Role of Music Therapy in Dementia

Dementia:

Dementia is a progressive neurologic disorder that changes behavior, diminishes cognition, and deteriorates memory due to a disease or injury. Some causes of dementia which may or may not be reversible are brain injury, use of certain medications, hypoglycemia, hypothyroidism, immune disorders, vitamin B12 deficiency, excessive alcohol intake, and smoking. The common types of dementia are Alzheimer’s disease, Lewy body dementia, and vascular dementia.

The most pronounced effects of dementia are on memory and visual-spatial. Some psychological and behavioral expressions that can manifest are aggression, agitation, depression, wandering, restlessness, and trouble eating or swallowing. During the late stages of disease, difficulty in swallowing can result in breathing food into the lungs that may lead to aspiration pneumonia.

Treatment:

The symptoms associated with behavior and psychology affect patients and their caregivers. Available pharmacologic treatments used to treat behavior have little benefit and significant risks. Due to increased risk of mortality associated with these drugs, FDA has issued warnings against their use especially in elderly patients. The Dementia Action Alliance encourages integrated approach to focus on a person’s behavioral and psychological expressions rather than following general practices.

In a holistic approach patient-specific behavior is identified and modified to eliminate conditions which contribute to a specific behavior. A targeted approach provides patient activity program and builds skills that simplify communication and tasks. Various therapies that have been used to support a person living with dementia are music therapy, art therapy, reality orientation, aromatherapy, and cognitive behavioral therapy.

Music therapy:

It is a health profession in which music is used as a therapy to improve mental, physical, and social wellbeing of an individual. It helps to balance spiritual and emotional needs of an individual to improve quality of life.

The qualified music therapist provides treatment based on individual patient’s needs and may include playing musical instruments or video games, singing, dancing, song drawing, listening to music, and/ or multisensory stimulation. It can be provided as individual or group therapy, however studies have shown more positive results with group therapy. Active therapy engages patient with direct participation while passive therapy allows patient to listen to music or engage in another activity. Active therapy has been found to be more helpful in improving physical functions of the patient like grasping an object.

Credentialing of music therapist:

Music therapy is a health profession based on evidence. The therapist must earn at least a bachelor’s degree, complete 1200 hours of internship and obtain MT-BC credential issued by the Certification Board for Music Therapists to become a certified music therapist.

The therapist may hold different designations like Certified Music Therapist, Advanced Certified Music Therapist, or Registered Music Therapist. He must obtain continuing education credits and hold licensure in states that require board-certification to safeguard competent practice.

Impact of music therapy:

When we listen to music different parts of brain become stimulated. For instance, music stimulates amygdala which is involved in processing of emotions. Dancing and playing an instrument involves motor cortex which controls movement. Musical experiences excite hippocampus which is responsible for memory and spatial navigation. It increases blood flow in the brain, strengthens executive functions, supports heart, improves communication, and reduces stress.

Studies have shown the positive effect of music therapy on psychological and behavioral symptoms of dementia. A study by Ozdemir L et al., 2009[1] improved cognition and reduced depression and anxiety with continued effect for three weeks following the completion of study in mild dementia. Another study by Li CH et al., 2015[2] showed that cognition in music therapy group was reduced less as compared to the control group and change of abstraction domain in the music therapy group was better.

Numerous other studies have been done using different assessment instruments like Mini-Mental State Examination, Geriatric Depression Scale, Beck Anxiety Scale, Hamilton Anxiety Rating Scale, Clinical Dementia Rating, Cognitive Abilities Screening Instrument, and Neuropsychiatric Inventory. Several studies have shown promising results in the form of decreased anxiety, positive emotional states, and increased relaxation.

It has the potential effect to enhance the quality of life, improve neuropsychiatric symptoms, and reduce symptoms like cognitive decline and depression. It benefits patients who have difficulty communicating or expressing themselves in words. This, in turn, strengthens patients’ abilities and transfer it to other areas of their lives.

Conclusion:

A clinician can play a role in facilitating collaboration with specialists and other healthcare professionals to implement music therapy. Researchers have demonstrated that music therapy can protect cognition, executive function, psychomotor speed, and autobiographical and episodic memories and can yield high levels of patient and caregiver satisfaction. Additional clinical trials will add evidence to support the positive effect of music therapy. Multisensory stimulation with dance, art, video game, and physical exercise seems an exciting and promising approach.

References:

1. Ozdemir, L, and N Akdemir. “Effects of Multisensory Stimulation on Cognition, Depression and Anxiety Levels of Mildly-Affected Alzheimer’s Patients.” Journal of the Neurological Sciences., U.S. National Library of Medicine, 15 Aug. 2009, www.ncbi.nlm.nih.gov/pubmed/19289242/.

2. Fang, Rong, et al. “Music Therapy Is a Potential Intervention for Cognition of Alzheimer’s Disease: a Mini-Review.” Translational Neurodegeneration, BioMed Central, 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5267457/.