Dementia Harmony: The Comparative Analysis of Music Therapy Approaches

In many studies, the music therapy (MT) is regarded as an effective way to offer treatment for resolving as well as improving symptoms related to behaviour and psychological aspects of the patients with dementia (Cohen and Maxwell, 2020; Wang, 2019; dos Santos et al. 2019; Atiwannapat et al. 2016). This is evident from the three quantitative articles published by Raglio et al. (2010), Shiltz et al. (2018) and Cheung et al. (2018) along with one of the review article by Clare (2014) where it is mentioned with proper evidence that MT administration to the dementia patients has contributed to reduce behavioural and emotional disturbances in severely and mild dementia patients. Raglio et al. (2010) executed a randomised controlled trial study on 60 people suffering from severe dementia with the focus to examine whether or not MT scheme of administration that involves three working cycles each month with no treatment provided for single month to be effective for reducing disturbances with behaviour among the patients suffering from severe dementia. The selected participants are divided in equal numbers into experimental and control group. The study by Flannelly et al. (2018) mentions that presence of control and experimental group in the study is effective to help the researchers to differentiate and manage the confounding variables in such a way so that the validity of the study is improved. Raglio et al. (2010) identified that NPI global scores for both the control and experimental group were considerably reduced with higher reduction in behavioural and psychological disturbances among the dementia patients in the experimental group was faced at the end of the treatment. The NPI global scores are the sum of the subscale of neuropsychiatric scores and presence of higher scores informs increased behavioural disturbances among the patients (Raglio et al. 2018). It indicates that music therapy is able to create differences in the behaviour of dementia people compared to those dementia patients who are not involved in the treatment. This is evident as the control group who are not receiving music therapy intervention expressed increased NPI scores that mention they are facing increased behavioural disturbances compared to the patients in the experimental group. Raglio et al. (2010) inform that delusion, apathy and agitation are the mood factors that are significantly improved for the patients in the experimental group. The fact can be supported by the study of Clare (2014) where they have mentioned music therapy intervention for the dementia patients in the care home lead them to show improved mood and engagement to execute activities. This is evident as seen in one of the participants it was seen that the individual’s well-being score increased from -1 to +3 within the commencement of the music therapy and it further improved to +5 and showed sustainable score for extra ten minutes indicating exceptionally increased and high well-being (signs of improved moods and engagement) of the patient. Raglio et al. (2010) mentioned that anxiety, depression and irritability are improved effectively among both the control and experimental group indicating no differences is seen with the implication of the music therapy for the dementia patients in these factors of behaviour and psychology. The fact is contrasted to some extent in the study of Shiltz et al. (2018) where it is mentioned that they used Profile of Mood Stress (POMS) for evaluating the anger, anxiety and depression of the dementia patients with the implication of the music therapy. The results developed were that increased improvement of the depression of the non-medicated dementia patients listening to music was seen whereas the depression was worsening among the medicated patients listening to music in the study. However, the POMS scale was unable to provide any statistically significant data regarding anxiety reduction or improvement through music therapy intervention among the patients on three-way interaction between antipsychotics, time-neared significance and group. Thus, the results indicated that music therapy Shiltz et al. (2018) in their study mentioned no significant changes in the agitation level were seen among the medicated and non-medicated patients when both were provided music listening therapy. Thus, it was unable to determine whether or not music therapy is effective to reduce agitation among patients with dementia with or without the use of medication. Shiltz et al. (2018) mentioned that the analysis which included MMSE (Mini-Mental State Examination) as the initial outcome variable has drawn an essential four-way interaction between dementia severity, antipsychotic, group and time. The MMSE results in the study indicated that cognition of the usual care participants who have severe dementia lowered within the next four months whereas the cognition of the individuals with moderate dementia was improved. In addition, the follow-up analysis indicated Antipsychotics × Time interaction approach is of significant level for the patients with moderate dementia who are accessing music listening intervention along with the MMSE scores were variable through time for patients using antipsychotic medications. However, the study was unable to identify any impact of significant nature regarding cognitive development for severe dementia patients who were provided with ML therapy. In this aspect, on gathering the data it informed influence of ML on factors such as medical registration or dementia severity for patients rather than influence on the factors such as reduced agitation, mood enhancement, cognition improvement and others. Cheung et al. (2018) performed a randomised controlled trial to determine the impact of the six-week intervention of music-with-movement (MM) compared to music listening (ML) and Social Action (SA) among the patients with dementia. The effect regarding MM and ML on depression and anxiety for the dementia patients in the research is seen to be equal. However, the baseline data and post-intervention data informed that level of anxiety and depression is comparatively low MM and ML group of patients compared to SA group. In the study by Kim et al. (2017), it is mentioned that music intervention is effective to lower psychological symptoms of the patients suffering from dementia as music creates a soothing impact on the emotional and mental activity of the patients making them perceive lower stress and complicated thinking. The study by Cheung et al. (2018) surprisingly identified that depression was lowered only in MM group and not in ML group indicating it contrasts the findings of Raglio et al. (2010) where depression has been seen to get lowered among dementia patients with the use of music therapy. The significant difference regarding music therapy is seen in the study may be out of limitation of lack of presence of additional group that is usual care group to determine the true efficacy of the music-with-movement intervention to enhance the cognitive functions of the patients. Raglio et al. (2010) mentioned that patient’s relation and communicative skills are not improved with the music therapy intervention for the patients. The fact is supported in the study by Cheung et al. (2018) where it is mentioned that verbal fluency among the dementia patients who were provided MM intervention was seen whereas no significant improvement was experienced for the patients who are provided SA or ML intervention. The MM was effective compared to ML (music listening) in case of dementia may be because through active form of music intervention dementia patients have increased opportunity for communicating with other groups or individual to improve their verbal ability (Mc Parland et al. 2017). However, ML being more individualised activity it makes the patients unable to develop any interaction for betterment of their verbal activity (Melhuish et al. 2017). Cheung et al. (2018) mention that music-with-movement (MM) is more useful than music listening (ML) in dementia patients. This is evident from the results where impact size partial ƞ2 at T0–T1 of MM was 0.24 that indicates medium effect whereas no significant impact of ML was seen among the patients. The fact is supported by the study of Raglio et al. (2014) where active approach for the intervention of music is one where the music is oriented to create cognitive rehabilitation that means making patients have improved memory and speech. The music is helping the dementia patients to improve their memory because it allows the brain to become disengaged and resolve complication as well as engages the brain to remember certain incidences and aspects from a single piece of music, in turn, promoting memory and perception of the individuals (Kindell et al. 2018). The fact is supported by the study of Clare (2014) where it is informed use of preferred music for the dementia patients would allow the individuals to connect with their past helping them to remember incidences. The study further informs recalling memories from the past creates soothing impact on the people with dementia that in turn acts to prevent or reduce their increased level of agitation. It is also mentioned that music played according to the preference reduces the stress level of dementia patients to reach and exceed the threshold (Zhang et al. 2017). In the studies of Raglio et al. (2010), Shiltz et al. (2018) and Cheung et al. (2018) randomised control trial are mainly used as research design which was an effective approach as it allowed them to develop direct comparison of health intervention to determine which nature of music therapy is most effective for the dementia patients. The study by Raglio et al. (2010) faced the limitation that the criteria used for random selection in the study are not standardised due to which error in the selection of the participants for the two groups may have been raised. However, the limitation of the study by Cheung et al. (2018) was that it was unable to recruit proper number of participants to determine the true efficacy of intervention of music-with-movement on improving the cognitive functions of individuals. The conclusion that is reached by analysing the articles is that music therapy does have a positive impact on controlling and reducing behavioural and psychological symptoms among patients with dementia. Moreover, music-with-movement is found to be more effective compared to music listening intervention for the dementia people and the music to be used in the intervention are required to be preferred piece of music by the service users.

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References

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Cheung, D.S.K., Lai, C.K.Y., Wong, F.K.Y. and Leung, M.C.P., 2018. The effects of the music-with-movement intervention on the cognitive functions of people with moderate dementia: a randomized controlled trial. Aging & mental health, 22(3), pp.306-315.

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Kim, H.Y., Kim, N.R., Ko, K.J., Jeong, H.J. and Kim, H.M., 2017. Effect of Korean music therapy on depression: Daegeum playing of Arirang. International Journal of Psychiatry and Psychotherapy, 2. pp.23-45.

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Zhang, Y., Cai, J., An, L., Hui, F., Ren, T., Ma, H. and Zhao, Q., 2017. Does music therapy enhance behavioral and cognitive function in elderly dementia patients? A systematic review and meta-analysis. Ageing research reviews, 35, pp.1-11.