Abstract

Migraine is the sixth most disabling illness in the world and the third most common (Saper, 2021). Many studies have found that migraines have numerous causes, which creates a wide variability in the effectiveness of treatments. In recent years, there has been exploration of alternative methods of treatment, such as music therapy. There have been many studies regarding music therapy and pain treatment, but very few specifically for headaches, and results have been inconclusive. The proposed research seeks to examine the extent to which predisposed beliefs about music therapy impact its efficacy when treating chronic migraines. Over the course of a six-week study, patients will be randomly assigned to one of two experimental treatment conditions whereby they will receive a combination or standard pharmaceutical treatment plus music therapy or standard pharmaceutical treatment plus therapeutic rhythmic class. Patients will also report the degree to which they perceive music therapy and other alternative treatments as effective pain-relieving measures. Patients will also report their pain symptoms weekly. It is anticipated that patients with stronger belief in the efficacy of music therapy, in particular, will experience greater reduction in pain symptoms when in the music therapy condition. The implications of an interaction between treatment efficacy beliefs and actual treatment effectiveness are discussed.

The Impact of Belief in Treatment Methodology on the Efficacy of Music Therapy in Those with Chronic Migraines

While many people have friends or family members who suffer from migraines, individuals who do not experience migraines themselves may be unaware of how chronic, unpredictable, and often mysterious migraine symptoms are. Approximately 1 billion people around the world have migraines (Pool, 2021), making migraines the third most prevalent illness in the world, along with being the 6th most disabling (Saper, 2021). Lipton et al. (2007) reported that 53.7% of those with migraines were severely impaired.  Munakata et al. (2009) found that those with episodic migraine had direct and indirect costs of $1757 per year, and those with transformed migraine had costs of $7750 per year.  Those who experience migraine–as well as their closest family and friends–are more likely to pursue knowledge regarding migraine causes and treatment (Saper, 2021), but they often find that migraines have many different causes and thus there is wide variability in types of treatment and their efficacy (Dodick & Gargus, 2008). Recently, there has been increasing interest in alternative treatments for migraine sufferers such as yoga (John et. al, 2007), risk factor modification (Schwedt, 2014), and music therapy (Diamante & Roxas, 2020). However, the degree to which such alternative treatments alleviate symptoms may be influenced by patients’ beliefs in their efficacy (e.g., Horne, 1999). Accordingly, the current research proposal seeks to examine how much predisposed beliefs about music therapy impact its efficacy, and if music therapy is actually effective in treating chronic migraines.

Music Therapy

Music therapy has been examined as a potential treatment for dementia (Vink et. al, 2003), generalized anxiety disorder (Gutiérrez & Camarena, 2015), as well as chronic migraine symptoms (Diamante & Roxas, 2020). Research on the use of music therapy as a treatment for migraines has demonstrated that it shows a significant improvement from no treatment (Oelkers-Ax, 2008). Music therapy has been shown to be effective for those seeking treatment for chronic migraine and tinnitus (Nickel et al., 2005). Additionally, Langenburg and colleagues (1995) did a case study on music therapy as treatment for someone with chronic migraines which demonstrated that it does lessen migraine symptoms. While additional studies have demonstrated similar efficacy for MT as a treatment for migraines (e.g., Diamante & Roxas, 2020), other studies have found that MT, while effective, is no more effective than other alternative treatments (Koenig, 2014). Moreover, music therapy can better improve executive functioning when it is able to provide functional support (Thaut & Hoemberg, 2017). Accordingly, we should expect music therapy to reduce migraine symptoms in patients when used in conjunction with standard treatment, but perhaps not more so than other distracting treatments. However, there are moderating factors that could influence the degree to which individual patients respond to alternative treatments such as music therapy–one of which may be their belief in the efficacy of music therapy.

Patient’s Beliefs in the Efficacy of Treatment

The ability of a patient’s belief in the efficacy of certain treatments to affect treatment outcomes has been examined in a variety of contexts. Patients’ beliefs about the type of treatment they’re receiving has been shown to impact the efficacy of that treatment (Horne, 1999). The symptoms of patients suffering from various illnesses were shown to respond more strongly to medical treatment among patients who believe more strongly in the effectiveness of traditional medicine as a treatment (Foulks et. al, 1986): the expectation of a drug’s impact on symptoms strongly influences the therapeutic efficacy of that drug (Bingel et al, 2011). Similarly, Clatworthy et. al found that patients better adhered to their treatment plan when they believed that it would work, and thus they found more benefits from their treatment (2007). In addition, a study regarding the effects of methotrexate on rheumatoid arthritis symptoms found similar results (de Thurah et. al, 2009). Studies have also demonstrated that beliefs regarding severity of the patient’s illness impact the efficacy of the treatment (Marks et al., 1986). However, to the best of our knowledge, no research has yet investigated this moderating influence regarding the efficacy of music therapy in migraine treatment. Accordingly, the current research will assign patients to two conditions of music therapy, one who has strong beliefs in the efficacy of music therapy, and one who does not. These two groups will demonstrate the relationship between belief in the efficacy of treatment and pain reduction.

Research Hypothesis: We expect that the efficacy of music therapy, in comparison to a different alternative treatment, in reducing migraine symptoms will be moderated by patients’ beliefs in music therapy’s effectiveness. Specifically, we expect that the relative efficacy of music therapy, in comparison to yoga therapy, in relieving chronic pain symptoms will be greater among individuals who already perceive music therapy as an effective treatment.

Method

Participants

Participants will be recruited from a hospital circuit, through compliant doctors asking their patients with chronic migraines. They will be given a small monetary sum, and the study will be conducted in an academic center with music facilities.  

Measures

Belief in Treatment Efficacy. Prior to being randomly assigned to a treatment condition, patients will fill out a brief survey asking them to report how effective they believe each of the following therapies would be for reducing their migraine symptoms: music therapy, rhythmic class, yoga, mindfulness meditation, traditional western medicine, and pet therapy (Appendix A). Brief descriptions of each therapy type will accompany the items. Participants will indicate their belief in the efficacy of each therapy on a 1 (“Not at All Effective”) to 7 (“Highly Effective”) Likert-type scale. The variable of interest is patients’ beliefs in the efficacy of music therapy, and patients will be told that their beliefs will not affect the treatment condition to which they are assigned. 

Treatment Condition. Patients will be randomly assigned to receive one of two treatments in addition to traditional pharmaceutical treatment: music therapy or rhythmic class This treatment manipulation is similar to one used in previous research (Gutgsell et. al 2013).  In each condition, patients will undergo their additional treatment 3 times per week. Patients in the music therapy condition will go into a dark room without distractions for 20 minutes and have a music therapist play harp pieces for them. Patients in the rhythmic class (Bozorg-Nejad et. al 2018) condition will go into a dark room without distractions for 20 minutes and will be taught how to control the various paces of the body with breathing. These conditions will last for 6 weeks.

Improvement of Symptoms. The dependent variable that will be measured is the difference in pain before treatment and after treatment using a standardized scale. Patients will rate their overall severity of their symptoms at the end of each week on a scale from 0 (“No Symptoms”) to 10 (“Emergency Treatment Necessary”) similar to measures of migraine pain used in previous research (Jensen et. al 1999). Average scores from the final three weeks will be subtracted from average scores from the first three weeks to determine the change in symptoms over the treatment period.

Procedure

 When first agreeing to participate in the study, the participants will complete an informed consent document. They will be given their monetary reimbursement of $50 for their time, and then will be separated into two groups, after being sent and completing the survey about their beliefs in the efficacy of music therapy remotely. From those two groups they will be randomly assigned to either the music therapy condition or the rhythmic class, depending on what time of day they fill out the survey. They will then go to these therapies at least three times per week for 20 minutes for six weeks. Over the course of these six weeks their pain symptoms will be monitored and recorded through their respective nurses on the standardized scale in Appendix B. 

Results

Correlational Analyses

A zero-order Pearson correlational analysis will be conducted to assess the relationship between belief in the efficacy of music therapy and improvement of pain symptoms for patients in the MT condition only. We hypothesize that, among patients in the MT condition, higher belief in MT will predict more improvement of symptoms. We expect to see a similar correlation between belief in the effectiveness of rhythmic class in the comparison condition.

T-Test

A t-test will be conducted to compare symptom improvement between the two experimental groups. We expect that without taking into account the patients’ beliefs in MT’s effectiveness that patients in the MT conditional will not show significantly more or less improvement than patients in the rhythmic class condition. 

 Moderation Analysis

To test our primary research hypothesis, a moderation analysis will be conducted using the PROCESS macro (Hayes, 2013) Model 1. Treatment condition will be added to the model as the independent variable (x), belief in the efficacy of music therapy as the moderator (w), and symptom improvement as the dependent variable (y). We predict that belief in the efficacy of MT will moderate the difference between treatment groups such that MT will be more effective than rhythmic class among participants with higher beliefs in MT’s efficacy. The conceptual model is illustrated in Figure 1.

Discussion

The proposed study seeks to explore the relationship between patients’ beliefs in the efficacy of alternative forms of treatment for chronic pain and the actual effectiveness of those treatments. In particular, this study intends to focus on music therapy (MT) as a potential treatment. Patients’ beliefs about MT, and other alternative treatments, will be measured prior to random assignment to a treatment condition that includes typical pharmaceutical treatment plus either music therapy or a comparison treatments condition. It is hypothesized that beliefs in the efficacy of MT will interact with assignment to the MT condition such that patients who perceive MT as more effective and are assigned to the MT condition will experience more pain symptom relief over the course of the study. 

Implications

Approximately 5-12% percent of people worldwide suffer from migraines (MacGregor et. al, 2003), which is millions of people. Therefore, the majority of people at least know someone who is a victim of this kind of pain. Additionally, making strides within the treatment of these migraines could vastly improve quality of life. Music therapy specifically is an instance of alternative methods, based on other facts. If the experimental hypothesis was supported, then pain treatment would be reimagined to adjust to the beliefs of the patient. To ensure the best outcomes, physicians could prescribe whichever alternative treatment an individual patient has the most positive views of in addition to pharmaceutical treatment. Additionally, results that support our hypotheses would suggest that physicians should emphasize scientific support for alternative methods to their patients. Doing so may make beliefs about such treatments more positive, which would in turn make the treatments more effective.

Limitations

This study would be done on adults, so it probably would not be as conclusive for the same study done on children or adolescents. The proposed study also does not account for potential disparities among those who have chronic migraines. This study also would not discuss the musical aspect involved in rhythm. The proposed study also does not account for the influence of those providing the treatment on the patient’s belief in efficacy. This study also only compares two types of alternative therapies, when there are many others which could have different results.

Future Directions

In future studies, there should be much deliberation regarding the control therapy and how it relates to music therapy. There could be focus on how different types of music impact the efficacy, or how it relates to what is being treated. . For instance, it has been shown that music can help those with dementia express themselves with language (Brotons & Kroger, 2000). Moreover, connecting these two things is something worth looking into, based on how music has a unique impact on the brain and has helped lessen the impacts of other neurological disorders. As far as pain management goes, it is important to consider the different ways that people can feel pain and how each experience it unique, along with the wide variety of treatment methods- beyond the ones discussed in this proposal.

References

Bingel, U., Wanigasekera, V., Wiech, K., Mhuircheartaigh, R. N., Lee, M. C., Ploner, M., & Tracey, I. (2011). The effect of treatment expectation on drug efficacy: imaging the analgesic benefit of the opioid remifentanil. Science translational medicine, 3(70), 70ra14-70ra14.

Bozorg-Nejad, M., Azizkhani, H., Ardebili, F. M., Mousavi, S. K., Manafi, F., & Hosseini, A. F. (2018). The effect of rhythmic breathing on pain of dressing change in patients with burns referred to ayatollah mousavi hospital. World journal of plastic surgery, 7(1), 51.

Brotons, M., PhD, MT-BC, Koger, S. PhD, The Impact of Music Therapy on Language Functioning in Dementia, Journal of Music Therapy, Volume 37, Issue 3, Fall 2000, Pages 183–195, https://doi.org/10.1093/jmt/37.3.183

Clatworthy, J., Bowskill, R., Rank, T., Parham, R., & Horne, R. (2007). Adherence to medication in bipolar disorder: a qualitative study exploring the role of patients’ beliefs about the condition and its treatment. Bipolar disorders, 9(6), 656-664.

de Thurah, A., Nørgaard, M., Harder, I. et al. Compliance with methotrexate treatment in patients with rheumatoid arthritis: influence of patients’ beliefs about the medicine. A prospective cohort study. Rheumatol Int 30, 1441–1448 (2010). https://doi.org/10.1007/s00296-009-1160-8

Foulks, E. F., Persons, J. B., & Merkel, R. L. (1986). The effect of patients’ beliefs about their illnesses on compliance in psychotherapy. The American Journal of Psychiatry, 143(3), 340–344. https://doi.org/10.1176/ajp.143.3.340

Gutiérrez, E. O. F., & Camarena, V. A. T. (2015). Music therapy in generalized anxiety disorder. The Arts in Psychotherapy, 44, 19-24. 

Gutgsell, K. J., Schluchter, M., Margevicius, S., DeGolia, P. A., McLaughlin, B., Harris, M., … & Wiencek, C. (2013). Music therapy reduces pain in palliative care patients: a randomized controlled trial. Journal of pain and symptom management, 45(5), 822-831.

Horne, R. (1999). Patients’ beliefs about treatment: The hidden determinant of treatment outcome?[Editorial]. Journal of Psychosomatic Research, 47(6), 491–495. https://doi.org/10.1016/S0022-3999(99)00058-6

Jensen, M. P., Turner, J. A., Romano, J. M., & Fisher, L. D. (1999). Comparative reliability and validity of chronic pain intensity measures. Pain, 83(2), 157-162.

John, P., Sharma, N., Sharma, C.M. and Kankane, A. (2007), Effectiveness of Yoga Therapy in the Treatment of Migraine Without Aura: A Randomized Controlled Trial. Headache: The Journal of Head and Face Pain, 47: 654-661

Koenig J. Music therapy in the treatment of primary headache disorders. OA Alternative Medicine 2014 Jan 18;2(1):1

Langenberg, M., Frommer, J., & Tress, W. (1995). Music therapy single case research–a qualitative approach. Psychotherapie, Psychosomatik, medizinische Psychologie, 45(12), 418-426.

MacGregor, E. A., Brandes, J., & Eikermann, A. (2003). Migraine prevalence and treatment patterns: the global Migraine and Zolmitriptan Evaluation survey. Headache: The Journal of Head and Face Pain, 43(1), 19-26.

Lipton, R. B., Bigal, M. E., Diamond, M., Freitag, F., Reed, M. L., & Stewart, W. F. (2007). Migraine prevalence, disease burden, and the need for preventive therapy. Neurology, 68(5), 343-349.

Marks, G., Richardson, J. L., Graham, J. W., & Levine, A. (1986). Role of health locus of control beliefs and expectations of treatment efficacy in adjustment to cancer. Journal of personality and social psychology, 51(2), 443.

Munakata, J., Hazard, E., Serrano, D., Klingman, D., Rupnow, M. F., Tierce, J., … & Lipton, R. B. (2009). Economic burden of transformed migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache: The Journal of Head and Face Pain, 49(4), 498-508.

Oelkers-Ax, R., Leins, A., Parzer, P., Hillecke, T., Bolay, H. V., Fischer, J., … & Resch, F. (2008). Butterbur root extract and music therapy in the prevention of childhood migraine: an explorative study. European Journal of Pain, 12(3), 301-313.

Thaut, M. H. (2010). Neurologic music therapy in cognitive rehabilitation. Music Perception, 27(4), 281-285.

Vink, A. C., Bruinsma, M. S., & Scholten, R. J. (2003). Music therapy for people with dementia. Cochrane database of systematic reviews, (4).

Appendix A

Questionnaire for measuring belief in efficacy of music therapy.

How confident are you in the ability of pet therapy to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

How confident are you in the ability of rhythmic classes to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

How confident are you in the ability of yoga to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

How confident are you in the ability of music therapy to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

How confident are you in the ability of traditional western medicine to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

How confident are you in the ability of mindfulness meditation to treat your pain?

  1                   2                 3                   4                  5                 6                 7

Not at all                                                                                                  Extremely 

confident                                                                                                  confident

Appendix B

Measurement of pain

How would you rate your pain symptoms this week??

  1               2              3                 4              5              6              7                8               9            10

No symptoms                                                                                                                                                                                                                                                                                                    

About the author

Karishma Kulshrestha

Karishma is currently a Senior at the Thomas Worthington High School in Ohio. She has a strong passion for people, and her extraverted nature is where this seed was planted. As someone with chronic migraines herself, she has seen a lot of the medical systems from the patient perspective which has allowed her to think about things others might not normally. Karishma is in marching band and was a drum major this year. She also plays volleyball, and started a ski club at her school.

The post The Impact of Belief in Treatment Methodology on the Efficacy of Music Therapy in Those with Chronic Migraines appeared first on Exploratio Journal.

Abstract 

Dementia is an increasingly common syndrome and while pharmacotherapy is available, its potential benefit is limited, especially in non-cognitive, emotional outcomes. Non-pharmacotherapy such as music therapy is thought to be associated with improved outcomes. There is strong evidence that engaging with music and art related activities can improve our health and well-being. Music-based interventions, approaches and practices, such as group music-making which includes singing or playing musical instruments, listening to music and music therapy, have all been shown to reduce symptoms of depression and anxiety.

The goal of this descriptive overview is to provide a broad overview of this field by bringing together research examples from various practises and research disciplines. Selected evidence is examined, and presented to show how music-based interventions, approaches, and practises can reduce labour anxiety and pain, improve language function, orientation, and memory scores, and support brain structures associated with reward and pleasure experiences.

The examined research includes single studies and reviews that use both qualitative and quantitative methods. Overall, we highlight how music and other potential behavioral therapies, employed in a variety of ways, may support mental health with the aim of stimulating more interest and research in this area.

Keywords: music therapy, dementia, systematic review, behavioural therapies, art therapy in dementia etc.

Introduction: 

Alzheimer’s disease is a neurodegenerative disorder that severely impairs memory and thinking skills and, ultimately, the ability to perform simple tasks. For most people diagnosed with the disease – especially the form known as a type of “late arrival”, symptoms begin to appear in the age group of 60-64 years. 

[Wikipedia contributors. (2021, September 1). Addiction-related structural neuroplasticity. In Wikipedia, The Free Encyclopedia. Retrieved 14:53, October 22, 2021]

Some of the symptoms found in other forms of AD early onset AD, are memory loss, vision loss, experiencing personality and mood changes. In reference to the major symptoms, Alzheimer’s disease is the most common cause of dementia among older adults. Detailed neuropsychological testing can reveal mild cognitive difficulties up to eight years before a person fulfills the clinical criteria for diagnosis of Alzheimer’s disease. People who have this form tend to have more of the specific brain alterations that are linked with Alzheimer’s. Furthermore, a form of muscle twitching and spasm, called myoclonus, is also more common in early onset Alzeihmer’s. The early-onset form also appears to be linked with a defect in a specific part of a person’s DNA: chromosome 14.[https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.12068]

While the exact causes of Alzheimer’s disease aren’t fully understood, scientists believe that for most people, Alzeihmer’s disease is caused by a combination of genetic, lifestyle and environmental factors that affect the brain over time. Moreover, there are a number of measurable changes in the brain that can be associated with the disease. At a basic level, for most neurodegenerative diseases, brain proteins fail to function normally, disrupting the work of neurons to control our normal activity and through a series of toxic events, neurons are damaged, lose connections to each other and eventually die. This particular disease is named after Dr. Alois Alzheimer who noticed changes in a woman’s brain tissue after she died of an unusual mental illness in 1906. 

Memory loss, language difficulties, and erratic behaviour were among her symptoms. He examined her brain after she died and discovered many abnormal clumps (now known as amyloid plaques) and tangled bundles of fibres (now called neurofibrillary, or tau, tangles). These plaques and tangles in the brain are still considered to be some of Alzheimer’s disease’s hallmark symptoms. The loss of connections between nerve cells (neurons) in the brain is another feature.

As neurons die, additional parts of the brain are affected. By the final stages of Alzheimer’s, damage is widespread, and brain tissue has shrunk significantly.[https://www.nia.nih.gov/health/what-alzheimers-disease]

Currently several prescription drugs are approved and used by the U.S. Food and Drug Administration (FDA) to help manage symptoms in people with Alzheimer’s disease. Most medicines work best for people in the early or middle stages of Alzheimer’s. However, it is important to understand that as of now, none of the medications available at this time have been shown to be Alzheimer’s. The following describes several of these medications. Aricept is the only treatment approved by the FDA for all stages of Alzheimer’s  disease: mild, moderate, and severe. Razadyne is also for mild to moderate Alzheimer’s. Exelon is for people who have mild to moderate Alzheimer’s. Mematine treats moderate-to-severe Alzheimer’s disease. It works by changing the amount of a brain chemical called glutamate, which plays a role in learning and memory. Brain cells in people with Alzheimer’s disease give off too much glutamate. Namenda keeps the levels of that chemical in check by blocking the receptors. It may improve how well the brain works and how well some people can do everyday tasks. The drug may work even better when you take it with Aricept, Exelon, or Razadyne. Namenda’s side effects include tiredness, dizziness, confusion, constipation, and headache.

[https://www.webmd.com/alzheimers/news/20141229/combo-pill-alzheimers-disease] 

Namzaric contains a combination of donepezil( also called Aricept) and memantine( also called Namenda) . Donepezil improves the function of nerve cells in the brain. It works by preventing the breakdown of a chemical called acetylcholine. People with dementia usually have lower levels of this chemical, which is important for the processes of memory, thinking, and reasoning. Memantine reduces the actions of chemicals in the brain that may contribute to the symptoms of Alzheimer’s disease. It’s best for people with moderate to severe Alzheimer’s who already take the two drugs separately.

 Because of its debilitating Alzheimer’s disease, many antiretroviral drugs also offer many unwanted side effects because of their harsh nature. Interestingly and also important in this review, cognitive interventions have found a lot of attention to many psychiatric disorders. This could include the use of computer-based training programs, which have shown superior performance in delayed memory development, recognition, clock drawing, digital forwarding and back-to-back testing. These programs, however, can cost and expose learning barriers for adults who may opt for traditional pencil and paper methods.

On the other hand, in recent years, music and art interventions have grown in popularity as a non-pharmacological and alternative treatment for people with AD for a number of reasons. In addition to medications and cognitive-based therapies, music therapy offers cheap interventions that reduce the stress and side effects associated with other therapies. Music therapy has been studied in the psychological community and has been found to be effective in reducing behavioral symptoms and positively affecting emotional and mental well-being.

In this review, we will take a closer look at existing literature on music and artistic interventions that include people with dementia and Alzheimer’s. First we will summarize whether behavioral methods (such as art and music) are more effective compared to the pharmaceutical methods used and second, we will examine whether they have a significant impact on understanding and behavior if patients are actively involved or just watching / listening. We think that behavioral therapies, such as music therapy, will be useful or complementary to the treatment of Alzheimer’s disease because it has no side effects and is not addictive.

Methods 

For this review,  a literature research was carried out using primarily the following databases: NCBI, PubMed, ScienceDirect , Google Scholar search engine to collect all of the literature cited. In our search, the parameters included studies published in the last 10 years, and available in English. Keywords used to search included: music therapy, art therapy, dementia, behavioural therapy, non pharmacological intervention. The studies gathered in our review included only patients with AD dementia. The patients were in the age bracket of above 60 years of age.

We relied on the above-mentioned search engines for assistance and data. We wanted to include review papers with experimental evidence of the impact of behavioural therapies on the cognitive abilities of Alzeihmer’s patients’ brains. In the end we included a total of roughly 30 articles. 

The purpose of this narrative review is to investigate the effectiveness of  behavioral therapy intervention strategies (pharmaceutical therapy vs. behavioral therapy), so many articles contained these interventions for our data collection. A literature research was carried out using the following databases: NCBI, PubMed, ScienceDirect , Google Scholar  

All clinical trials were used to create a more comprehensive review. These included interventional trials randomized controlled trials, observational trials, case-control studies,  systematic reviews etc

 Furthermore, this study focused majorly on the music and art therapies: thus, the type used in the intervention (individualized vs. non-individualized music) on cognitive and behavioral outcomes for persons with AD was another important factor when choosing articles

Results 

Music therapy has strong neuroscientific and psychological foundations. Individuals’ psychological and physiological health can be improved through music therapy. In this study, we discovered that music has a significant effect on our brain, particularly in the nucleus accumbens, amygdala, and cerebellum, which are responsible for emotional responses. 

Non-pharmacotherapy, such as music and art therapy, has been linked to better outcomes. We evaluated and demonstrated the effects of music therapy on dementia patients in order to determine its potential benefits.

Positive 

In a systematic review of 5 randomized controlled trials, Vink et al. (2004) investigated the effects of music intervention on the treatment of behavioral, emotional, cognitive, and social problems in older adults with dementia. He concluded that music interventions are more likely to have positive effects on cognitive skills, quality of life, and complexity (as shown in Figure 1), but acknowledged that methodological errors and inconsistencies in published work in 2004 reduce the strength and comparability of reported findings, reducing any conclusions that can be drawn.

Another positive effect of music therapy is shown by Koike et al. (2018), presenting neural in vitro cells in the range of sound waves from 10 to 200 Hz for 30 minutes while using the sensory growth factor. You have found that between 150 and 200 Hz sounds have little effect on neurite output, but that sound between 10 and 100 Hz has caused a significant increase in neurite growth. The frequency of 40 Hz was very active, producing three times the rate of growth as NGF alone. The sound using p38 mitogen-activated protein kinase (MAPK), which has a major impact on neurite growth, has been shown to be a mechanism here.

[Wikipedia contributors. (2021, August 16). Disease management (health). In Wikipedia, The Free Encyclopedia. Retrieved 14:04, October 22, 2021]

Another study which supports the fact that the patients only show improvements to specific music types was performed by Hans Ragneskog RNT et al. (2018) The influence of dinner music on food intake and symptoms common in dementia such as depressed mood, irritability and restlessness was studied. The study was carried out in a nursing-home ward in Sweden. Soothing music was played as dinner music for two weeks, Swedish tunes from the 1920s and 1930s for two weeks and pop music for two weeks. Prior to these periods, there was one week without music, and at the end of the intervention there was a two-week control period. The effects of the intervention were assessed by psychological ratings and by weighing the food helpings. It was found that during all three music periods the patients ate more in total. The difference was particularly significant for the dessert. The staff were thought to be influenced by the music, as they served the patients more food, both main course and dessert, whenever music was played. The patients were less irritable, anxious and depressed during the music periods. The results of the study suggest that dinner music, particularly soothing music, can reduce irritability, fear-panic and depressed mood and can stimulate demented patients in a nursing-home ward into eating more.[Ragneskog, H., Bråne, G., Karlsson, I., & Kihlgren, M. (1996). Influence of dinner music on food intake and symptoms common in dementia. Scandinavian journal of caring sciences, 10(1), 11–17. https://doi.org/10.1111/j.1471-6712.1996.tb00304.x]

Hei long lam et al. (2018) conducted a study to show the effects of singing on memory, which examines the idea of active involvement (as shown in Figure 2)

Results for the effect of music therapy on the memory of patients living with dementia were mixed, with 4 out of 5 studies reporting significant improvements. (see table 1 ) Two RCTs assessed the effects of singing on memory; one study reported significant improvements in memory, as measured by a comprehensive battery of neuropsychological tests. It is worth noting that significant improvements in memory occurred in the two studies that used a combined music therapy modality.

Similarly, another study by Roger Y Wong et al. explored the effects of music listening, and reported that apathy was significantly reduced in which active music therapy was implemented (using musical instruments and combined music therapy respectively) in 137 patients.  There were improvements in apathy levels in the intervention group in which live music was played, but no significant effect was observed for the group in which pre-recorded music was played. This suggests that patient participation might be a factor affecting apathy.

Art Therapy

Interestingly, we found that some have approached alternative therapy by way of art. Kinney et al (2018) used an intervention to encourage patients with mild and moderate dementia to express themselves through artistic activities while also providing sensory stimulation; the patients experienced the joy of creation and gained satisfaction and a sense of self-worth through the challenging creative process, thereby improving their well-being and quality of life. They were happy at the end of the procedure and exuded self esteem and confidence (as shown in Figure 3) 

Similarly, Shinichiro et al (2014) discovered that after participating in art colouring activities for 12 weeks, five dementia patients had lower scores on wandering, excretion, and calling for no reason, as well as an increase in daily average sleep time from 4.5 to 7.9 hours, easing caregivers’ burden.

Negative

However there are some studies that do not support the benefits of music intervention. Table 1 below provides the positive as well as the negative impacts of musical therapy.

Shiltz, DL, et al. conducted research to investigate the effects of combining music therapy with other therapies. While six of the eight studies found that listening to music reduced agitation, mixed results were obtained in studies looking at the effects of integrated music therapy, which often included listening to music. It is noteworthy that when Baroque music was played in 75 patients in a crossover trial, there was a significant increase in the number of episodes of outrageous behavior while playing music. So while many forms of music can help reduce stress and mood swings, there may be subtle conflicts with other forms of music, such as Baroque music, which may be more musical and complex, and may increase the agt levels of patients’ anonymity, thus creating a negative effect. The short-term benefits of music therapy in reducing the behavioral and psychological symptoms of dementia and quality of life, may be due to reduced emotional comfort and safety, which may not last long, and therefore, may not improve the quality of life for patients living with dementia.

Animal studies for evidence

​​It is important to note that, in addition to human studies, there are several geological studies of various species that strongly support the impact of a rich neurological environment on memory (as shown in Figure 4) 

Amy Shephard et al. taking into account the time difference and duration of EE intervention in the APP / PS1 mouse model in this review. A novel object recognition task with Barnes Maze was used to test the understanding of animals kept in EE conditions for between 3 and 6 months. They found that both of these interventions improved performance in the novel object recognition function, regardless of when they were used or how long they were acquired in it, but it was a version of the work that tested temporary memory.

Discussion 

Our systematic review illustrates that behavioral therapy is an important, perhaps even indispensable, tool to gain such knowledge. Future work with music and art can contribute to the investigation of the neural connections underlying different emotions, with the particular advantage that music and art can be used to study a range of positive as well as negative emotions.

Music has a high likelihood of improving cognitive abilities, quality of life, and agitation. One of the key  findings of this study was that patients only responded to a specific type of music. It covered everything from the frequency of music to the genre of music and how the music was connected to the patients’ lives. This suggests that lyrics in music therapy pieces may play an important role in memory formation activation and, as a result, improve verbal fluency in dementia patients.

Also, as we saw in the review, music therapy only has short-term benefits and does not completely cure dementia; we can use pharmacotherapy, such as cholinesterase inhibitors, which have been linked to improvements in cognitive function and daily activities, whereas music therapy has been linked to improvements in verbal fluency as well as reductions in anxiety, depression, and apathy.

In addition, Art therapy induces significant positive changes in the brain that stimulates the temporal lobe, which affects object recognition and accurate expression using language, and the parietal lobe, which perceives the spatial position of objects and controls fine motor functions of the hand.

 Additionally, art therapy provides an effective way to train patients in the capacities of language and fine motor movement of the hand, in which the hand-brain interaction helps maintain and develop motor skills and coordination and improves the perception by the brain of color, shape, space, proportion, etc.  Interestingly, there are also a few studies that report a benefit of doll therapy. For people who are withdrawn, restless, distressed, or anxious, holding or simply being with a doll or soft toy animal, such as a cat or dog, can improve their wellbeing and ability to communicate. 

It may bring back memories of when they had small children or a pet of their own. 

Caring for a doll or soft toy can give dementia sufferers a renewed sense of purpose and allow them to reconnect with the outside world. [Catarina, M. C. (2014). A review on auditory space adaptations to altered head-related cues.]

Interestingly,  our review shows that there are certain negative impacts of music on general cognition and related aspects such as memory, orientation, and registration. While most forms of music might be helpful in relieving behavioral and psychological symptoms of dementia, there might be subtle differences with some types of music, specifically Baroque music, which might be more musically activating and complex, and which could unknowingly increase the agitation levels in patients. To counteract this problem one can probably contact the families of the patients and ask for a list of their favorite songs as it could  play an important role in memory formation activation, and hence improve verbal fluency in patients living with dementia.

Further, even if one considered art therapy as playing a certain role in monitoring the disease, detecting changes in a patient’s condition and prognosis, there was a lack of universality, making it difficult for average family caregivers to comprehend the use of art therapy in dementia assessment without systematic education and training. Art therapy requires that patients have hand function and the ability to complete simple tasks; although this approach has been recognized to reduce the behavioral and psychological symptoms of patients, art therapy has had mixed outcomes in improving the patients’ cognitive abilities.  Therefore due to the limited number of related studies, there are variations regarding the duration, frequency and measuring tools of the intervention, which must be improved in future investigations. 

While we didn’t find a clear measurable improvement in memory, the animal studies suggest something clear in how enrichment changes the brain and behavior, so there might be a real benefit to music with pharmaceutical treatment. Therefore, although several questions remain, better insight into the neural basis of emotions evoked by music and art will lead to a better understanding of how to employ music and art in the therapy of affective disorders.

Conclusion:

Although there does not appear to be any proven benefits on memory quantification, music therapy may improve verbal fluency and reduce anxiety, depression, and apathy in some dementia patients. More clinical trials are needed before definitive conclusions can be drawn about the therapeutic value of music therapy for dementia patients.

References: 

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About the author

Anika Bajpai

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