Letter from the Editor
Staff Articles
- Non-Suicidal Self-Injurious Behavior in Adolescents across Gender and Sexual Orientation
- The Impact of Eating Disorders on Sexual Functioning in Women
- Effects of Participation in Sports on Men’s Aggressive and Violent Behaviors
- The Major Influences of Self-Regulation Development in Early Childhood
- The Effectiveness of Music Therapy in Treating Symptoms of Alzheimer’s disease
Lauren Banker
Estimates suggest that, as of 2011, almost five million Americans over the age of sixty-five have Alzheimer’s disease (National Institutes of Health [NIH], 2012). Alzheimer’s disease (AD) is a gradual, neurodegenerative disease in which cognitive, behavioral, and emotional processes deteriorate due to suspected plaque growth, neuron decay, and neurofibrillary tangles throughout the brain (NIH, 2012). Among individuals with moderate to severe AD, the most prominent and pervasive symptoms are those that affect cognitive functioning, such as memory and language (Alzheimer’s Association, 2014; NIH, 2012). However, the scope of symptoms in patients with AD is not limited to cognitive processes. Other well-documented symptoms target behavioral, psychological, and emotional functioning (Alzheimer’s Association, 2014; NIH, 2012). Medications are predominantly cited as the most common method for treating AD symptoms (Consumer Reports, 2012). However, these medications are often accompanied by unwanted side effects, including nausea, vomiting, diarrhea, muscle weakness, and weight loss (NIH, 2014), and many medications treat only specific symptoms at a time (Bishara & Taylor, 2014; NIH, 2014). Furthermore, these drugs can be costly, making it difficult for patients or their caregivers to afford treatment (Consumer Reports, 2012). These concerns have led researchers to explore alternative therapies for treating symptoms of AD that are less expensive and less invasive.
One such alternative therapy is music therapy. Music therapy is a non-invasive intervention that utilizes music in various ways to treat the cognitive, behavioral, emotional, and social needs of individuals (American Music Therapy Association, 2015). Music therapy typically takes one of two forms: it can be characterized as either Interactive/Active, in which participants sing, hum, move along with music, or play an instrument, or Passive/Receptive, in which participants listen to live or recorded music (Vink, Bruinsma, & Scholten, 2003). The increasing interest in music therapy as a treatment for AD specifically can be attributed to early case studies. These studies found that patients with AD were able to perform musical acts that had been forgotten after musical interventions (Cowles et al., 2003; Crystal, Grober, & Masur, 1989). Since then, a growing amount of literature on music therapy and AD has shown the therapy’s effectiveness in treating both the most recognized symptoms of AD—memory and language functioning (Brotons & Koger, 2000; Dassa, 2014; Ledger & Baker, 2007; Prickett & Moore, 1991; Sambandham & Schirm, 1995; Simmons-Stern, Budson & Ally, 2010)—as well as other common symptoms of AD, such as agitation, mood, or delusions, that affect behavioral (Brotons & Pickett-Cooper, 1996; Chen et al., 2014; Gerdner, 2000; Jennings & Vance, 2002; Ledger & Baker, 2007), psychological (Chen et al., 2014; Raglio et al., 2013; Sakamoto, Ando, & Tsutou, 2013; Svansdottir & Snaedal, 2006; Ueda, Suzukamo, Sato, & Izumi, 2013), and emotional functioning (Clément, Tonini, Khatir, Schiaratura, & Samson, 2012; Gerdner, 2000; Sakamoto et al., 2013; Svansdottir & Snaedal, 2006; Ueda et al., 2013). Given the extensive literature on music therapy as a potential treatment for patients with AD, the purpose of this literature review was to address the following question: To what extent is music therapy effective in improving symptoms of Alzheimer’s disease?
Music Therapy in Treating Major Cognitive Symptoms of AD
Improved memory. As stated previously, one of the most prevalent and pervasive symptoms of AD is memory loss (Alzheimer’s Association, 2014; NIH, 2012). Incredibly, studies have shown that old memories in patients with AD were greatly improved when treated with music therapy (Dassa, 2014; Ledger & Baker, 2007; Prickett & Moore, 1991; Sambandham & Schirm, 1995). When patients with AD sang along with familiar songs, they were able to not only recall the words to the old songs, but also recall both semantic and emotional facts about themselves or others; patients were able to recall the date of their birth and facts about their past memories (Ledger & Baker, 2007; Prickett & Moore, 1991; Sambandham & Schirm, 1995), as well as old feelings and thoughts associated with the old songs (Dassa, 2014; Sambandham & Schirm, 1995). While music therapy was able to revive old memories, researchers found that it was also successful in helping form new memories (Prickett & Moore, 1991; Simmons-Stern et al., 2010). For example, patients exposed to music therapy were more likely to learn and remember new words and lyrics from a new song than if the new material was simply spoken (Prickett & Moore, 1991; Simmons-Stern et al., 2010). Even patients who were unable to recall the words from the song still attempted to hum or sing along with the newly learned melody (Prickett & Moore, 1991). These findings indicated that music therapy acted as a catalyst for remembering old memories and for forming new memories in patients with poor memory recollection.
Improved language functioning and communication. Like memory, music therapy improved other cognitive processes, such as language functioning and communication (Brotons & Koger, 2000; Dassa, 2014; Ledger & Baker, 2007; Sambandham & Schirm, 1995). Impaired language functioning is a major symptom of AD, as it hinders the ability of the individual to comprehend and produce language (Cohen-Mansfield, 1997). Often times, the individual has trouble understanding what is happening, which is often associated with comprehension, or expressing himself or herself, which is often associated with production (Cohen-Mansfield, 1997). However, both comprehension and production are greatly improved in patients with AD after music therapy. When patients with AD sang in the therapy session, they were able to comprehend topics of conversation better, as shown by engaging more in verbal conversations related to the topic of the songs (Dassa, 2014) and staying on topic more frequently (Brotons & Koger, 2000; Dassa, 2014).
Regarding the production of language, after music therapy, patients with AD talked more and were more fluid in their speech (Brotons & Koger, 2000). Additionally, patients increased communication and interaction with others (Dassa, 2014; Ledger & Baker, 2007; Sambandham & Schirm, 1995). Further, patients who sang along to music and played instruments showed increased positive verbal and social interactions with other patients in the form of greeting and complimenting others, sharing memories, and joking (Ledger & Baker, 2007; Sambandham & Schirm, 1995). Overall, these findings suggested that language functioning and communication were greatly improved when patients with AD participated in music therapy. This is indicated by the findings in which patients were able to comprehend conversations better, and engage in conversations more frequently. Improving language functioning and communication is particularly important for patients with AD who may also suffer from behavioral symptoms, such as agitation, as patients with AD are most likely to become agitated or express themselves behaviorally when they have difficulty articulating their thoughts, needs, or desires (Cohen-Mansfield, 1997).
Music Therapy in Treating Other Symptoms of AD
Improved behavioral symptoms. Music therapy was successful in reducing various types of agitated behaviors (Brotons & Pickett-Cooper, 1996; Chen et al., 2014; Gerdner, 2000; Jennings & Vance, 2002; Ledger & Baker, 2007). In patients with AD, agitated behaviors can include pacing or aimless wandering, verbal and physical aggressions, grabbing, repetitive sentences or questions, and complaining (Cohen-Mansfield, 1997). Patients who engaged in interactive music therapy by singing along to music and playing instruments showed markedly reduced agitated behaviors (Brotons & Pickett-Cooper, 1996; Chen et al., 2014; Jennings & Vance, 2002; Ledger & Baker, 2007). Additionally, patients who listened to music showed a reduction in agitated behaviors as well, including a decrease in insulting, grabbing at others, or complaining (Gerdner, 2000; Ledger & Baker, 2007). Furthermore, patients who listened to music that was specifically unique to their lives or backgrounds exhibited fewer agitated behaviors than patients who were exposed to typical relaxation music (Gerdner, 2000). While music therapy was successful in improving behavioral symptoms, other symptoms of AD, such as psychotic or psychological symptoms can accompany behavioral symptoms (Chen et al., 2014; Raglio et al., 2013; Sakamoto et al., 2013; Svansdottir & Snaedal, 2006; Ueda et al., 2013). Therefore, it is important to investigate the extent to which music therapy is effective in targeting and treating psychological symptoms of AD.
Improved psychological functioning. According to the literature, music therapy is also able to improve psychological symptoms of AD (BPSD) (Chen et al., 2014; Raglio et al., 2013; Sakamoto et al., 2013; Svansdottir & Snaedal, 2006; Ueda et al., 2013). BPSD symptoms can include paranoia and delusional ideations, hallucinations, activity and affective disturbances, and anxiety (Reisberg, Auer, & Monteiro, 1997). Overall, patients who participated in either form of music therapy (i.e., Interactive/Active vs. Passive/Receptive) saw reductions in these BPSD symptoms compared with patients who were not treated with music therapy (Chen et al., 2014; Raglio et al., 2013; Sakamoto et al., 2013; Svansdottir & Snaedal, 2006; Ueda et al., 2013). Across the two music therapy modalities, patients exposed to interactive music therapy saw a greater reduction in BPSD symptoms than patients treated with passive music therapy (Raglio et al., 2013; Sakamoto et al., 2013). Patients showed the greatest reductions specifically in the BPSD symptoms of anxiety, aggressiveness, and activity disturbances (Sakamoto et al., 2013; Svansdottir & Snaedal, 2006; Ueda et al., 2013). Noticeable decreases in psychotic symptoms, such as hallucinations and delusions, were also present (Chen et al., 2014).
Improved emotional symptoms. Finally, music therapy helped improve emotional symptoms of AD (Clément, et al., 2012; Gerdner, 2000; Sakamoto et al., 2013; Svansdottir & Snaedal, 2006; Ueda et al., 2013). Specifically, music therapy reduced negative affect (Sakamoto et al., 2013; Svansdottir & Snaedal, 2006; Ueda et al., 2013) and stress (Sakamoto et al., 2013). At the same time, music therapy elevated positive emotions. At the end of music therapy sessions, patients’ mood improved (Clément et al., 2012; Dassa, 2014; Gerdner, 2000, Sakamoto et al., 2013), and they reported feeling more positive overall (Clément et al., 2012; Sakamoto et al., 2013). Additionally, patients felt an increased sense of belonging and accomplishment at the end of the therapy sessions (Dassa, 2014). Overall, these findings contribute to the consensus that music therapy is an effective treatment in improving symptoms of AD.
Conclusion
As the literature has shown, music therapy is an effective alternative treatment for improving many symptoms of AD (Brotons & Koger, 2000; Dassa, 2014; Ledger & Baker, 2007; Prickett & Moore, 1991; Sambandham & Schirm, 1995; Simmons-Stern et al., 2010; Svansdottir & Snaedal, 2006). A review of the literature indicates that music therapy is not only beneficial in treating the hallmark, cognitive symptoms of AD, such as memory and language functioning (Brotons & Koger, 2000; Ledger & Baker, 2007; Prickett & Moore, 1991; Simmons-Stern et al., 2010), but is also effective in improving behavioral, psychological, and emotional processes as well (Brotons & Pickett-Cooper, 1996; Chen et al., 2014; Jennings & Vance, 2002; Ledger & Baker, 2007; Svansdottir & Snaedal, 2006; Ueda et al., 2013). Additionally, interactive music therapy in the form of singing or playing instruments is found to be more effective in improving symptoms of AD than passive music therapy (Dassa, 2014; Ledger & Baker, 2007; Sakamoto et al., 2013; Svansdottir & Snaedal, 2006). Overall, this body of research emphasizes that music therapy is a valuable therapy for treating symptoms of AD, as its effectiveness is strong. Additionally, its relatively low cost and low risk methods make it attractive to patients and family members compared to medication (Koger, Chapin, & Brotons, 1999; Sambandham & Schirm, 1995; Svansdottir & Snaedal, 2006). With its success in treating symptoms of AD, music therapy has the potential to be effective in treating other populations, such as populations that typically have high levels of anxiety or agitation, as well as other neurodegenerative disorders, which should be the focus of future research.
However, despite an overwhelming interest in music therapy as an effective treatment for treating symptoms of AD, a major limitation of the therapy is its longevity. More specifically, literature suggests that music therapy is most effective for treating AD symptoms short-term (Clément et al., 2012; Ledger & Baker, 2007; Sambandham & Schirm, 1995; Svansdottir & Snaedal, 2006). However, there is conflicting data on how effective long-term music therapy is. The majority of studies suggest that music therapy is not an effective long-term treatment for patients with AD, as symptoms return two to four weeks after the end of treatment (Ledger & Baker, 2007; Svansdottir & Snaedal, 2006). Some studies find otherwise: music therapy is shown to be effective in reducing symptoms of AD long term (Clément et al., 2012; Sakamoto, et al., 2013; Ueda et al., 2013). In some cases, reduced symptoms lasted up to eight weeks after ending treatment (Clément et al., 2012). Conducting more longitudinal studies should help to address the discrepancy in music therapy’s long-term effectiveness.
Finally, while these studies suggest that music therapy is effective in treating AD symptoms in their sample of patients, in most studies, sample sizes were small, indicating another major limitation of the past and current research (Brotons & Koger, 2000; Prickett & Moore, 1991). Additional and future research on music therapy should be conducted with larger sample sizes and longer studies in order to determine its true potential as an effective, alternative, low-cost, and low-risk treatment for improving symptoms of AD.
References
Alzheimer’s Association. (2014). 2014 Alzheimer’s disease facts and figures. Retrieved from https://www.alz.org/downloads/Facts_Figures_2014.pdf
American Music Therapy Association. (2015). What is music therapy. Retrieved from http://www.musictherapy.org/about/musictherapy/
Bishara, D., & Taylor, D. (2014). Adverse effects of clozapine in older patients: Epidemiology, prevention and management. Drugs & Aging, 31(1), 11-20.
Brotons, M., & Pickett-Cooper, P. K. (1996). The effects of music therapy intervention on agitation behaviors of Alzheimer’s disease patients. Journal of Music Therapy, 33(1), 2-18.
Brotons, M., & Koger, S. M. (2000). The impact of music therapy on language functioning in dementia. Journal of Music Therapy, 37(3), 183-195.
Chen, R., Liu, C., Lin, M., Peng, L., Chen, L., Liu, L., & Chen, L. (2014). Non-pharmacological treatment reducing not only behavioral symptoms, but also psychotic symptoms of older adults with dementia: A prospective cohort study in Taiwan. Geriatrics & Gerontology International, 14(2), 440-446.
Clément, S., Tonini, A., Khatir, F., Schiaratura, L., & Samson, S. (2012). Short and longer term effects of musical intervention in severe Alzheimer’s disease. Music Perception, 29(5), 533-541.
Cohen-Mansfield, J. (1997).Conceptualization of agitation: Results based on the Cohen-Mansfield agitation inventory and the agitation behavior mapping instrument. International Psychogeriatrics, 8(Supplement S3), 309-315.
Consumer Reports. (2012). Evaluating prescription drugs used to treat: Alzheimer’s disease. Consumers Union of U.S.
Cowles, A., Beatty, W. W., Nixon, S. J., Lutz, L. J., Paulk, J., Paulk, K., & Ross, E. D. (2003). Musical skill in dementia: A violinist presumed to have Alzheimer’s disease learns to play a new song. Neurocase, 9(6), 493-503.
Crystal, H. A., Grober, E., & Masur, D. (1989). Preservation of musical memory in Alzheimer’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 52(12), 1415-1416.
Dassa, A. (2014). The role of singing familiar songs in encouraging conversation among people with middle to late stage Alzheimer’s disease. Journal of Music Therapy, 51(2), 131-53.
Gerdner, L. A. (2000). Effects of individualized versus classical “relaxation” music on the frequency of agitation in elderly persons with Alzheimer’s disease and related disorders. International Psychogeriatrics, 12(1), 49-65.
Jennings, B., & Vance, D. (2002). The short-term effects of music therapy on different types of agitation in adults with Alzheimer’s. Activities, Adaptation & Aging, 26(4), 27-33.
Koger, S. M., Chapin, K., & Brotons, M. (1999). Is music therapy an effective intervention for dementia? A meta-analytic review of literature. Journal of Music Therapy, 36(1), 2-15.
Ledger, A. J., & Baker, F. A. (2007). An investigation of long-term effects of group music therapy on agitation levels of people with Alzheimer’s disease. Aging & Mental Health, 11(3), 330-338.
National Institutes of Health, National Institutes on Aging. (2012). Alzheimer’s disease fact sheet. (NIH Publication No. 11-6423). Retrieved from http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-fact-sheet
National Institutes of Health, National Institutes on Aging. (2014). Alzheimer’s disease medication fact sheet. (NIH Publication No. 08-3431). Retrieved from http://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-medications-fact-sheet
Prickett, C. A., & Moore, R. S. (1991). The use of music to aid memory of Alzheimer’s patients. Journal of Music Therapy, 28(2), 101-110.
Raglio, A., Bellandi, D., Baiardi, P., Gianotti, M., Ubezio, M. C., & Granieri, E. (2013) Listening to music and active music therapy in behavioral disturbances in dementia: A crossover study. Journal of the American Geriatrics Society, 61(4), 645-647.
Reisberg, B., Auer, S. R., & Monteiro, I. M. (1997). Behavioral pathology in Alzheimer’s disease (BEHAVE-AD) rating scale. International Psychogeriatrics, 8(Supplement S3), 301-308. Sakamoto, M.,
Ando, H., & Tsutou, A. (2013). Comparing the effects of different individualized music interventions for elderly individuals with severe dementia. International Psychogeriatrics, 25(5), 775-84.
Sambandham, M., & Schirm, V. (1995). Music as a nursing intervention for residents with Alzheimer’s disease in long-term care: Music may be a memory trigger for patients with Alzheimer’s and provide a means of communication. Geriatric Nursing, 16(2), 79-83.
Simmons-Stern, N. R., Budson, A. E., & Ally, B. A. (2010). Music as a memory enhancer in patients with Alzheimer’s disease. Neuropsychologia, 48(10), 3164-3167.
Svansdottir, H., & Snaedal, J. (2006). Music therapy in moderate and severe dementia of Alzheimer’s type: A case–control study. International Psychogeriatrics, 18(4), 613-621.
Ueda, T., Suzukamo, Y., Sato, M., & Izumi, S. (2013). Effects of music therapy on behavioral and psychological symptoms of dementia: A systematic review and meta-analysis. Ageing Research Reviews, 12(2), 628-641.
Vink, A. C., Bruinsma, M. S., & Scholten, R. J. (2003). Music therapy for people with dementia. The Cochrane Database of Systematic Reviews, 4, 1-48.