Music-based interventions in the acute setting for patients with dementia: a systematic review

The effects of music-based interventions on behavioural and psychological symptoms of people living with dementia: a systematic review and network meta-analysis protocol

OBJECTIVES

People living with dementia often experience behavioural and psychological symptoms of dementia (BPSD), which severely affect their well-being during the course of the disease. Particularly for BPSD outcomes, there is a high demand for increasing the evidence-based knowledge of non-pharmacological approaches, such as music-based interventions. Although previous reviews emphasize the potential effects of music-based interventions in people with dementia, they cover a wide range of different interventions and outcomes.

METHOD

Therefore, this systematic review (SR) and network meta-analysis (NMA) aims to not only investigate the efficacy of music-based interventions on BPSD, but also to compare the impact of different types of music-based interventions on outcomes. Preferred reporting items for SR and meta-analysis protocols (PRISMA-P) and the PRISMA NMA extension were followed. Several databases will be searched from inception to the date the search will be performed, for relevant randomized or non-randomized controlled trials comparing a music-based intervention with treatment as usual, active controls, or another music-based intervention. Multivariate pairwise meta-analyses will be conducted for each outcome. NMA based on a frequentist random-effects model will be used to estimate the comparative effects of each type of music-based intervention and related components across outcomes. Heterogeneity will be investigated by meta-regression models.

CONCLUSION

Based on our knowledge, this may be the first SR and NMA study to compare the efficacy of different types of music-based interventions. In addition, combined with our multivariate analysis approach, it will allow us to identify potential effect modifiers in music-based intervention for treating BPSD.

Study protocol: randomized controlled trial of an individualized music intervention for people with dementia in the home care setting

BACKGROUND

Studies suggest that individualized music listening is an effective, non-pharmacological intervention for improving the quality of life of people with dementia in the institutional care setting. Noting that most people with dementia live at home, we conduct a randomized controlled trial to assess the feasibility and effectiveness of an app-based individualized music listening intervention for people with dementia in the home care setting. The intervention is delivered by family caregivers.

METHODS

We will recruit N = 130 dyads consisting of one person with dementia living at home and their family caregiver. After a baseline assessment, dyads are randomly assigned by gender to either the intervention or control group. People with dementia in the intervention group listen to individualized music playlists for 20 min every other day for six weeks via the self-developed Individualized Music and Dementia app. The control group receives standard care. All dyads complete paper-and-pencil questionnaires six weeks before the start of the intervention (T0), directly before the intervention (T1), directly after the intervention (T2), and six weeks later (T3). During the intervention period, all caregivers also complete daily ecological momentary assessments via the app. During three home visits, a trained project member will observe the dyads and collect hair samples. After the intervention, semi-structured interviews will be conducted to collect information about participants' experiences with the app and intervention. The primary outcome is the attainment of individual goals established during the baseline assessment. Secondary outcomes are the well-being, physiological stress and quality of life of people with dementia and their caregivers; people with dementia's behavioural and psychological symptoms of dementia, resistance during care, and reactions to the music; caregivers' burden of care, positive aspects of care, and caregiving self-efficacy; and the quality of the caregiver-care recipient interaction.

DISCUSSION

Our study will assess the extent to which an app-based individualized music listening intervention is feasible and effective for enhancing the well-being and quality of life of people with dementia living at home and their family caregivers.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00025502 and ISRCTN registry ISRCTN68084105, https://doi.org/10.1186/ISRCTN68084105.

Music Intervention for older adults: Evidence Map of Systematic Reviews

BACKGROUND

With the increasing aging population, the health problems of the elderly have received increasing attention. As a non-pharmacological interventions, music intervention has been widely used in clinical practice to improve the physical and mental health of the elderly. This article aims to provide a comprehensive review of existing systematic reviews on the health effects of music interventions for older adults in clinical practice.

METHODS

The study utilized the evidence map methodology, which involved identifying all relevant systematic reviews, meta-analysis from 7 electronic databases from their inception to November 2022. The studies were analyzed using AMSTAR 2.

RESULTS

The researchers identified 67 studies, with the majority published in the past 5 years. The effects of music interventions were categorized into 4 groups of health outcomes: positive (58 results), potentially positive (4 results), inconclusive (2 results), and no effect (3 results). The health outcomes were further classified into 5 groups: psychological well-being, cognitive functioning, physiological responses, quality of life, and overall well-being.

CONCLUSIONS

The study revealed that music interventions for older adults can have positive or potentially positive effects on health outcomes, encompassing psychological well-being, cognitive functioning, physiological responses, quality of life, and overall well-being. However, some studies yielded inconclusive or no effect. The study offers valuable insights for healthcare professionals and serves as a visual resource to access evidence-based information on the use of music interventions in promoting health and addressing various conditions in older adults.

Effectiveness of Music Therapy in People Living with Dementia: An Umbrella Review Protocol

BACKGROUND

Dementia stands out as a neurological disorder which constitutes a progressive decline in cognitive, behavioral, emotional, and social functioning. However, non-pharmacotherapy, such as music therapy, can be combined with pharmacological treatment as a possible strategy to improve functionality regarding the cognitive and non-cognitive dimensions of people diagnosed with dementia.

OBJECTIVES

To analyze and synthesize published evidence regarding the effectiveness of music therapy in people diagnosed with dementia, concerning cognitive and non-cognitive outcomes.

DESIGN

Descriptive study protocol of an umbrella review.

METHODS AND ANALYSIS

An umbrella review method will guide this study, focusing on an extensive search of published systematic reviews and meta-analyses reviews that include randomized controlled trials and other types of trials. Databases for the article search include ISI Web of Knowledge, Scopus, and Joanna Briggs Institute (JBI) EBP database, and EBSCO Host platform (Cochrane Database of Systematic Reviews, MEDLINE, and CINAHL). Two reviewers will independently review all titles and abstracts and identify articles considering the inclusion criteria. Afterward, two reviewers will independently extract relevant information from each article for the characterization table, and evaluate the quality of selected articles using the Measurement Tool for Evaluating Systematic Reviews (AMSTAR) 2 guideline.

RELEVANCE TO CLINICAL PRACTICE

Data from this study will aid in designing healthcare workers' training courses, clinical intervention guidelines, and specific intervention protocols that support pharmacological interventions in treating dementia.

Neural Entrainment to Musical Pulse in Naturalistic Music Is Preserved in Aging: Implications for Music-Based Interventions

Neural entrainment to musical rhythm is thought to underlie the perception and production of music. In aging populations, the strength of neural entrainment to rhythm has been found to be attenuated, particularly during attentive listening to auditory streams. However, previous studies on neural entrainment to rhythm and aging have often employed artificial auditory rhythms or limited pieces of recorded, naturalistic music, failing to account for the diversity of rhythmic structures found in natural music. As part of larger project assessing a novel music-based intervention for healthy aging, we investigated neural entrainment to musical rhythms in the electroencephalogram (EEG) while participants listened to self-selected musical recordings across a sample of younger and older adults. We specifically measured neural entrainment to the level of musical pulse-quantified here as the phase-locking value (PLV)-after normalizing the PLVs to each musical recording's detected pulse frequency. As predicted, we observed strong neural phase-locking to musical pulse, and to the sub-harmonic and harmonic levels of musical meter. Overall, PLVs were not significantly different between older and younger adults. This preserved neural entrainment to musical pulse and rhythm could support the design of music-based interventions that aim to modulate endogenous brain activity via self-selected music for healthy cognitive aging.

The Multicomponent Day-Care Program Prevents Volume Reduction in a Memory-Related Brain Area in Patients with Mild Cognitive Impairment

INTRODUCTION

Mild cognitive impairment (MCI) is considered an important period for interventions to prevent progression to dementia. Nonpharmacological interventions for MCI include exercise training, cognitive intervention, and music therapy. These play an important role in improving cognitive function, but their effects on brain plasticity in individuals with MCI are largely unknown. We investigated the effects of a multicomponent day-care program provided by the University of Tsukuba Hospital on the longitudinal brain volume changes in MCI patients.

METHODS

MCI patients who participated in the multicomponent day-care program and underwent whole-brain magnetic resonance imaging (MRI) twice during their participation (n = 14), were included. We divided them into two groups according to their attendance rate and conducted a between-group analysis of longitudinal volume changes in the whole cerebral cortex. Regional brain volumes derived from the patients' MRI were calculated with Freesurfer 6.0.0.

RESULTS

The neuroimaging analysis demonstrated that the left rostral anterior cingulate cortex volume was significantly preserved in the high-attendance group compared to that of the low-attendance group.

CONCLUSION

Our results suggest that continuous participation in a multicomponent day-care program could help prevent a volume reduction in memory-related brain areas in patients with MCI.

Music Therapy and Parkinson's Disease: A Systematic Review from 2015-2020

Parkinson’s disease can be approached from various points of view, one of which is music therapy—a complementary therapy to a pharmacological one. This work aims to compile the scientific evidence published in the last five years (2015–2020) on the effects of music therapy in patients with Parkinson’s disease. A systematic review has been performed using the Web of Science and Scopus databases with the descriptors “music therapy” and “Parkinson’s disease”. A total of 281 eligible articles were identified, which, after applying the inclusion and exclusion criteria, were reduced to 58 papers. The results display a great diversity of evidence, confirming positive effects on various spheres. All mentioned patients with Parkinson’s disease had experienced different music therapy programs. Some studies focused on the motor component, which can be addressed through listening, body rhythm, and rhythmic auditory stimulation. Other studies confirm effects on communication, swallowing, breathing, and the emotional aspect through programs that focus on singing, either individually or in groups, in order to improve the quality of life of people with PD. It was concluded that music therapy programs can achieve improvements in various areas of patients with Parkinson’s.

How Singing can Help People With Dementia and Their Family Care-Partners: A Mixed Studies Systematic Review With Narrative Synthesis, Thematic Synthesis, and Meta-Integration

Background: Recent research on the efficacy of music-based interventions for people with dementia have focused on specific outcomes and methods, and singing has been noted as a particularly beneficial activity. However, due to heterogeneity of research methods, there is a need to synthesise the findings of both quantitative and qualitative research in order to better understand both the impact and potential mechanisms of singing for people in this population.

Method: This systematic review included quantitative, qualitative and mixed-methods studies, and analysed these using a systematic mixed-studies synthesis (with a results-based convergent approach). Quantitative and qualitative data were initially synthesised using a narrative synthesis and thematic synthesis method, respectively, before a final meta-integration method was used to synthesise common themes across the two data forms.

Results: Electronic and hand search strategies revealed 1,815 relevant studies, 40 of which met the full eligibility criteria. Narrative synthesis of quantitative data revealed six key outcome areas (quality of life; psychological well-being; cognition; engagement; activities of daily living; care-partner well-being), and thematic synthesis of qualitative data generated seven themes relating to the impact and mechanisms of singing (pragmatic elements; social benefits; mood; identity; memory; flow-on effects; and relationships). Meta-integration identified four key areas relating to the impact and mechanisms of singing for people with dementia and care-partners: psychological well-being, quality of life, cognition, and care-partner well-being.

Conclusion: Results from the syntheses suggest that singing can positively impact the lives of people with dementia and their care-partners, although due to heterogeneity of study design and outcome measures, it is difficult to draw conclusions based on quantitative data alone. Qualitative data provides further context and insights from participant perspectives, and when integrated with quantitative data, contextual factors that may influence the benefits that participants experience from singing are revealed.