Music Therapy in Dementia

Description of Dementia

In reference to the National Institute on Aging, dementia is defined as the decline of cognitive functioning, such as remembering, reasoning and thinking, and the behavioural capabilities to the extreme that it affects how a person carries on with their life and daily activities (National Institute of Aging, 2018). When a person is experiencing difficulties with language or solving problems, and to a certain extent, memory loss, then that person could be diagnosed with dementia. Once diagnosed with dementia, some people become unable to have control over their emotions. At first, these changes can be small, but for those with dementia, the changes worsen to affect a person’s daily life. The range of severity of dementia increases from the mild stage until the most severe stage. As severity increases, personal functioning is progressively affected and, at the most severe stage, a person becomes dependent on those around them to help them around basic living activities.

Dementia begins when the once healthy nerve cells (neurons) in the brain are damaged, stop working and become unable to send messages due to lost brain connections effectively and then die. Every human being loses neurons as they grow old, but those with dementia experience this loss at a fast rate. The prevalence of dementia increases with age, where nearly 50% of adults above the age of 85 years have a particular type of dementia (National Institute of Aging, 2018). Depending on the part of the brain which is damaged and sick, there are different types of dementia. Among the causes of dementia the most common are, vascular dementia, Alzheimer’s disease, frontotemporal dementia and Lewy body dementia (DementiaUK, 2018).

Causes of Dementia

Alzheimer’s disease commonly causes dementia in the UK. This physical condition results from changes in the brain structure as a result of protein build-up which cause ‘tangles’ and ‘plaques’ that damage the ability of a brain cell to transmit messages leading to the death of the brain cell. Vascular dementia results from problems with the blood supply to brain cells usually due to repetitive incidences of strokes called Transient Ischaemic Attacks (TIAs). Frontotemporal dementia is the kind which grows with time. The brain parts affected by this condition are the frontal lobes and temporal lobes. The affected frontal lobes interfere with a person’s insight, motivation, empathy and decision-making. The affected temporal lobes interfere with memory, language ability and speech. The Lewy body dementia is one which symptoms worsen progressively with time. This condition interferes with motor control and movement (DementiaUK, 2018).

The signs and symptoms experienced in dementia are different for different patients. One factor which affects how well a person will live with the dementia is the way people respond to and treat them as well as the surroundings they are in. Notably, some of them have trouble recalling events that occurred recently in a day, have trouble finishing a series of tasks like cooking food, find it difficult to follow through a conversion or find the right word to describe something and experience problems judging the distance of objects or seeing three-dimensional objects. Some even get confused about where they are (Alzheimer's Society, 2017).

Treatment for Dementia

Crucial towards the better living of people with dementia is treatment. Dementia does not have a cure yet as there is on-going research to discover appropriate vaccines, drugs and other types of medical treatment. For the existing kinds of treatment, it is recommended that a person-centred approach is used while providing care and support with a focus on non-medical treatments, talking therapies, cognitive behavioural therapy (CRT), cognitive simulation therapy, cognitive rehabilitation and artistic life work. Artistic life work can is greatly enjoyed throughout the progress of dementia, especially work that is reminiscent in nature. This includes music, art and singing (Alzheimer's Society, 2017). Recently, the psychiatry community has recognized the significance of artistic life work, particularly music, in the treatment of dementia.

Music Therapy Treatment

Music evokes emotions. From infancy, a time where one can barely talk or form words, up to old age and death, people have always responded to music. In comparison to language, music can access more parts of the brain, and this property recommends the use of music to interact with people with dementia. Soothing and melodious sounds played to a dementia patient will trigger an emotional reaction from them. Most probably because the music must have been their favourite, or must have acquired a specific meaning to the person. Some music can be reminiscent of essential memories such as childhood, a wedding or a celebration (Dementia UK, 2017).

By definition, music therapy (MT) is the using of music and its elements, such as rhythm, sound, harmony and melody, by a certified music therapist (Alexio, et al., 2017). Organizations such as Music & Memory Inc. have recognized the significance of music in restoring connection and meaning to the people with dementia by training care professionals put together a music playlist containing personalized music as a way of recovering lives lost to dementia (Music & Memory Inc., 2018). By restoring individual functions, music therapy helps a person with dementia to regain better interpersonal and intrapersonal integration, and a better life quality throughout rehabilitation, treatment and prevention of the disease. As a way of reducing agitation, depression, and anxiety, music therapists stimulate the emotional and social well-being as well as cognitive functions through the use of music parameters. These music parameters include playing instruments, singing and listening (Alexio, et al., 2017).

The music therapy is appraised as a prospective non-pharmacological approach for controlling the behavioural and psychological symptoms in dementia. Also, the increased use of music therapy owes to the fact that non-pharmacological interventions are recommended as the first strategies for controlling functional decline, disorders and delaying the progress of Alzheimer’s disease (Alexio, et al., 2017). This is because pharmacological interventions are hard to manage and have burdensome complications and side effects. One study reveals that out of 421 patients who were given pharmacological treatment for Alzheimer disease, 16% of patients treated using quetiapine, 18% using risperidone and 24% using olanzapine discontinued from their treatments due to intolerability by the 36th week (Raglio, et al., 2008). MT is also far more effective than hormone replacement therapy (HRT) in the treatment and prevention of Alzheimer’s disease. This is because, not all Alzheimer’s patients can be treated using HRT because it has the potential of causing harmful reactions like heart disease, strokes and breast cancer. MT is preferred due to its unlikelihood of creating risks of adverse reactions to patients (Fukui, et al., 2012).

For MT to be successful, it is a requirement that the music therapist plays music to which the person with dementia has attached meaning as this has the potential to bring about powerful emotions and memories (Dementia UK, 2017). This is because, a demented individual will exhibit more reduced agitation while listening to music they prefer, than listening to classic music. Raglio et al. (2008) add that MT is useful in the reduction of psychological and behavioural symptoms of dementia as well as enhancing the communication relationship between the music therapist and the patients. A study by Fukui, Arai and Toyoshima (2012) explains that, in patients with Alzheimer’s disease routing from diminishing levels of sex hormones, MT has the potential to decelerate the progress of the disease. This is because MT restores hormones to a normal level, protects the nerve cells and suppresses the damage caused to nerve cells (Fukui, et al., 2012).

A variety of studies concerning the impact of MT on neuropsychiatric disturbances show that between the experimental group and the control groups which were used, the former showed diminishing levels of disturbances compared to the latter. For instance, in the study by Raglio et al. (2008), behavioural disturbances reduced more significantly in the experimental group than the control group. In this case, the experimental engaged in MT activities while the control group involved in other entertainment activities such as reading, and educational support. In a randomized controlled experiment by Svansdottir and Snaedal, over a period of 6 weeks, patients with severe and moderately severe Alzheimer’s had neuropsychiatric disturbances reduced significantly, but no impact was seen in the control group. Although, the shortcoming to the study is that effects were only observed according to the active participation type of music therapy. Other music therapies such as singing or passive listening were not tested (Svansdottir & Snaedal, 2006).

To aid in future studies concerning MT in dementia patients, a variety of recommendations are provided. First, more clinical protocols are recommended for systematic studies so that they can present the image of the efficacy of MT more accurately (Alexio, et al., 2017). Some studies, such as Fukui’s, Arai’s and Toyoshima’s article fails to provide detailed information concerning the shortcomings of using MT as a replacement for HRT. The study mentions the likelihood of MT causing music epilepsy as an aversive reaction in very few cases (Fukui, et al., 2012).

Bibliography

Alexio, M. A., Santos, R. L. & Dourado, M. C. d. N., 2017. Efficacy of music therapy in the neuropsychiatric symptoms of dementia: a systematic review.

Alzheimer's Society, 2017. What is Dementia?. [Online] Available at: https://www.alzheimers.org.uk/sites/default/files/pdf/what_is_dementia.pdf [Accessed 2 December 2018].

Dementia UK, 2017. Music Therapy. [Online] Available at: https://www.dementiauk.org/music-therapy/ [Accessed 2 December 2018].

DementiaUK, 2018. What is Dementia?. [Online] Available at: http://www.dementiauk.org/wp-content/uploads/2018/07/What-is-dementia-WEB-June-2018.pdf [Accessed 2 December 2018].

Fukui, H., Arai, A. & Toyoshima, K., 2012. Efficacy of Music Therapy in Treatment for the Patients with Alzheimer's Disease. International Journal of Alzheimer’s Disease.

Music & Memory Inc., 2018. Help Spread the Music and Give New Life to Someone You Love. [Online] Available at: https://musicandmemory.org/ [Accessed 2 December 2018].

National Institute of Aging, 2018. What is Dementia?. [Online] Available at: https://www.nia.nih.gov/health/what-dementia [Accessed 2 December 2018].

Raglio, A. et al., 2008. Efficacy of Music Therapy in the Treatment of Behavioral and Psychiatric Symptoms of Dementia. Alzheimer Dis Assoc Disord, 22(2), pp. 158-162.

Svansdottir, H. B. & Snaedal, J., 2006. Music therapy in moderate and severe dementia of Alzheimer's type: a case-control study. Int Psychogeriatr., 18(4).

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