This phenomenon has been attributed to acute arousal caused by the enjoyment of listening to music, and not because classical music has the ability to enhance cognition beyond the music listening session Chabris, ; Thompson et al. Additionally, Giovagnoli et al.
The authors found only slight clinical improvements in a verbal initiative executive functioning task and episodic memory in 7. This study also found that, although some mood improvements were found in their intervention, the same improvements were found in CT and Neuroeducation NE groups, and therefore can be attributed to the creation interpersonal relationships with group members, experience of a change of setting from their regular routine, or interaction between group members and clinicians and music therapists Raglio and Oasi, rather than a unique effect of music on mood, behavior, or cognition.
Sakamoto et al. The benefit of music on cognition and behavioral symptoms of AD have been commonly attributed to arousal and improved mood Chabris, ; Thompson et al. However, our investigation showed that music that is individualized to the patient show greater benefits than music that the patient does not know, suggesting more than arousal is involved in improving cognitive and behavioral outcomes for patients.
We suggest this is due to the positive effects that long-known music can have on the brain of AD persons. Previous literature suggests that music can evoke autobiographical memories in persons with AD Foster and Valentine, ; Irish et al.
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The deterioration of memory in AD is often linked with impairment of autonomy and the sense of Self Fargeau et al. Since music that is known to the patient has the ability evoke autobiographical memories El Haj et al. Our investigation provided evidence that the intervention approach used may also have an effect on cognition and behavior.
Namely, Sakamoto et al. However, these results disappeared after the intervention. Conversely, the other two studies utilizing active music therapy provided conflicting results on both cognition and mood Giovagnoli et al. The music intervention approach may also have different impacts on the sympathetic and parasympathetic nervous systems of participants, which may affect acute and long-term outcomes. Active music therapy tends to focus more on and activity and the social aspects of participation Raglio and Oasi, , such as interactions between client and clinician and the act of clapping, dancing and playing instruments.
While all the active music therapies encouraged interpersonal relationships with others and emotional introspection, the music listening approaches undergone by the studies in this review focused more on engaging participants to music they enjoy and know from their past. Additionally, music listening approaches provided a calm and relaxing environment to induce relaxation, while active music therapies increased arousal with participation Sakamoto et al.
As postulated by Peck et al. During active music therapy sessions, Sakamoto et al. Therefore, the effects of active sessions may be based more on arousal mechanisms to reduce behavioral symptoms acutely, while music listening may act to train participants in relaxation techniques that provide parasympathetic regulation and prolonged benefits to the patients. The authors created this type of music program with individualized music for each participant.
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In addition to providing benefits for anxiety and depression after completion of intervention, the authors found the effects of the therapy lasted 6 months after completion. Our findings of the benefits of music listening for persons with AD compared to active music therapy is supported by a recent review by Tsoi et al. Our review has limitations that should be addressed.
The aim of this narrative review was to determine the impact of various music intervention approaches specifically for persons with AD. However, the studies included vary in other aspects which may impact the results, such as participant age, disease severity, cognitive level, outcome measures, length of intervention, etc.
Furthermore, the methodology differed within musical approaches. For example, music listening regimens ranged in their method of exposing participants to music, such as via headphones or streamed through the room. Music therapy techniques differed in the activities conducted during the sessions. As well, our investigation included only a small amount of studies, which may result in low power of our results. In this review, we discussed six studies involving a music intervention approach for AD persons that met our search criteria.
In summary, our investigation into the aforementioned studies suggested music interventions which used individualized music playlists and focused on relaxation techniques tended to yield greater benefits on AD persons. We hypothesize this is due the enhancement of autobiographical memory, autonomy, and parasympathetic modulation which in turn has positive effects on cognition and behavior.
While there are many reviews available looking at the effect of music on various symptoms, intervention studies that assess music, cognition, and memory are less common. As cognitive decline is a main effect of AD and can contribute further to increasing neuropsychiatric symptoms, medication use, and visits to the emergency room, investigation of music on cognition in the future is imperative.
As well, more rigorous behavioral studies, as well as systematic reviews and meta-analyses, are needed to investigate the impact of individualized vs. Lastly, although many studies have investigated outcomes pre- and post-music intervention for AD persons, there is a lack of studies investigating brain changes associated with a music intervention. As well, imaging studies investigating brain areas involved in music listening have thus far only been investigated in healthy, young controls.
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Such studies could provide empirical evidence to further the understanding of mechanisms involved in musical memory, and how music can work to improve cognition and behavior in persons with AD. ML formulated the research paper idea, wrote the main body of the manuscript, participated in revisions, and submitted the final manuscript. MT provided substantial edits to the paper and final draft, and aided in the interpretation of the paper. LF contributed to the formulation of the research paper idea, provided substantial edits to the paper and the final draft, and aided in the interpretation of the paper.
TS provided substantial edits to the paper and final draft, and aided in the interpretation of the paper.
JB provided edits to the final draft, and aided in the interpretation of the paper. DM provided edits to the final draft, and aided in the interpretation of the paper.
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CF contributed to the formulation of the research paper idea, provided substantial edits to the paper and the final draft, and aided in the interpretation of the paper. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Abraha, I. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia.
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