the efficacy of non-pharmacological treatment were limited. There are clear indications for an advantage of specialized environments and treatment settings for the elderly with dementia in hospitals, wards and nursing homes. There are consistent indications for positive effects of psychosocial activation alone or in combination with cognitive or physical activation, partly with high-quality study designs. This is consistent with the German S3 guidelines for dementia. For single interventions, such as electroconvulsive therapy or horticultural activities, the level of evidence remains limited.