Music Therapy and Dementia

I was alerted to a story in one of our local newspapers about a study of music therapy in patients with dementia. The researchers are here at The University of Iowa Hospitals and Clinics: Dr. Daniel Tranel, PhD and Alaine Reschke-Hernandez, both in the Neurology Department. The study measures participants’ moods and feelings before and after hearing music.

They are seeking recruits and funding from donations through the University of Iowa Foundation. They’re very keen on getting some momentum for their study and others on music-based therapy for dementia, especially as baby-boomers come of age, so to speak.

Psychiatric consultants in the general hospital are often called to assist with managing challenging behaviors in the demented elderly, especially when they develop delirium postoperatively or are admitted for general medical problems. In fact, there’s a small but growing evidence-base for music therapy in this population:

Cheong, C. Y., et al. (2016). “Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia.” Dementia and Geriatric Cognitive Disorders Extra 6(2): 268-275.
Background/Aims: The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods: Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient’s choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results: Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion: These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients’ daily routines or incorporated into other areas of care to increase patient compliance and cooperation.

I agree with Dr. Tranel’s statement regarding the utility of most psychotropic medications in this context. They are “profoundly unsuccessful.” Their effectiveness is limited and for antipsychotics, the FDA Black Box Warning limits use because of the associated higher mortality rates.

In addition to scientific studies, there are first person accounts from both treaters, patients, and families about how helpful music therapy can be. Sean Griser, BA, for example, writes in the Personal Reflection section of the Journal of Palliative Medicine,

To my surprise, the humble intervention rendered amazing results. Residents who were nonverbal began to sing along and even dance. One woman in particular who was 90 years old began dancing—even though she needed her walker to do so. It is a rare sight—but now I can say that I have seen it! Smiles, animation, and connectedness to their environment occurred more often than not when I gave the residents their favorite music. It is hard to express with words the impact of this seemingly simple intervention. Griser, S., et al. (2016). “Enjoy. Shuffle. Repeat: Using Personalized Music Playlists To Improve the Quality of Life for People with Dementia.” J Palliat Med.

Further, Griser mentions a documentary that I’ve not seen, a video of which is available for purchase, entited “Alive Inside.” It was released in July of 2014, just before the death of Oliver Sacks, world-renowned neurologist, who was cast in the film.

Even more amazing is that a small proportion of patients with dementia may actually gain positive behaviors including greater facility with music, as noted by researchers in one study:

Midorikawa, A., et al. (2016). “All Is Not Lost: Positive Behaviors in Alzheimer’s Disease and Behavioral-Variant Frontotemporal Dementia with Disease Severity.” J Alzheimers Dis.
BACKGROUND: Anecdotal evidence indicates that some patients with dementia exhibit novel or increased positive behaviors, such as painting or singing, after the disease onset. Due to the lack of objective measures, however, the frequency and nature of these changes has not been formally investigated. OBJECTIVE: This study aimed to systematically identify changes in these behaviors in the two most common younger-onset dementia syndromes: Alzheimer’s disease (AD) and behavioral-variant frontotemporal dementia (bvFTD). METHODS: Sixty-three caregivers of patients with dementia (32 caregivers of AD patients and 31 caregivers of bvFTD patients) participated in the study. Caregivers rated the presence and frequency of positive and negative behavior changes after the onset of dementia using the Hypersensory and Social/Emotional Scale (HSS) questionnaire, focusing on three domains: sensory processing, cognitive skills, and social/emotional processing. Six composites scores were obtained reflecting these three domains (two composite scores for each domain). Differences across scores and ratios of increased and decreased behaviors were analyzed between AD and bvFTD, at different disease severity levels. RESULTS: After disease onset, significant changes in the sensory processing domain were observed across disease severity levels, particularly in AD. Composite scores of the other domains did not change significantly. Importantly, however, some novel or increased positive behaviors were present in between 10% (Music activities) and 70% (Hypersensitivity) of AD and bvFTD patients, regardless of disease severity. CONCLUSIONS: We provide the first systematic investigation of positive behaviors in AD and bvFTD. The newly developed HSS questionnaire is a valid measure to characterize changes and progression of positive behaviors in patients with dementia.

Certainly there is reason to hope for effective non-pharmacologic as well as pharmacologic methods for helping patients and families cope with the losses incurred by dementia.