M USIC THERAPY IN MODERATE AND SEVERE DEMENTIA OF A LZHEIMER ’ S TYPE : A CASE - CONTROL STUDY H.B. Svansdottir and J. Snaedal Presented by Justine Ho

I NTRODUCTION Alzheimer’s disease (AD): Behavioural and psychological symptoms of dementia (BPSD) Decrease well-being of patient, impairment of quality of life & pose a heavy burden on care-takers Reasons for hospitalizations and nursing homes

I NTRODUCTION Small improvements could be drastically beneficial i.e. quality of life Treatment most often pharmacological Severe patients (high BPSD): treated with sedatives, neuroleptics or antidepressents Result in inappropriate use of psychoactive drugs in nursing homes Insufficient + side effects are common

I NTRODUCTION Non-pharmacological treatment Far less popular -> lack of reliable research Music Therapy : use of tunes, sounds & movements Increase well-being + increase interaction -> decrease sense of isolation Purpose of this experiment: Study the effect of music therapy on BPSD in patients with moderately severe and severe AD

M ETHODS : P ARTICIPANTS 46 participants (71-87 years of age) Diagnosed with AD in accordance with ICD-10 with either moderate or severe dementia according to the Global Deterioration Scale In the end, only 38 patients participated Eight patients dropped out b/c had to move from psycho-geriatric ward to a nursing home, deterioration or death 20 in music therapy group / 18 in control group

M ETHODS : E VALUATION All patients were interviewed and then rated according to the Behaviour Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD) Has 7 categories (symptoms) defining AD Therapy Group: received 18 sessions of music therapy, each lasting 30 mins, 3 times/week for 6 weeks All patients were evaluated after 6 weeks Evaluated again after 10 weeks, but with no music therapy sessions

M ETHODS : M USIC T HERAPY Three or four patients participated in each session Collection of songs familiar to the patients were selected by patients & therapist Encouraged participation whether actively or passively (songbook, listening) Patients were given the opportunity to pick an instrument to play along with the song Dancing was also freely allowed

R ESULT #1 Non-significant decrease in total points of the BEHAVE-AD in the therapy group Smaller and non-significant decrease in control group Further decrease in control group during the next 4 weeks mainly due to changes in one patient Benefits of music therapy disappeared after the 6 th week

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R ESULT #2 After 6 weeks, significant decrease in average scoring for activity disturbance, aggressiveness and anxiety in the therapy group No significant results found in the control Benefits of music therapy decreased 4 weeks later without therapy sessions

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D ISCUSSION Active participation in music therapy creates meaningful activity, lessens anxiety, elevates depressed mood Positive effects resulted by repeated sessions for 6 weeks Effects diminished after one month Supports previous research However, hard to prove that hallucinations and misidentification would benefit Supports first results

S TRENGTHS & L IMITATIONS Had comparable groups with a baseline Only had patients with AD; other dementias excluded Same nurses/qualified therapists Used only one type of music therapy: active participation (playing instruments & singing) Did not address passive participation Only tested with one type of music

F URTHER R ESEARCH Effects of music therapy on cognition and behaviour Comparison with different types of music Explore other types of music therapy such as passive listening or singing T HOUGHTS Concise, straight-forward No images of brain scans