Music, Mind, Mood, and Mingling in Alzheimer's Disease and Related Dementias: A Scoping Review

Therapeutic use of music in neurological disorders: A concise narrative review

Background

Music elicits multifactorial benefits in emotional, social, cognitive, and academic aspects of human life. Music is clinically proven to reduce stress and anxiety, and improve mood and self-expression, particularly after traumatic events. Studies have also demonstrated that music promotes parasympathetic autonomic systems, suppresses hyperactivation of stress responses, and boosts immune functions. However, its ability to promote brain plasticity and signalling are only beginning to be realized. Moreover, its employment as a therapy for the treatment of specific aspects of other neurological disorders, including neurodevelopmental and neurodegenerative conditions and their comorbidities, is fast becoming an interesting field of research.

Objective

The aim of this review is to summarize some of the recent studies focused on evaluating the applications of music therapy. For this purpose, we have focused on disorders encompassing both temporal extremities of brain developmental stages, from developmental conditions of autism and attention deficit hyperactivity disorder (ADHD), to ageing-related pathologies of Parkinson's disease and dementias.

Results

The findings of the reviewed studies indicate potent utilities of music-based interventions in beneficially affecting multiple spheres of brain functions, such as sensorimotor, auditory, communication/language, psychological/emotional, behavioural, sleep and memory and cognitive attributes of patients diagnosed with diverse neuropathologies. Nevertheless, lack of standardized protocols for music provision as well as absence of information regarding key aspects, such as cultural and musical orientations of subjects and therapists'/caregivers' attitudes, have hindered the complete realization of music's therapeutic potential for neurological conditions. Further, while some studies have undertaken assessments of core neurophysiological mechanisms underlying music therapy, this information is largely lacking for most clinical studies.

Conclusion

While this is not an exhaustive review of literature, we do hope that it serves as a platform to promote future research for establishing music therapy as a relevant neurotherapeutic strategy.

The use of photovoice to explore the physical disability experience in older adults with mild cognitive impairment/early dementia

Although co-occurring cognitive impairment and physical disability in older adults is common, there is little understanding of how this group perceives their ability to do their daily activities. This study used photovoice to explore how older adults with MCI/early dementia and physical disability without and with care partners (dyads) perceive challenges with their daily activities. Photovoice is a visual research methodology to capture participants' insight on aspects of their daily lives. No known studies have taken this approach to explore the experiences of older adults with MCI/early dementia and co-occurring physical disability. We used a cross-sectional, exploratory research design to understand participants' (n = 12) experiences in their home environment. Photos and participant thoughts on the photos were categorized based on the Blackfoot Breath of Life Theory and the Hierarchy Model of Needs in Dementia, an adaptation of Maslow's Model. Notable findings included: awareness of physical/cognitive difficulties by older adults, solutions for ADL difficulty in persons with MCI/early dementia, care partners' difficulty recognizing pain without the presence of severe emotional or physical responses, reducing mood severity, and self-esteem needs met with structured, memory-issue adapted, meaningful activities. Older adults with co-occurring physical disability and MCI/early dementia identified both physiological and psychological needs despite challenges impacting their cognition. Photovoice evoked daily situations of these individuals and revealed the importance of developing individualized intervention elements for older adults with dementia and physical disability.

Exploring the Clinical Utility of the Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) with People with End-Stage Dementia

Dementia is a major health concern globally and cross-culturally with progressive decline in cognition, mobility and communication. There are few interventions for end-stage dementia (ESD) although music interventions have been observed to be accessible for people with mid to late-stage dementia. The lack of protocols and measures suited to ESD has limited research into the effects of music therapy. Measure sensitivity to minimal responsiveness is one limitation to the use of existing music intervention measures with ESD. This exploratory study examined the clinical utility of the Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) for use with people with end-stage dementia, including preliminary reliability and validity. The MATADOC is a standardized assessment for minimally responsive patients with disorders of consciousness and may be useful for ESD. Using repeated measures with blinded MATADOC-trained raters, MATADOC data were collected with a small convenience sample of people with ESD in a residential care setting. Clinical utility data were collected from the raters and evaluated using a multidimensional model. To explore its functionality, MATADOC outcomes were compared to another measure for music interventions in dementia. The MATADOC may be useful for assessing functioning and responsiveness to music interventions for people with ESD without the risk of floor effects. Modifying the MATADOC protocol and assessment documentation prior to testing with a larger sample will enhance its sensitivity specific to ESD and age-related needs, providing a new music-based ESD assessment.