Music therapy, dementia and Alzheimer’s disease – a review (ISSN 2753-8176 (online))

1. Ana Pedro

1.Gwyntwr1386 Health & Social Care, Regus Chester Business Park, Heronsway, Chester, CH49QR, UK. info@gwyntwr1386.com

Music shows a positive effect on cognitive functioning and music-making has a small but statistically significant effect on cognitive functioning for older adults with probable mild cognitive impairment (MCI) or dementia (1). Music therapy (MT) positively affects mood, neuropsychiatric behaviour, apathy, communication and physical functions for dementia improving symptomatology. Also, behavioural/psychological symptoms improve in severe dementia, and memory and verbal fluency improve in mild Alzheimer's disease. Both active (playing music) and receptive (listening to music) methods are used for dementia (2). Also, MT besides improving patients' symptomatology also helps with caregivers' burden(3). Also, music based interventions (MBIs) consisting of either of singing or music listening interventions and with variable duration seem to have immediate positive effects on cognition. Short-term MBIs (lasting 1-4 months) seem to benefit cognition, anxiety and pain (4). Moreover, it is sugested that possible uses of non-pharmacological circadian-based music therapy to target mechanisms involved in the pathogenesis of Alzheimer's disease and Parkinson's disease may enhance clinical treatment and potentially indicate neuroprotection as a preventative measure (5). Positive effects of music on sleep outcomes were observed in some studies, specifically with decreases in night time sleep disturbances, increases in daytime alertness, and improvements in sleep quality (6). Also other studies show benefits of music in cognitive diseases, being improvements on memory and cognition the most frequent outcomes. Other common benefits are on social behavior, mood and emotion, anxiety and agitation, quality of life, and depression. Out of the 334 music-related genes, 127 (38%) were found to be linked to epigenome/transcriptome analysis in Alzheimer’s disease. Some of these genes (SNCA, SLC6A4, ASCC2, FTH1, PLAUR and ARHGAP26) have been reported to be associated, for example, with musical aptitude and music effect on the transcriptome. Other music-related genes (GMPR, SELENBP1 and ADIPOR1) associated to neuropsychiatric, neurodegenerative diseases and music performance, emerged as hub genes in consensus co-expression modules detected between Alzheimer’s disease and music stimulated transcriptomes. In addition, it was found connections between music, Alzheimer’s disease and dopamine related genes, with SCNA being the most remarkable (a gene previously associated with learning and memory, and neurodegenerative disorders (for example, Parkinson's disease and Alzheimer’s disease)(7, 8, 9).

Additional trials suggest that, music-based therapies significantly improve the cognition of patients with dementia compared with non-music therapies. Music-based therapies also significantly improved the quality of life of patients with dementia compared with non-music therapies including significantly improving patients' neuropsychiatric symptoms compared with non-music therapies (10). However, the current approach to MT practice is enormously heterogeneous with studies demonstrating variable therapist qualifications, uses of music, therapy approaches, and clinical populations. MT has not been standardized with protocolized interventions, making it difficult for clinicians and researchers to objectively assess the evidence, and thus, prescribe MT interventions. The lack of MT standardization, coupled with a low number of music therapists relative to people with Alzheimer’s dosease, result in a lack of awareness that hinders access to MT as a psychosocial treatment for neuropsychiatric symptoms in people with Alzheimer’s disease (11), being that music evoked autobiographical memories appear to be relatively well preserved in neurodegenerative diseases, especially in Alzheimer’s disease (12). Music interventions utilizing personalized music playlists and headphones result in positive outcomes, including mood improvement and a significant decrease of behavioral and psychological symptoms of dementia although as mentioned before there is a need for further and more focused research (13). Also, techniques like musical mnemonics may help to learn and remember verbal information in cognitively unimpaired individuals and individuals with memory impairment (14).

References:

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2. Eur J Public Health. 2022 Feb 1;32(1):27-34. doi: 10.1093/eurpub/ckab042. Effectiveness of music therapy for autism spectrum disorder, dementia, depression, insomnia and schizophrenia: update of systematic reviews. Gassner L(1)(2)(3), Geretsegger M(4), Mayer-Ferbas J(1).

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10. Psychiatry Res. 2023 Nov;329:115498. doi: 10.1016/j.psychres.2023.115498. Epub 2023 Sep 27. Effects of music therapy on cognition, quality of life, and neuropsychiatric symptoms of patients with dementia: A systematic review and meta-analysis of randomized controlled trials. Lin TH(1), Liao YC(2), Tam KW(3), Chan L(4), Hsu TH(5).

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