The Effect of Music Therapy on Patients With Dementia

Dementia is an umbrella term for the mental decline that affects daily living in older adults. Some forms of dementia include Alzheimer’s Disease, Lewy Body Dementia, Frontotemporal Dementia, Huntington’s Disease, Parkinson’s Disease, and more. The disease is progressive and currently has no cure. These diagnoses are often caused by changes in the brain with old age, genetic predisposition, and environmental factors. Symptoms of dementia include, but are not limited to, memory loss, behavioral changes, personality changes, confusion, difficulty with daily tasks, getting lost, social withdrawal, depression, difficulty conversing with others, and more. Music therapy is an allied health profession that can utilize evidence-based music interventions to treat symptoms of dementia.

The most common symptom areas that music therapists address with dementia patients are behavioral and psychological symptoms in dementia (BPSD), psychosocial, memory recall, mental health, and quality of life. Live receptive music listening, group therapy, active music therapy (instrument play), and other approaches are considered effective forms of treatment for different symptoms when done over longer periods.

In an umbrella review from Garrido (et. al), several studies found that music therapy interventions and therapeutic singing had a positive effect on BPSD symptoms and improved them in comparison to those without music therapy treatment. Garrido (et. al) also discussed that music therapy decreased anxiety levels and elevated the mood of people with dementia. Garrido (et. al) also stated that the reported benefits of music therapy participation were, “positive effects on mood and well-being; increases in energy level; cognitive stimulation; collective bonding and peer support; a sense of contributing to something bigger and more aesthetically beautiful; increases in confidence; motivation and self-esteem; and a sense of personal transcendence,” (Garrido, et. al, 2019, p. 271). For cognitive needs, Moreno-Morales (et. al) found that receptive music therapy interventions, such as music listening, are one of the most effective. The study discusses that the positive effects could be due to activation in several parts of the brain. Activating these areas of the brain could create new connections, which promotes neuroplasticity. When researching the effect of music therapy on Alzheimer’s dementia, Gómez Gallego (et. al) found that music therapy improved hallucinations, agitation, delusions, anxiety, and other psychological symptoms. The results highlighted that music therapy “increases the level of tolerance to stressful environmental stimuli that may trigger such symptoms,” (Gómez Gallego, et. al, 2017, p. 305). Receptive music therapy may allow the autonomic nervous system to remain calm, which decreases the activation of the parasympathetic nervous system. When addressing quality of life, psychosocial, and mental health needs, group music therapy increases positive moods and promotes social relationships. Furthermore, the study found that cognitive function, memory recall, language understanding, speech development and processing, and more all improved. All of these improvements are most likely due to increased spatial orientation, singing and being social with others, music-associated memories, and brain plasticity.  

The studies above found results from studies that utilized individual and group music therapy treatment, and music therapy was effective in both settings. A range of results can be found depending on the setting, interventions, and individuals in the music therapy sessions. Music therapists have the ability to assess and treat the needs of others in various settings with evidence-based music interventions to treat the non-musical needs of many populations. Although dementia is not reversible, long-term music therapy treatment is evidenced as a successful solution for decreasing a variety of symptoms within this population.

-Lila Finke, Music Therapy Intern

References 

Dementia. (2023, March 15). World Health Organization (WHO). Retrieved July 6, 2023, from https://www.who.int/news-room/fact-sheets/detail/dementia 

Gómez Gallego, M., & Gómez García, J. (2017). Music therapy and alzheimer’s disease: Cognitive, psychological, and behavioural effects. Neurología (English Edition), 32(5), 300–308. https://doi.org/10.1016/j.nrleng.2015.12.001 

Garrido, S., Baird, A., & Tamplin, J. (Eds.). (2019). Music and dementia: From cognition to therapy. Oxford University Press.

Moreno-Morales, C., Calero, R., Moreno-Morales, P., & Pintado, C. (2020). Music therapy in the treatment of dementia: A systematic review and meta-analysis. Frontiers in medicine, 7, 160. https://doi.org/10.3389/fmed.2020.00160

Benefits of Co-Treating with Music Therapy & Speech Therapy

            Speech and Language therapists focus on communication disorders in individuals who struggle in areas such as improving coordination and strength in speech muscles, improving fluency of speech, articulation of speech, auditory processing, methods of eating, and a plethora of other speech related goals. While speech therapists have been trained to assess and create treatment plans for these specific goals, other therapies have been beneficial towards addressing these goals as well. A research study by Geist, McCarthy, et al., discusses the benefits of MT and ST services practiced together in a co-treatment model. Music therapists are trained to use the therapeutic functions of music such as tempo, rhythm, key, texture, etcetera, to assist with communication skills in individuals with those particular needs. For example, using methods such as OMREX (oral, motor, and respiratory exercises) can be beneficial for the promotion of deep breathing, muscle control, and vocal suspension. Music can also assist with articulation by using songs with specific and repeated words, phrases, or sounds.

            In Geist’s (et al.) study, she created the requirements of one client who needed to be between the ages of two and twelve, had a communication impairment, and had parental consent to participate in the study. The client selected was four years of age and had participated in speech therapy services prior to the experiment. The speech therapist had been working on transitioning from bottle feeding, as well as expressing wants and needs. The client’s biggest need, which was assessed by both therapist’s after an initial assessment, was the need to communicate with other children and participate in the classroom. Before co-treatment with music therapy and speech therapy, the client had the comprehension and expression of a 9-to-12 month old child according to the Rossetti Infant Toddler Scale.

            The two therapists selected specific co-treatment interventions to address the client’s needs. For example, working on greetings through songs, using a voice output device to select instruments that he wanted to play, or using sound cues to work on sign language. After treatment, ten teachers watched a video of the client's pretreatment and post-treatment. Each agreed that the client had better class participation after treatment concluded.

            While speech and music therapy have different domains, they can be beneficial when used together to create faster and more long-term results in areas such as pitch, timbre, rhythm, duration, etcetera. By combining and adapting two types of therapy together, there is a better chance of improving client’s quality of life in an efficient and productive manner.

- Mallory McDonald, Music Therapy Intern

Resources

Geist, McCarthy, et al., (2008) Integrating music therapy services and speech-language therapy services for children with severe communication impairments: A co-treatment model. Journal of Instructional Psychology. 35(4), 311-316.

Tam, L. (2018, April 11). Music Therapy & Co-treatment: What does it look like?. Music Therapy Connections. https://musictherapyconnections.org/2018/04/music-therapy-co-treatment/

Speech-language therapy and music therapy collaboration: The DOS, the ... (n.d.). https://leader.pubs.asha.org/do/10.1044/speech-language-therapy-and-music-therapy-collaboration-the-dos-the-donts-and-the-why-nots/full/

Welcome Mallory!

Hi! My name is Mallory McDonald, and I am one of the new music therapy interns at Therabeat, Inc. For the next six months, I have been offered the privilege of working alongside exceptional therapists as well as clients, and I could not be more excited to begin this journey. This week consisted of a lot of observation of sessions, note taking, and friend making! I have had the time of my life thus far, and I am so thrilled to be able to finish my degree with In Harmony Pediatric Therapy.

Music therapy is an extremely special form of healthcare that utilizes the therapeutic functions of music to improve quality of life. I have always enjoyed music and have been involved in activities such as choir, musical theater, and singing lessons for as long as I can remember. I felt a little disheartened before attending college because I thought that I would have to set aside my passion for music to pursue a career. It was such a pleasant surprise when music therapy was introduced to me as an option. I had not heard of music therapy until my brother and sister were diagnosed with autism. Watching my sister receive treatment and meet goals was so special, and opened a door to discovering how the therapeutic functions of music can be used to meet an individual’s needs. I knew that I wanted to do the same for others and promote positive change in people’s lives.

My first week at Therabeat has just come and gone, and I am so giddy to wake up and come into the clinic every morning. Having the opportunity to observe successful music therapists treat clients has been incredible. I have met some of the most spectacular individuals, and have enjoyed every minute of making music with them. Some of my favorite moments of the week were observing other therapies including speech, physical, and occupational. It was so intriguing to see the different forms of treatment. Along with that, observing a co-treatment session with physical therapy was insightful, and allowed me to view how much progress can be made when therapists work together on a treatment plan. I have also enjoyed listening to the clients prepare for the recital in adaptive lessons. I can tell how hard these kiddos have worked on their songs, and can hardly wait to hear the finished product. I also had the opportunity to observe an evaluation/assessment using IMTAP.

Being at Therabeat this past week has already educated me on so much and has made me extremely excited to become a board certified music therapist. I am honored to be working with these individuals and making music with them for the next six months. I am so thrilled to be here and so excited to contribute to sessions in the weeks to come!

-Mallory McDonald, Music Therapy Intern

Welcome Lila!

Hello! My name is Lila Finke, and I just started my music therapy internship with Therabeat Inc. I am so honored and excited to work alongside the incredible staff of music therapists and other allied health professionals. I am from Roswell, Georgia, and am currently taking the final step to complete my Bachelor’s Degree in Music Therapy. My primary instrument is my voice, but I also play guitar, piano, ukulele, and percussion. My other hobbies consist of pickleball, art, hiking, yoga, being in nature, and spending time with friends and family.

When looking for a career, I knew that I was interested in music and serving others. Singing has always been a passion of mine, and I have been in choir and have taken music lessons from a young age. Before I knew about music therapy, I was considering pursuing a career as a child psychologist and minoring in music. When I was introduced to music therapy for the first time, I was blown away to hear that music interventions have the ability to do things such as help individuals relearn how to walk or talk. After observing a music therapist at a local hospital, I learned about the therapeutic functions of music and how music is used to treat the needs of the individual. I was so happy to discover that there was a career path that combined my interests and was able to help so many people.

I just finished my first week of internship, and I already feel that I have learned so much. The therapists have been so kind and helpful this past week as I have been observing their music therapy sessions with their clients. It has been so wonderful meeting clients, seeing their unique strengths, and building rapport with them this week. I was also able to observe some allied health professionals from In Harmony Pediatrics, such as several physical therapists and a speech and language therapist. Working at a clinic with other allied health professionals is such a great opportunity to work as a multidisciplinary team to benefit a client’s specific needs. I was able to observe a co-treatment session with a music and physical therapist. Even in one session, it was obvious that the combination of the therapies was extremely beneficial for this client.

This first week has been so educational and exciting! I am looking forward to continuing my education and growth as a music therapist at Therabeat Inc. for the next six months!

-Lila Finke, Music Therapy Intern

Music Therapy Impacting Patients with Alzheimer’s Disease & Dementia

Famous jazz vocalist Tony Bennett’s experience with Alzheimer’s disease while actively performing the lyrics and melodies of a multitude of songs is a glimpse into the impact of music on brain function throughout cognitive decline. Dementia and Alzheimer’s disease affect a large number of older adults every year globally. In 2022, approximately 6.5 million people 65 years and older in America will be diagnosed with Alzheimer’s dementia (Alzheimer’s Association, 2022). While memory impairment and cognitive decline are the primary symptoms, agitation, anxiety, depression, and paranoia are among some of the other symptoms that affect people with Alzheimer’s disease (Brotons & Pickett-Cooper, 1996). Music therapists can address various behavioral, emotional, and cognitive goals with these patients.

Many types of music therapy interventions have been found to be successful in treating different behaviors and symptoms present within this population. One important goal is improving cognition. Movement and instrument playing interventions were found to be effective in improving next-day cognition and were greatly preferred by clients over other types of music interventions (Bruer, et. al., 2007). When facilitated by a board-certified music therapist, these interventions are accessible and adaptable to all clients regardless of their prior musical training or lack thereof. The goal of improving cognition can be achieved through more specific Neurologic Music Therapy (NMT) techniques. NMT techniques are a subset of music therapy interventions requiring special training and qualifications, which are used primarily in rehabilitative goals and settings. Techniques such as Associative Music and Memory training and Musical Executive Function training engage the patients and assist them in reaching orientation and cognitive goals through music (Álvarez, 2022). These focused interventions utilize music improvisation, singing, discussion, and other methods to provide cognitive stimulation.

“Sundown Syndrome” is an even more specific phenomenon that can be addressed by music therapists working with geriatric populations. Sundown syndrome, or sundowning, is the colloquial term for a set of negative behaviors that arise for dementia patients in the late afternoon or evening. These behaviors can include “confusion, disorientation, anxiety, agitation, aggression, pacing, wandering, resistance to redirection, screaming, yelling and so forth” (Khachiyants, 2011, p. 275). Agitation reduction is an important emotional and behavioral goal addressed by music therapists. Interventions such as therapeutic singing, instrument playing, movement with music, musical games, and improvisation have all been found to be effective in reducing agitation (Brotons & Pickett-Cooper, 1996). One study noted comments from caregivers that claimed patients were “more cooperative and responsive” following music therapy sessions (Brotons & Pickett-Cooper, 1996, p. 14). This implies that strategically timed music therapy sessions facilitated by a board-certified music therapist can be beneficial to improving the patient’s symptoms while aiding the jobs of the caregivers of patients actively experiencing sundowning. 

In addition to agitation and anxiety, music therapists can address depression symptoms in patients with Alzheimer’s disease and dementia. Reminiscence-based music therapy interventions use strategic familiar song choices and focused questions to facilitate discussion about certain topics. These types of interventions provide patients “a safe place to interact socially, to share their memories with other residents, and to improve self-image” (Ashida, 2000, p. 180). This positive social interaction and discussion leads to a decrease of depression symptoms among patients. Music therapists have the ability to positively impact many goal areas with patients with Alzheimer’s disease and dementia. The use of research-based interventions can improve the overall quality of life for patients in a rapidly growing geriatric population.

-Tess Vreeland, Music Therapy Intern

References

Álvarez, L. (2022). Neurologic music therapy with a habilitative approach for older adults with dementia: A feasibility study. Music Therapy Perspectives, 40(1), 76–83. https://doi.org/10.1093/mtp/miab021 

Alzheimer's disease facts and figures. Alzheimer's Disease and Dementia. (2022). Retrieved October 17, 2022, from https://www.alz.org/alzheimers-dementia/facts-figures 

Ashida, S. (2000). The effect of reminiscence music therapy sessions on changes in depressive symptoms in elderly persons with dementia. Journal of Music Therapy, 37(3), 170–182. https://doi.org/10.1093/jmt/37.3.170 

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. https://doi.org/10.1093/jmt/33.1.2 

Bruer, R. A., Spitznagel, E., & Cloninger, C. R. (2007). The temporal limits of cognitive change from music therapy in elderly persons with dementia or dementia-like cognitive impairment: A randomized controlled trial. Journal of Music Therapy, 44(4), 308–328. https://doi.org/10.1093/jmt/44.4.308 

Khachiyants, N., Trinkle, D., Son, S. J., & Kim, K. Y. (2011). Sundown Syndrome in persons with dementia: An update. Psychiatry Investigation, 8(4), 275. https://doi.org/10.4306/pi.2011.8.4.275