Music therapy in moderate and severe dementia of Alzheimer’s type: a case-control study

1. Music therapy in moderate and severe dementia of Alzheimer’s type:a case-control study H.B. Svansdottir and J. Snaedal Presented by Justine Ho

2. Introduction • Alzheimer’s disease (AD): • Behavioural and psychological symptoms of dementia (BPSD) • Decrease well-being of patient, impairment of quality of life & pose a heavy burden on care-takers • Reasons for hospitalizations and nursing homes

3. Introduction • Small improvements could be drastically beneficial i.e. quality of life • Treatment most often pharmacological • Severe patients (high BPSD): treated with sedatives, neuroleptics or antidepressents • Result in inappropriate use of psychoactive drugs in nursing homes • Insufficient + side effects are common

4. Introduction • Non-pharmacological treatment • Far less popular -> lack of reliable research • Music Therapy : use of tunes, sounds & movements • Increase well-being + increase interaction -> decrease sense of isolation • Purpose of this experiment: • Study the effect of music therapy on BPSD in patients with moderately severe and severe AD

5. Methods: Participants • 46 participants (71-87 years of age) • Diagnosed with AD in accordance with ICD-10 with either moderate or severe dementia according to the Global Deterioration Scale • In the end, only 38 patients participated • Eight patients dropped out b/c had to move from psycho-geriatric ward to a nursing home, deterioration or death • 20 in music therapy group / 18 in control group

6. Methods: Evaluation • All patients were interviewed and then rated according to the Behaviour Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD) • Has 7 categories (symptoms) defining AD • Therapy Group: • received 18 sessions of music therapy, each lasting 30 mins, 3 times/week for 6 weeks • All patients were evaluated after 6 weeks • Evaluated again after 10 weeks, but with no music therapy sessions

7. Methods: Music Therapy • Three or four patients participated in each session • Collection of songs familiar to the patients were selected by patients & therapist • Encouraged participation whether actively or passively (songbook, listening) • Patients were given the opportunity to pick an instrument to play along with the song • Dancing was also freely allowed

8. Result #1 • Non-significant decrease in total points of the BEHAVE-AD in the therapy group • Smaller and non-significant decrease in control group • Further decrease in control group during the next 4 weeks mainly due to changes in one patient • Benefits of music therapy disappeared after the 6th week

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10. Result #2 • After 6 weeks, significant decrease in average scoring for activity disturbance, aggressiveness and anxiety in the therapy group • No significant results found in the control • Benefits of music therapy decreased 4 weeks later without therapy sessions

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12. Discussion • Active participation in music therapy creates meaningful activity, lessens anxiety, elevates depressed mood • Positive effects resulted by repeated sessions for 6 weeks • Effects diminished after one month • Supports previous research • However, hard to prove that hallucinations and misidentification would benefit • Supports first results

13. Strengths & Limitations • Had comparable groups with a baseline • Only had patients with AD; other dementias excluded • Same nurses/qualified therapists • Used only one type of music therapy: active participation (playing instruments & singing) • Did not address passive participation • Only tested with one type of music

14. Further Research • Effects of music therapy on cognition and behaviour • Comparison with different types of music • Explore other types of music therapy such as passive listening or singing Thoughts • Concise, straight-forward • No images of brain scans