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LITERATURE

ARTIGO ORIGINAL
REVIEW Efficacy of music therapy in the neuropsychiatric
symptoms of dementia: systematic review
Eficácia da musicoterapia nos sintomas neuropsiquiátricos
da demência: revisão sistemática

Mariângela Aparecida Rezende Aleixo1, Raquel Luiza Santos1, Marcia Cristina do Nascimento Dourado1

ABSTRACT

Objective: A large number of psychosocial interventions in dementia are based on music
activities and music therapy interventions. We aim at assessing the efficacy of music thera-
py in the neuropsychiatric symptoms of people with dementia. Methods: This systematic
review is according to the methodology suggested by the Preferred Reporting Items for Sys-
tematic Reviews and Meta-Analyses. We searched for articles in PubMed, Web of Knowledge
Cross Search, Cochrane Library, Scopus and Lilacs/Bireme databases published from 2005 to
2016. The search keywords included “early onset” and “late onset” combined with “demen-
tia”, “Alzheimer”, “vascular dementia”, “mixed dementia”, “frontotemporal dementia”, “neurop-
sychiatric symptoms”, “behavioral disturbances”, “behavioral and psychological symptoms of
dementia” and “music therapy”. The studies were categorized according to its efficacy on the
decline of neuropsychiatric symptoms and improvement of cognitive function, quality of
life and well-being. Results: We selected 12 out of 257 papers. Music therapy interventions
were applied individually or in group setting, using active or receptive technique. In general,
studies indicated the efficacy of music therapy on the decline of depression, agitation and
anxiety. There were heterogeneity of interventions, methodological design and instruments
of evaluation among the studies. Conclusions: Although there are reports of the efficacy of
Keywords music therapy on the decline of neuropsychiatric symptoms of dementia, the area still needs
Music therapy, dementia, randomized studies aimed at the solution of important methodological problems like the
neuropsychiatric symptoms. lack of standardized approaches.

RESUMO

Objetivo: Muitas intervenções psicossociais na demência estão baseadas em atividades
musicais e intervenções de musicoterapia. Nosso objetivo consiste em avaliar a eficácia das
intervenções de musicoterapia nos sintomas neuropsiquiátricos de pessoas com demência.
Métodos: Esta revisão sistemática está de acordo com a metodologia sugerida pela Prefer-
red Reporting Items for Systematic Reviews and Meta-Analyses. Foi realizada busca por artigos
nas bases de dados PubMed, Web of Knowledge Cross Search, Cochrane Library, Scopus e
Lilacs/Bireme publicados de 2005 a 2016. As palavras-chave incluíram descritores como “iní-
cio precoce” e “início tardio” combinados com “demência”, “Alzheimer”, “demência vascular”,
“demência mista”, “demência frontotemporal”, “sintomas neuropsiquiátricos”, “distúrbios com-

1 Universidade Federal do Rio de Janeiro (UFRJ), Institute of Psychiatry, Center for Alzheimer’s Disease and Related Disorders.

Received on
9/22/2016
Approved on
3/14/2017

Address for correspondence: Mariângela Aparecida Rezende Aleixo
DOI: 10.1590/0047-2085000000150 Av. Venceslau Bras, 71-fundos
22290-140 – Rio de Janeiro, RJ – Brazil
Telephone: +55 (21) 99967-0343
E-mail: maraleixo@gmail.com

20. os estudos indicaram a eficácia da musicoterapia na diminuição da depressão. na diminuição dos sintomas neuropsiquiátricos da demência. Receptive or passive MT is based on listening to However. melody and harmony) by a qualified music therapist with a client or group. in group. Os estudos foram categorizados segundo sua eficácia na redução dos sintomas neuropsiquiá- tricos e na melhora da função cognitiva. a better This systematic review is according to the methodology quality of life for the prevention. People are invited to play musical pharmacological treatments are efficacious among mild instruments or sing with the therapist. Other studies are focused in delaying the progression of Alzheimer Disease (AD)5. a área ainda necessita de estu- demência. playing instruments. In this context. such as agitation11. “sintomas comportamentais e psicológicos da demência”. agitation and depression. music is focused Web Services). agitação e ansie- dade. consequently. We searched for such as rhythm and mode. on cognitive and behavioral functions3. Dementia involves development of multiple cognitive MT can be applied individually or in a group setting. Scopus on musical experience through improvisation. The MT aims to develop potentials and/or restore functions of the METHODS individual so that he or she can achieve better intra and/ or interpersonal integration and.12. either individually or and moderate PwD and show significant statistical results. Active MT involves the use of neuropsychiatric symptoms can lead to suffering for musical instruments. The current relational and clinical level. como a neuropsiquiátricos.16 or anxiety16. and can adapt the in dementia4. playing musical instruments onset” combined with “dementia”. Moreover. as well as singing.8. falta de abordagens padronizadas. to active or relax. who needs to have specific expertise at a musical. According to the World Federation of National this systematic review aims to analyze the factors related to Music Therapy7. socializing. Conclusões: Embora haja relatos de eficácia da musicoterapia Musicoterapia. MT should not be confused with the generalized use of music8.Literature review Efficacy of music therapy in dementia 53 portamentais”. it is required the presence of a trained music the stabilization and improvement of symptomatology therapist. quality of life (QoL)23 and well- A large number of psychosocial interventions in being24. disorders and functional decline. expressing emotions. and offers a broad people with dementia (PwD) and their caregivers2. . and show an important role depression10. MT for dementia has frequently been dementia are based upon music activities and the use of developed without a clear theoretical background or proper music therapy (MT) interventions has increased over the last evidence from research or clinical practices. “vascular J Bras Psiquiatr. PubMed/MEDLINE. In advance in the pharmacological knowledge has enabled the active MT. The range of opportunities for expression and communication. decades6. INTRODUCTION and musical listening. a combination of pharmacologic treatments music (LtM). using functions and social or emotional well-being.18. on cognitive functions21. sintomas dos randomizados que visem à solução de problemas metodológicos importantes. the voice or body. In practice. utilizando técnica ativa ou receptiva. qualidade de vida e bem-estar. listening and studies about MT in dementia published in Portuguese. As intervenções de musicoterapia foram aplicadas individualmente ou em grupo. Non-pharmacological interventions aim at method according to disorders6. improving cognition. desenho metodológico e instrumentos de Palavras-chave avaliação entre os estudos. or its elements (sound. the cognitive and active or receptive technique. In MT. interventions among PwD are focused on the context of They are recommended as initial strategy for behavior neuropsychiatric symptoms9-20. Moreover. Houve heterogeneidade das intervenções. “musicoterapia”. 2017. rehabilitation or treatment suggested by the Preferred Reporting Items for Systematic of diseases.66(1):52-61.22. Resultados: Fo- ram selecionados 12 dos 257 artigos encontrados. of music (singing a familiar song and recreating it by The search keywords included “early onset” and “late changing the rhythm or lyrics). Most studies exploring the benefits and efficacy of MT decreasing agitation and offering guidance to caregivers. re-creation and Lilacs/Bireme databases. “Alzheimer”. MT is defined as the use of music and/ the efficacy of MT in PwD neuropsychiatric symptoms. rhythm. and participants are asked to listen to any genre and nonpharmacologic approaches is necessary for the of music that can be live or recorded. to stimulate cognitive English or Spanish from January 2005 to August 2016. and to reduce the Web of Knowledge Cross Search (Thomson Scientific/ISI anxiety. using and functional deficits1. the music appropriate management of the symptoms and disturbances therapist can combine both techniques. Em geral.19. Cochrane Library. The music therapist uses music parameters Reviews and Meta-Analyses (PRISMA)25.

After the exclusion pharmacologic interventions. Criteria of inclusion We included cross-sectional or longitudinal studies. “frontotemporal dementia”.11. depression and anxiety at the end of the “music therapy”. mental health 27 ↓ N=6 Assistance models Elderly with dementia or not 6 ↓ N=0 J Bras Psiquiatr. and the other trials used various designs such as within- subject design15. 146 in Web or frontotemporal dementia.11. We retrieved all applied14. Primary outcome “neuropsychiatric symptoms”. in all stages of severity. other pathologies or matters 12 ↓ N = 33 Other matters Music. Literature review dementia”.17.18-20 stages. familiar/caregivers. Afterwards. 2017.18-20 and severe9. pharmacological treatment. its efficacy on the neuropsychiatric symptoms. elderly people without dementia.13.19. We excluded all studies that clearly did not meet all inclusion criteria or Types of participants that met at least one of the exclusion criteria. Table 1. no clinical trial 74 ↓ N = 48 Music therapy using physiological parameters 3 ↓ N = 45 Participants Elderly.54 Aleixo MAR et al. young adults or abstracts. clinical trial of other nature. The primary outcome was reduction in PwD neuropsychiatric “behavioral and psychological symptoms of dementia” and problems. vascular dementia. We of Knowledge Cross Search/ISI. Selection of excluded studies Domains Exclusion criteria Excluded N = 190 ↓ Study design Review. with or without a control group. excluded articles with no casuistic. When necessary. program15. . neuroscience. tertiary hospital14 and hospice clarify study eligibility. We also excluded studies Our sample comprised 12 studies (Table 1). Two authors independently screened the titles and crossover study20.16. “behavioral disturbances”. other age. studies about MT among of redundant cross-references (N = 55) and screening of people with other pathologies or children. possibly relevant articles in full text. a third female. male and reach a consensus about inclusion. and 5 in Lilacs/BIREME. intervention. without abstract. mixed17 dementia. “mixed dementia”. letter.66(1):52-61.16-19 or residential20 homes and co-author of this paper was asked for further information to in treatment in-day center20. evaluative tests. developed in mental health institutions. two authors independently reviewed the full publications vascular dementia14. among people with AD. in mild16. controlled trial17. without music 68 ↓ N = 122 Intervention Stimulation with music and/or other modalities no pharmacological. One study did not mention the method abstracts to identify eligible papers.15. as well as the use of music or other non-pharmacological interventions only Design with caregivers. AD14. living in nursing9-13. The studies were categorized according to Seven out of the 12 studies used a randomized method9-13. clinical trials about 14 in Scopus. other languages.15. 46 in Cochrane Library. 190 studies were excluded for different reasons. a longitudinal repeated Selection of studies measures design with an experimental and control group18.13. no full version. cognition.20. of the remaining papers and had consensus meetings to moderate9. RESULTS randomized or nonrandomized. Elderly with uncategorized dementia9-13. mixed We found 257 articles: 46 in PubMed/MEDLINE.

Digit Span.12.11. popular music etc. CDR-1 = mild. Comprehension. attuned production. 3-8 errors – moderate. This assesses the level of acceptance of the MT approach. Nonempathetic behavior (n-EB): both patients and music Wechsler Adult Intelligence Scale (WAIS)10 therapist play musical instruments without establishing an WAIS32 is used as a general test of intelligence and was empathetic relationship.15. is a specific tool derived from a previous general coding scheme: the Music Therapy Check List Global Deterioration Scale (GDS)11. including calculation. wandering. are: Information. with a maximum score of 30. instrument aids in examining the relationship between measured by remarking the presence of: Smile: the patient intellectual function and memory. active Clinical Dementia Rating (CDR)17. The second part of the scheme developed to assess cognitive ability for adults.13. Picture Completion. language. Body movements: verbal and five performance subtests. performance The music therapist completed the interest in music IQ and full scale IQ may be obtained. Three groups of severity of chronic brain syndrome Communication. patients actively participate in MT sessions. CDR-3 = severe.17-20. non Mini-Mental State Examination (MMSE)10. The verbal tests the patient moves the body synchronically with the music. Instruments judgment and problem solving. The first part of the scheme assesses were proposed according to number of errors: 0-2 errors – two possible behaviors: 1.Literature review Efficacy of music therapy in dementia 55 Type of MT interventions Dementia severity The studies showed the use of active group10.16 The CDR28 is used to characterize six domains of cognitive MT interventions. orientation. Empathetic behavior (EB): the none or minimal.16-18.17. The evaluations are based on analysis of sonorous communication between the degenerative dementia such as Alzheimer’s disease. disturbances in dementia: delusions. body contact. numbness).66(1):52-61.18. and functional performance applicable to Alzheimer disease and related dementias: memory. and Digit Symbol. It is a 5-point scale in which MT Assessment CDR-0 connotes no cognitive impairment. hallucinations. . Arithmetic. aphaty. verbal of domains. variations.5 = very mild Music Therapy Check List–Dementia (MTCL-D)9 dementia.11. It consists of and temporal orientation. A score of 0 is ideal. omissions are counted as Communication. and Sonorous Musical errors. Similarities. Stages 4-7 are the dementia stages. and personal care. PwD and the music therapist is measured for each type of Cognition behavior: individual production (nonnatuned production.19 (MTCL)26. memory. Nonverbal knowledge. Block Design. anxiety. The test consists of six laughs or smiles according to the context. Interest in Music Evaluation Form10 Object Assembly.20 and previous experience with musical activities and their The NPI33 evaluates 12 common neuropsychiatric frequency. home and hobbies. The MMSE30 assesses cognitive ability within a wide range agitation. orientation.13. It affective and behavioral characteristics expressed by the comprises 10 items with 31 questions which cover spatial patient and the therapist during a MT session. Singing: the patient sings during MT session. CDR-2 = moderate. The Performance subtests are: Picture Arrangement. This tool is useful for music therapists to monitor GDS29 provides caregivers an overview of the stages of and evaluate the music therapeutic process and assesses cognitive function for those suffering from a primary musical.20 individual9. Stages 1-3 are the pre- minute) and the quality of the interaction between the dementia stages. and Vocabulary. objective. receptive group19 and receptive individual9. A verbal IQ.14. and verbal behavior. negative verbalizations). remote memory. The frequency (occurrences/ broken down into 7 different stages. The MTCL-D9.12-14. and quantitative measuring patient-therapist interaction specifies both measurement of cognitive functioning of elderly people. CDR-0. and general four behavioral classes: Verbal Communication. and behaviors (positive verbalizations. It is music therapist and the PwD. nonverbal. J Bras Psiquiatr. smile.) Neuropsychiatric Inventory (NPI)9. This video-based assessment method The MSQ31 provides a brief. community affairs. listening to music). 9 or 10 errors – severe. Countenance. A score below 23 on the MMSE generally indicates cognitive impairment.20 verbal behaviors. establishing an empathetic relationship with the music therapist. Music Therapy Coding Scheme (MTCS)17 The MTCS27 is an assessment method using video recordings Mental Status Questionnaire (MSQ)18 of MT sessions. body engagement. 2. 2017. evaluation form with each participant before the start of Neuropsychiatric symptoms the intervention to collect data on individual musical genre preference (such as classical music.

and appetite and eating abnormalities. (mental agitation and psychological distress) and somatic generally with an emotional and physical component. Scores above 18 indicate a definite major BEHAVE-AD34 is a 25-item scale that measures behavioral depression. diurnal rhythm disturbance. A summed score was once per week. activity disturbances. by a series of symptoms. 2 = severe). ideation. hitting and mobility in their activities of daily living (ADL): feeding. denoting ‘never’. 4 = very frequently. with 5 point intervals. Changes are in reference to the AES37 was used to measure changes in the primary outcomes patient’s premorbid behavior. denoting severity (1 = mild. (including self). 1 = present.66(1):52-61. The total score of these 12 items varies Version of Cornell Scale for Depression in Dementia (C-CSDD)10 from 0 to 144. and measures both psychic anxiety generally with an emotional component. Each item extreme distress). with higher scores denoting a more positive affect.20 and CMAI. . index also indicates the need for assistance in care. Functional capacity Cohen-Mansfield Agitation Inventory (CMAI) 11. Some items on the CBS require respondents to indicate if a patient is engaging in more or less Apparent Emotion Scale (AES)14 of a particular type of behavior. 18– the disturbance to the caregiver and/or dangerousness to 24 mild to moderate severity and 25–30 moderate to severe. aggressiveness. repetitive sentences or questions. the patient. 2 = present. anxieties Hamilton Anxiety scale (HAM-A)16 and fobies. domains: social interaction.g. Revised Memory and Behavioral Problems Checklist (RMBPC)14 Quality of life RMBPC36 consists of 24 items scored on a scale of 0–4 and assesses the occurrence of behavior problems in dementia Cornell-Brown Scale for Quality of Life in Dementia (CBS-QoL)9 and their impact on the caregiver using an objective scaling The CBS41 provides a global assessment of QoL in patients criterion: never occurs (0) to occur daily or more often (4). The ADRQL42 consists of 48 items that evaluates five QoL anxiety. ambulation and stair climbing. about and depression) were reverse scored. where 0 = not present. chair transfer. 3 = frequently. dressing. verbal aggressive. bladder control. The aggressive.56 Aleixo MAR et al.. hallucinations. indicate the dependence of the individual in performing daily living activities. Barthel Index17 modified version12 Barthel Index40 is a 10-item ordinal scale that measures The CMAI assesses 29 agitated behaviors. the better the functional status. e. Scores above 10 indicate a probable Behavioral Pathology in Alzheimer’s Disease (BEHAVE-AD)19 major depression. irritability. thus seven-point scale (1–7) ranging from ‘never’ to ‘several times the closer to 100 points the score reached by the individual an hour’. Caregiver distress is rated by the caregiver The CSDD38 is specially designed for assessing signs and on a six-point scale from 0 (no distress) to 5 (very severe or symptoms depression in elderly with dementia. where < 17 indicates mild severity. anger. depression. The 29 bathing. night-time behavior PWD expressed a particular emotion in the previous 2 weeks disturbances. The using a Likert scale from 1. Responses were elicited from the caregiver on how often the disinhibition. diagnosed with dementia. dysphoria. anxiety. is rated for severity on a scale of 0-2 (0 = absent. bowel control. hiding or hoarding things. Each item is The BEHAVE-AD also contains a 4-point global assessment of scored on a scale of 0 (not present) to 4 (severe). 2 = moderate. with a total the overall magnitude of the behavioral symptoms in terms score range of 0–56. interest/motivation and contentment. aberrant motor behavior. grooming. anxiety (1 = occasionally. toileting. each defined severity. Scores below 6 as a rule are associated with disturbances in 7 major categories: paranoid and delusional absence of significant depressive symptoms. The negative emotions (anger. The modified AES. Scores below 50 that ranges from 29–203. to 5. rated by a proxy 35 functional independence in the domains of personal care caregiver. once or more per day or continuously) of each neuropsychiatric symptom are Depression and Anxiety rated on the basis of scripted questions administered to the Cornell Scale for Depression in Dementia (CSDD)9 and Chinese patient’s caregiver. anxiety (physical complaints related to anxiety). affective disturbances. The physical non-aggressive. euphoria. feelings and J Bras Psiquiatr. Each symptom is scored on a 4-point scale of HAM-A39 is a scale that consists of 14 items. 1 = mild or intermittent. pacing. The frequency of each symptom is rated on a scoring scale ranges from 0 to 100. non-verbal non. derived from the original Lawton Observed Emotion Rating Scale. 3 = present. less than once per week. Literature review agitation. was Alzheimer’s Disease-Related Quality of Life (ADRQL)11 used to measure 6 types of affect in the PWD: pleasure. items are divided in four subgroups: physical aggressive. of mood and disruptive behavior. 2017. 2 = often. less than every day. apathy. several times per week but calculated. awareness of self. prior to the onset of dementia. Summing all symptom scores reveals a total score in the test. 3 = severe) and frequency ‘several times a day’.

problems in PwD. In three Another study11 examined the effect of individual MT studies. singing. the receptive “relaxation” MT is a agitation disruptiveness increased during standard care method that probably better reduces neuropsychiatric and decreased during MT.16. after adjustment for dementia global NPI score as the primary outcome may have caused stage.20. During the MT intervention. Raglio et al. aberrant motor activity17. There was events.16. In the context of dementia. the selected studies focused on the at least three different ways of applying music in therapy use of MT approaches on neuropsychiatric symptoms.20. prior musical on the caregiver. They reported that MT10.Literature review Efficacy of music therapy in dementia 57 mood.20. and on individual receptive MT9. sung or played by the music playlist and without any interaction with a music therapist therapist (Dutch familiar songs. The RMBPC also evaluates the cognitive function. 2017.12-14. but without a significant and rhythmic instruments (improvisation) to facilitate the difference. or formal caregiver. there were no significant differences on agitated on agitation of people with moderate/severe dementia behaviors12. of MT was greater in Weeks 8–12 than in Weeks 1–6.17-20. J Bras Psiquiatr. included the use of both subjective and objective measures.20. PwD and controlled trial12 found a decrease in agitated behaviors music therapist interacted by singing and using melodic in both groups (MT and control). We observed a considerable heterogeneity of b) regulating arousal level to a point where self-regulation is intervention techniques and methods of MT. . instead of the music therapy intervention itself.11 or group active in order to fulfill psychosocial needs. A study carried out by Chu et al. One study showed of the intervention and the lack of long-term follow-up were positive results in eliciting and sustaining participants’ alert limitations of the study. The and formal or informal caregivers. The In a multicentric trial. compared to much active MT and LtM interventions on neuropsychiatric smaller improvement in those who received it first.20. night-time disturbances17.66(1):52-61. depression10. music-prompted reminiscence. Results suggested that the effect symptoms16. anxiety16. experiences and interest in participating in MT intervention). thereby providing an Music Evaluation Form to collect data before the beginning index of the impact of each behavior and behavioral domain of the intervention (musical preference. two-armed. aggressiveness19 the cognitive functions. The music playlist was created by The selected music aimed to incite pleasant memories music therapist on the basis of interviews with the PwD and to reduce agitation. apathy17. over a period of 6 weeks and after 6 weeks of standard care. aimed at evaluating immediate short-term participated in 20 individualized 30-minute sessions. PwD listened to music from a preferred started with a welcoming song. The positive outcome anxiety17. The larger number of differences in dementia severity between groups suggested PwD who dropped out in each group and the use of the better results in MT.10 reported that the The caregiver answers whether he or she ‘agrees’ or MT group significantly reduced depression and improved ‘disagrees’ to the items. other neuropsychiatric careful randomization and follow-up. based on musical parameters. in of agitation11. this trend disappeared completely suggesting that the possible non-recognition of the positive effect of music reductions in agitation were due to dementia severity stage therapy. They used a pragmatic. a randomized a week for 10 weeks. Two group sessions of 30 minutes per week during 6 weeks Outcomes used one or more of the following techniques: song choice. crossover. Each MT intervention lasted for 40 minutes.15. In the twice a week.20. among PwD: a) catching attention and creating a safe setting. In turn. up to a maximum of 34 sessions. classical and folk music). rhythm and singing may also significant improvement on delusions17. However. exploratory randomized controlled study. the temporal sequence of musical and other general behavior disturbances13. twice effects of MT in reducing agitated behaviors.21. behavior in the instrumental touch condition15.18 and on neuropsychiatric problems9 (Table 2). agitation17.9 showed that behavioral improvement in disruptiveness scores during MT was about assessment did not show significant differences between 8 points in those who received MT later. which can be relaxing. the logic of musical form. The music therapist used the Interest in caregiver’s reaction to each behavior.19. but the short duration symptom20. Participants randomized to MT or LtM Moreover. behavior14 and depression14. The positive effect on depression may Some studies (N = 8) showed significant difference be explained by the use of music as a pleasant stimulus between the MT group and control group on the reduction focused on familiar songs. A total of 12 sessions of individual MT intervention was given DISCUSSION twice a week. living in nursing homes. have helped to orient participants. expression and modulation of the PwD emotions.19. music listening and Neuropsychiatric symptoms (N = 12)9-20 instrument playing. enjoyment of activities and response to surroundings. irritability17. The music therapist should be aware of In this systematic review.20. The sessions LtM intervention. Interventions possible and c) engaging the PwD in social communication were focused on individual active MT9.

. 200817 n = 59 Controlled trial Group ↓ Neuropsychiatric symptoms AD. controlled active ↓ Agitation biweekly 30-40 minutes 6 weeks Vink et al.. 200915 n=9 Within-subject design Individualized Alert behavior was more effective AD 2 times per week in instrumental touch condition late stage 30 minutes 2 weeks Guétin et al.. permuted-block Group active ↓ Depression dementia randomization twice a week ↑ Cognitive function 30 minutes 6 weeks Ridder et al. Music therapy on the improvement of neuropsychiatric symptoms of dementia (N = 12) Study/year Sample Design Intervention Result Raglio et al. J Bras Psiquiatr. VaD: vascular dementia. 201014 n = 43 No mention Group ↓ Neuropsychiatric symptoms AD active VaD once a week ↓ Depression 2 months Belgrave. Individualized receptive ↓ Anxiety AD comparative. controlled. Individualized dementia. moderate/severe randomized. 3 cycles of 10 MT mixed dementia 30 minutes 16 weeks Ledger and Baker... crossover.58 Aleixo MAR et al. single-centre once a week mild to moderate 20 minutes ↓ Depression 24 months Raglio et al. 201013 n = 60 Randomized controlled Group ↓ Neuropsychiatric symptoms dementia severity active 3 times a week 30 minutes 6 months Han et al. 200620 n = 14 Crossover study Group ↓ Neuropsychiatric symptoms AD active VaD 3 times weekly moderate/severe 45 minutes 6 weeks AD: Alzheimer disease. 201311 n = 42 Pragmatic. exploratory. Literature review Table 2.. active VaD.. 201312 n = 77 Randomized controlled Group None behavior improvement dementia trial active twice a week 40 minutes 4 months Raglio et al.. 2017.66(1):52-61. 200718 n = 45 Longitudinal repeated measures Group None behavioral improvement AD design active moderate/severe weekly sessions 30-45 minutes 42 weeks Svansdottir and Snaedal. 2015 9 n = 120 Randomized controlled trial Individualized None behavioral improvement dementia moderate/severe active and receptive twice a week 30 minutes 10 weeks Chu et al. 201410 n = 104 Prospective. 200619 n = 38 Randomized controlled trial Group ↓ Neuropsychiatric symptoms AD active or receptive moderate/severe 3 times a week 30 minutes 6 weeks Tuet and Lam. . 200916 n = 30 Randomized.

and memory sequences accompanied by The experimental group participated in MT activities and music and drumming. the interpersonal should be considered very appropriate in different dementia relationship has great importance and it is considered stages. The independent variable in this study was the range and frequency of agitated behaviors are reflected in use of expressive and instrumental touches within the MT the participants’ mean total CMAI scores. this study observed may really have made an impact in the PwD and how this that the decrease in the neuropsychiatric symptoms change may have been effected. The disease. Another limitation was Ledger and Baker18 investigated the long-term effects of the small sample size. a randomized. Delusions. The music was streamed via headphones in the PwD rooms. The study was based on three working cycles instrumental touch condition was significantly more effective of 12 MT sessions. and movement. controlled comparative. as the use of a modified version of AES a month. Another limitation was that agitation. However. Svansdottir and Snaedal19. research sings to the participant during 15 minutes. 2017. A limitation of the study was the criteria for scale. Although the study had showed positive results in disturbances significantly improved in the MT group. based on Raglio et al. The music therapist intergroup difference. Although MT participants showed nature of the study. The control group did not attend this the control group participated in educational support intervention program.17. samples. This result indicated that there were no significant with no touch. 2) musical condition 1 (expressive touch) – differences between MT and control groups in the range and the researcher sings to the participant during 15 minutes frequency of agitated behaviors over time. irritability.Literature review Efficacy of music therapy in dementia 59 In addition. the anxiety and depression in the MT group. various). with a caring touch applied to the shoulder. The MT intervention aims at in a severe stage of dementia. the repeated administration of this scale randomization which was not standardized. but not the MT intervention. in other randomized controlled and then continues singing without applying touch for two trial with people with moderately severe and severe AD. there were no significant Belgrave15 examined the effect of MT interventions on differences between the MT and control groups in the the behavior of older adults with late-stage Alzheimer’s range and frequency of agitated behaviors over time. but not within-participants over time the researcher sings to the participant during 15 minutes by groups. because it facilitates active participation of PwD even the core of the intervention. facilitated various music activities for the group. short-term reductions in agitation. or entertainment activities. The songs were chosen based on the PwD the NPI global scores were heterogeneous (although not personal tastes following an interview/questionnaire. world music. The multivariate sessions. Disruptive behavior and depression improved in the MT apathy. with other randomized controlled trial13 suggested a significant instrumental touch. the only at the end of the intervention could have resulted in assessment for increased communication was done only for inaccurate caregiver recall about PwD emotions. assessed the needs and preferences of participants: singing. that was defined as a touch used to assist difference between groups in reduction of behavioral in a completion of a musical task. aberrant motor activity. Han et al. Moreover. In addition. Although single-centre design16. 3) musical condition 2 (instrumental touch) – the found significant reduction in neuropsychiatric disturbances J Bras Psiquiatr. facilitating the moments of harmony that help to organize Furthermore. arm or hand. The MT integrated symptoms of anxiety and depression for up to two months a program with other daily activities in a center for people after the end of the sessions was considered as the significant with moderate stage dementia. possibly affecting the comparability of the two styles suggested (classical music. agitation. The study showed that the disturbances. with one-month interval of no treatment. . and remarkably) at baseline between experimental and control a musical sequence was made from the different musical groups. in a non-verbal MT approach. while intervention was carried out. music MT effectiveness in reducing PwD behavioral disturbances. The MT approach followed a non-verbal model based on In addition. and regulate the PwD behaviors and emotions. active and multisensory interventions with PwD sound-music improvisation.16. regarding people with severe dementia. jazz. As Guétin et al. also measures. especially the experimental group but not for the control one. The persistent effect of MT on symptoms in PwD in a naturalistic setting. there were no evidences about what in the control group. and night-time group. depression and that was not standardized.66(1):52-61. some limitations occurred in the experimental group and persisted after should be considered. In this model. anxiety. nonrandomized and non-blinded group MT on agitation. found significant improvements in the results show significant improvements in MT group. in eliciting and sustaining participants’ alert behavior state.14 explored the effects of a weekly structured and a mask was also offered to avoid visual stimuli and allow MT and activity program on behavioral and depressive concentration on the music. The participants experienced each of the treatment analysis of variance revealed significant effects within- conditions three times: 1) baseline condition (no-touch) – participants over time. Individual receptive study presented a limitation in the criteria for randomization MT method was used to reduce anxiety. but continued to receive usual care.

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