Dementia Patients May Benefit From Music Therapy

By Linda Carroll

(Reuters Health) - Music therapy may improve depression and anxiety in dementia patients, a new analysis suggests.

Music therapy might also improve emotional well-being among those with dementia, researchers found. But they didn't find any benefits when it came to cognition and behavioral issues such as agitation or aggression, according to the report in the Cochrane Database of Systematic Reviews, online July 23.

Although the benefits of music therapy weren't large, "small effects are valuable, too, because even a small improvement or maintaining a certain level while otherwise a decline is expected is very important for people with dementia and those caring for them," said study leader Jenny van der Steen, a researcher with the department of public health and primary care at Leiden University Medical Center.

"These outcomes are closely linked to quality of life and may be more relevant than improving or delaying decline in cognition for the patients under study - mostly nursing home patients," van der Steen said in an email.

For the analysis, van der Steen and colleagues pooled data from 21 smaller randomized trials involving a total of 1097 patients. Patients in the trials received either music based therapies that involved at least five sessions, or usual care or some other activity with or without music.

Participants in the studies had dementia of varying degrees of severity and the majority were residents in institutions. Seven of the studies provided individual music therapy, while the others delivered the intervention in a group setting.

The new findings could have a significant impact on dementia patients, said Dr. Alexander Pantelyat, an assistant professor of neurology at the Johns Hopkins University School of Medicine and co-director of the Johns Hopkins Center for Music and Medicine.

"The alternative to these behavioral interventions is drugs with black box warning labels saying that they increase the risk of death," Pantelyat said. "The fact that they could be moderately confident that music-based treatments could improve symptoms of depression and overall behavioral problems would make this actionable from my standpoint even though the number of studies was low."

It's not surprising that music therapy could help those with dementia, Pantelyat said. "It's known that areas that process music in the brain overlap with the emotional areas and those that process language," he added. "If a song from somebody's youth is played it's possible it will bring back memories associated with the first time they heard it. And that speaks to the need for a tailored approach. Not a 'one song fits all' approach."

Other research, in healthy volunteers, has shown that music taps into the reward centers of the brain, Pantelyat said. "These are the same areas of the brain, such as the nucleus accumbens, that are activated by drugs such as cocaine," he added. "It's a very powerful effect. And if you're motivated to continue to go back to a personally meaningful song or genre, the benefits could potentially be sustained for a long time."

The new findings highlight the need for more studies involving larger groups of patients, said Dr. Borna Bonakdarpour, an assistant professor of neurology at Northwestern University's Cognitive Neurology and Alzheimer's Disease Center.

Bonakdarpour believes that music therapy can also be used to improve social interactions. "We are doing some interventions here to see if it can improve interactions between patients and caregivers," he said. "We have preliminary data that suggests it helps."

Bonakdarpour also believes that music therapy might allow some patients to skip powerful and risky medications. "For severe psychiatric issues we will still have to use medications, but the question is, can we (avoid) some of these medications that have side effects that can sometimes be pretty significant," he said.

SOURCE: https://bit.ly/2KZpwAM

Cochrane Database Syst Rev 2018.

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