Abbas Aslam
Mini CAT:In elderly individuals diagnosed with dementia, does participation in regular music therapy sessions compared to standard care without music therapy lead to improvements in cognitive function, mood, behavior, and quality of life ?
Clinical Scenario: 74 y.o female recently diagnosed with Alzheimer’s disease presents to the geriatric clinic with her daughters. In addition to donepezil, the daughters are asking if there are any other treatments that may slow the progression of dementia.
Search Question: In elderly individuals diagnosed with dementia, does participation in regular music therapy sessions compared to standard care(cholinesterase inhibitors) without music therapy lead to improvements in cognitive function, mood, behavior, and quality of life ?
Question Type: What kind of question is this? (boxes now checkable in Word)
☐Prevalence ☐Screening ☐Diagnosis
☒Prognosis ☒Treatment ☐Harms
Assuming that the highest level of evidence to answer your question will be meta-analysis or systematic review, what other types of study might you include if these are not available (or if there is a much more current study of another type)?
Please explain your choices.
If systemic review and meta-analysis are not available, I would want to use RCT as my study to yield the best results for my PICO question.A RCT would allow me to specifically focus on my target population and intervention.
| P | I | C | O |
| Dementia | Music therapy | Standard care | Cognitive function |
| Elderly | Music interventions | Non-musical therapy | Memory |
| Alzheimer’s disease | Music sessions | Anxiety | |
| Behavior |
Pubmed
Music Therapy AND Dementia →1,376 Filters: Free Full text, Meta-Analysis, Systemic Review, RCT, last 10 years→ 61
Cochrane
Music therapy AND Dementia→8
Filters: Since 2014→7
Science Direct
Music Sessions AND →3,890
Filters: Since 2024→114
Pubmed is the easiest way for me to find articles, so most of the articles I decided to use came from that database. After all my filters I would briefly look at the abstract of the articles I found to help narrow down which articles actually fit the intervention and outcome I am trying to discuss.
Article 1:
| Citation:Lam HL, Li WTV, Laher I, Wong RY. Effects of Music Therapy on Patients with Dementia-A Systematic Review. Geriatrics (Basel). 2020 Sep 25;5(4):62. doi: 10.3390/geriatrics5040062. PMID: 32992767; PMCID: PMC7709645. |
| Type of article: Systematic review |
| Abstract:Background:Dementia is an increasingly common syndrome and while pharmacotherapy is available, its potential benefit is limited, especially in non-cognitive outcomes. Non-pharmacotherapy such as music therapy is potentially associated with improved outcomes. We assessed the effects of music therapy on patients with dementia to evaluate its potential benefits on dementia. Materials and Methods:Two independent reviewers searched MEDLINE, EMBASE, CINAHL, CENTRAL, and ClinicalTrials.gov databases for clinical trials, using the keywords “music therapy” and “dementia”. Study outcomes included cognitive function, behavioral and psychological symptoms of dementia (BPSD), and quality of life. A total of 82 studies were included, of which 43 were interventional clinical trials, and 39 were systematic reviews or meta-analyses.Results:Thirteen studies reported overall cognition as an outcome, with 4 showing significant improvements and 8 reporting no significant improvements. One study reported a mixed effect, as only improvement in the abstraction domain of cognition was observed.Results were mixed for the effects of other forms of music therapy on the cognitive status in patients living with dementia. In one RCT, listening to music only improved the abstraction domain after adjustments for sex, age, education level, neuropsychiatric inventory, and corresponding baseline measurements . For music therapy involving two or more modalities, such as both listening to music and singing, only one out of four studies reported improvements in the overall cognition in the intervention groupConclusion: Significant improvements in verbal fluency occurred after music therapy, with significant reductions in anxiety, depression, and apathy. There were no significant improvements in cognition or daily functioning, and the results on quality of life and agitation were ambiguous |
| Why I chose it: I chose this article because it was a systematic review and is seen as the highest level of evidence that I can use. It directly answers my questions and discusses the results in separate categories such as memory,language, anxiety, depression and overall cognition. Even though it is a foreign articles, since its a systematic review using online webases for its data, there was no bias that needed to be addressed in the article. |
Article 2
| Citation: Moreno-Morales C, Calero R, Moreno-Morales P, Pintado C. Music Therapy in the Treatment of Dementia: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2020 May 19;7:160. doi: 10.3389/fmed.2020.00160. PMID: 32509790; PMCID: PMC7248378. |
| Type of article: A systematic review a meta-analysis |
| AbstractBackground:Dementia is a neurological condition characterized by deterioration in cognitive, behavioral, social, and emotional functions. Pharmacological interventions are available but have limited effect in treating many of the disease’s features. Several studies have proposed therapy with music as a possible strategy to slow down cognitive decline and behavioral changes associated with aging in combination with pharmacological therapy.Materials and Methods:The databases used were Medline, PubMed Central, Embase, PsycINFO, and the Cochrane Library. The search was made up of all the literature until present. For the search, key terms, such as “music,” “brain,” “dementia,” or “clinical trial,” were used.Results: Finally, a total of eight studies were included. All the studies have an acceptable quality based on the score on the Physiotherapy Evidence Database (PEDro) and Critical Appraisal Skills Program (CASP) scales. After meta-analysis, it was shown that the intervention with music improves cognitive function in people living with dementia, as well as quality of life after the intervention and long-term depression. Nevertheless, no evidence was shown of improvement of quality of life in long-term and short-term depression.Conclusion: Based on our results, music could be a powerful treatment strategy. However, it is necessary to develop clinical trials aimed to design standardized protocols depending on the nature or stage of dementia so that they can be applied together with current cognitive-behavioral and pharmacological therapies. |
| Why I chose it: I chose this article for similar reasons, seeing it was a meta-analysis and systematic review, I am able to get another article with the highest level of evidence. This study also looks at the results in subgroups by seeing music therapy outcomes in regard to cognitive function, depression and quality of life in my patients. This is also another foreign article but since it is the highest level of evidence, I did not need to discuss if there were any biases. |
Article 3
| Citation:Dorris JL, Neely S, Terhorst L, VonVille HM, Rodakowski J. Effects of music participation for mild cognitive impairment and dementia: A systematic review and meta-analysis. J Am Geriatr Soc. 2021 Sep;69(9):2659-2667. doi: 10.1111/jgs.17208. Epub 2021 May 18. PMID: 34008208; PMCID: PMC8440389. |
| Type of article: Systematic Review and Meta-analysis |
| AbstractBackground:To examine randomized controlled trials with active music-making interventions, in which older adults with probable mild cognitive impairment (MCI) or dementia physically participate in music, and their effects on cognitive functioning, emotional well-being, and social engagement. Participating in music-making is engaging and has shown diverse benefits. Additionally, this review categorized the music activities of each intervention.Materials and Methods: Published randomized controlled trials of active music-making interventions to support older adults with probable MCI or dementia were identified (to March 15, 2021) using searches on Medline (Ovid), APA PsycInfo (Ovid), CINAHL (Ebsco), and Embase (Elsevier). The outcomes were cognitive functioning, emotional well-being, and social engagement, including self- and clinician-reported measures such as the Mini-Mental State Examination, Positive and Negative Affect Schedule, and the Beck Depression Inventory. Studies were critically appraised and studies with similar methodology were meta-analyzed.Results:A total of 21 studies with 1472 participants were analyzed for potential effect sizes and intervention activities. Of the 21 studies, nine studies recruiting a total of 495 participants were used to produce a random-effects meta-analytic model for cognitive functioning. Music showed a small, positive effect on cognitive functioning; the combined standard mean difference for the experimental and control group was 0.30 (95% confidence interval [CI] 0.10, 0.51). There was low study heterogeneity, with an I2 of 24% (p = 0.004). Individual studies for emotional well-being in terms of quality of life and mood showed positive effect sizes, d = 1.08 and d = 1.74, respectively. [Corrections added on July 8, 2021, after first online publication: The preceding sentences were revised from: “… control group was 0.31 (95% confidence interval [CI] 0.10,0.52). There was low study heterogeneity, with an I2 of 25% (p = 0.004).”]Conclusion:This review shows that music-making has a small but statistically significant effect on cognitive functioning for older adults with probable MCI or dementia. Future music interventions can benefit from rigorous intervention protocols that isolate specific activities. |
| Why I chose it: I choose this article also because it is looked at as the highest level of evidence as it is a systematic review and meta analysis. This study differs from the others as it also includes individuals with mild cognitive impairment as well. Patients with dementia are most likely to respond to therapy when the disease is mild compared to severe dementia, so looking at individuals with mild impairment can also help us see if music therapy is beneficial at an earlier stage of dementia. |
Article 4
| Citation:Bleibel M, El Cheikh A, Sadier NS, Abou-Abbas L. The effect of music therapy on cognitive functions in patients with Alzheimer’s disease: a systematic review of randomized controlled trials. Alzheimers Res Ther. 2023 Mar 27;15(1):65. doi: 10.1186/s13195-023-01214-9. PMID: 36973733; PMCID: PMC10041788. |
| Type of article: Systematic Review |
| AbstractBackground:The use of music interventions as a non-pharmacological therapy to improve cognitive and behavioral symptoms in Alzheimer’s disease (AD) patients has gained popularity in recent years, but the evidence for their effectiveness remains inconsistent.Materials and Methods: A systematic literature search was performed in PubMed, Cochrane library, and HINARI for papers published from 1 January 2012 to 25 June 2022. All randomized controlled trials that compared music therapy with standard care or other non-musical intervention and evaluation of cognitive functions are included. Cognitive outcomes included: global cognition, memory, language, speed of information processing, verbal fluency, and attention. Quality assessment and narrative synthesis of the studies were performed.Results:A total of 8 studies out of 144 met the inclusion criteria (689 participants, mean age range 60.47-87.1). Of the total studies, 4 were conducted in Europe (2 in France, 2 in Spain), 3 in Asia (2 in China, 1 in Japan), and 1 in the USA. Quality assessment of the retrieved studies revealed that 6 out of 8 studies were of high quality. The results showed that compared to different control groups, there is an improvement in cognitive functions after music therapy application. A greater effect was shown when patients are involved in the music making when using active music intervention (AMI).Conclusion:The results of this review highlight the potential benefits of music therapy as a complementary treatment option for individuals with AD and the importance of continued investigation in this field. More research is needed to fully understand the effects of music therapy, to determine the optimal intervention strategy, and to assess the long-term effects of music therapy on cognitive functions. |
| Why I chose it: I chose this article because it was a systematic review and it directly answered my question whether music therapy was beneficial with patients with dementia. This article, unlike the other articles, discussed more in depth which type of music may be more beneficial to patients which helps me answer my question even better. Again, this was a foreign article but since it was a systematic review there were no biases that were seen throughout the methods. |
Summary of the Evidence:
| Author (Date) | Level of Evidence | Sample/Setting (# of subjects/ studies, cohort definition etc) | Outcome(s) studied | Key Findings | Limitations and Biases |
| Lam HL, Li WTV, Laher I, Wong RY.(2020) | Systemic Review | – MEDLINE, EMBASE, CINAHL, CENTRAL, and ClinicalTrials.gov -A total of 82 studies were included, of which 43 were interventional clinical trials, and 39 were systematic reviews or meta-analyses. | – Study outcomes included the effects of music therapy on cognitive function, behavioral and psychological symptoms of dementia (BPSD), and quality of life. | – Among 7 seven studies with music listening as primary intervention, 5 of those studies stated that music listening significantly improved mood, showing a significant reduction in anxiety measured state trait anxiety inventory.-All 3 RCT with language or verbal fluency as an outcome reported significant improvement with musical therapy groups. – Music therapy effects on memory with patients with dementia were mixed, with 4 out of 5 studies reporting significant improvements. | -Limitations of studies included low patient numbers, lack of standardized music therapy, and high heterogeneity in outcomes.-These evaluations frequently lacked a performance-based approach or input from clinicians, instead relying on observations from caregivers of the patients, potentially introducing reporting bias. |
| Moreno-Morales C, Calero R, Moreno-Morales P, Pintado C(2020) | A systematic review a meta-analysis | -Medline, PubMed Central, Embase, PsycINFO, and the Cochrane Library. -A total of eight studies were included. All the studies have an acceptable quality based on the score on the Physiotherapy Evidence Database (PEDro) and Critical Appraisal Skills Program (CASP) scales. | -The primary focus for comparison centered on music therapy effect on cognitive function, which was assessed using instruments such as the Mini-Mental State Examination (MMSE), Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-Cog), Revised Memory and Behavior Problems Checklist (RMBPC), or Immediate and Deferred Prose Memory test (MPI and MPD, respectively). Secondary outcomes encompassed quality of life, gauged through the Quality of Life in Alzheimer’s Disease (QOL-AD), and depression, evaluated via the Cornell–Brown Scale for Quality of Life in Dementia (CBS) and the Geriatric Depression Scale (GDS). | – The random-effects model analysis showed a standardized mean difference (SMD) of -0.23 (95% CI: -0.44, -0.02) for the effect of music therapy on cognitive function. – There was no significant short-term effect of music therapy on the depressive state of dementia patients. However, a positive effect was observed at the 6-month follow-up, suggesting a long-term benefit.- Music therapy showed an immediate improvement in the quality of life of dementia patients following the intervention. However, this improvement was not maintained at the 6-month follow-up assessment. | – Trials included in the analysis often had small sample sizes (<100 participants), potentially limiting the ability to detect group differences.- Diverse musical interventions and evaluation methods for cognitive function and depression made it challenging to clearly ascertain their benefits compared to standard care.- Lack of standardized methods for selecting musical stimuli was a common issue across the reviewed studies, contributing to inconsistencies (55).- Subgroup analysis regarding dementia severity to determine the optimal timing for music intervention within the disease trajectory was hindered by participants being randomly assigned to intervention or control groups regardless of dementia stage. |
| Dorris JL, Neely S, Terhorst L, VonVille HM, Rodakowski J.(2021) | Systematic review and meta-analysis. | -Medline (Ovid), APA PsycInfo (Ovid) CINAHL (Ebsco), and Embase (Elsevier)-21 studies were included,(22 papers)and met the eligibility requirements and were included in the systematic review, and nine studies were included in the meta-analysis. | -The outcomes were music therapy effects on cognitive functioning, emotional well-being, and social engagement, including self- and clinician-reported measures such as the Mini-Mental State Examination, Positive and Negative Affect Schedule, and the Beck Depression Inventory. | -A meta-analysis involving nine studies with 495 participants revealed a combined standardized mean difference (SMD) of 0.30 (95% CI, 0.10, 0.51) for cognitive functioning improvement with music interventions.- Six studies assessed QoL, with varying effect sizes. Positive effects were found in four studies, ranging from very small to large effect sizes. – Six studies examined depression, with effect sizes ranging from very small to medium. For example, Kim et al. (2020) found a medium effect size (d = -0.75, 95% CI = -1.42, -0.05), indicating a significant reduction in depression symptoms. | -Incomplete data hindered reporting of effect sizes across all studies, limiting comprehensive analysis.-Potential influence of drugs or other therapies on outcomes discovered in the analysis adds complexity and uncertainty to the findings. |
| -Bleibel M, El Cheikh A, Sadier NS, Abou-Abbas L(2023) | Systemic Review | – PubMed, Cochrane library, and HINARI-A total of 8 studies out of 144 met the inclusion criteria (689 participants, mean age range 60.47–87.1) | -Outcomes compared music therapy against standard care or other non-musical interventions and assessed cognitive functions. These functions encompassed global cognition, memory, language, speed of information processing, verbal fluency, and attention. We conducted quality assessments and synthesized the findings narratively. | -Music intervention for severe dementia patients showed short-term improvement in emotional state assessed by the facial scale and long-term benefits in reducing behavioral and psychological symptoms of dementia assessed by the BEHAVE-AD Rating Scale.-Music therapy interventions had positive effects on emotional states, but the duration of these effects varied among studies, lasting from 1 to 6 months.-Listening to classical music can positively influence cognitive functions, as the rhythmic and repetitive aspects of music help regulate brain function. | -Differences in participant characteristics, including age, severity of illness, and cognitive ability, may have influenced the results.- Variation in outcome measures and intervention methods across studies could have impacted the findings.- Diverse music therapy interventions, ranging from singing to playing instruments, were used in the studies, contributing to heterogeneity. |
Conclusion(s):
Article 1:Music therapy may enhance verbal fluency and alleviate anxiety, depression, and apathy in certain individuals with dementia. However, there seems to be insufficient evidence supporting its benefits on memory, daily functioning, or overall quality of life. More clinical trials are required to gain clearer insights into the therapeutic effectiveness of music therapy for individuals with dementia.
Article 2:This study reveals a promising indication supporting the efficacy of music therapy in enhancing cognitive function among individuals with dementia. Furthermore, it demonstrates positive outcomes in the long-term treatment of depression, but does not show a significant effect on short-term depression in these patients. Furthermore, music therapy seems to improve the quality of life for dementia patients following the intervention, yet the benefits do not seem to persist long term.
Article 3:This review finds that active music-making has a small yet significant impact on cognitive function in older adults with probable MCI or dementia. It also shows potential benefits for mood and quality of life.
Article 4:This review suggests music therapy may benefit cognitive functions in Alzheimer’s patients, enhancing memory, executive functions, and attention, thus improving their quality of life. Further research is necessary to understand mechanisms and optimize therapy, including follow-up evaluations.
Overarching Conclusion:
The articles suggest that music therapy holds promise for improving cognitive function and emotional well-being in individuals with dementia or mild cognitive impairment (MCI). While evidence supports its efficacy in enhancing verbal fluency, cognitive function, and mood, especially in the long term, there are inconsistencies regarding short-term effects, memory, daily functioning, and overall quality of life. Although there are promising findings, further investigation is necessary to determine the most effective approaches, duration, and frequency of music therapy interventions for maximizing benefits in this population.
Clinical Bottom Line:
Article 2
This article was a systematic review and meta analysis which typically represents the highest level of evidence in evidence based medicine . Data was collected from reputable databases and quality assessment of included studies was performed using standardized scales such as, physiotherapy evidence database and critical appraisal skills program scales, indicating a rigorous approach to study selection. Despite limitations such as small sample sizes and heterogeneity in interventions and outcomes, the inclusion of a meta-analysis enhances the strength of evidence by providing a comprehensive quantitative analysis which is why I decided to rank this as my highest article.
Article 1
In this article they conducted a systematic review that included a substantial number of studies(82). Outcomes such as cognitive function, behavioral and psychological symptoms of dementia (BPSD), and quality of life. Some weaknesses that were identified included limitations in regards to low patient numbers, lack of standardized music therapy, and high heterogeneity in outcomes. As this is only a systematic review I put this below article number 2.
Article 3
This was also a systematic review and meta analysis but included fewer studies than article 2, 22 studies and only addressed outcomes of cognitive functioning, emotional well-being, and social engagement.While still valuable, its smaller scope and fewer studies might limit its applicability compared to Article 2 and 1.
Article 4
This was a systematic review which included a relatively small number of studies compared to other articles (8 out of 144). This article had some limitations that included having differences in participant characteristics(severity of illness) that could have influenced the results.With fewer studies and potential biases, it may offer less robust evidence compared to the other articles which is why I have it ranked the lowest.
Magnitude of any effects:
All four articles suggest that music therapy has potential benefits for individuals with dementia, including improvements in cognitive function, mood, and quality of life. While some effects may be more significant in the long term or for specific aspects like verbal fluency or mood, they all point to positive outcomes. However, they also highlight the need for more clinical trials and research to fully understand the magnitude of these effects compared to standard care like cholinesterase inhibitors. So, while there’s promising evidence, further investigation is needed to determine the exact impact of music therapy on cognitive function, mood, behavior, and quality of life in elderly individuals with dementia.
Clinical significance
The four articles collectively suggest that music therapy can offer significant benefits for elderly individuals with dementia compared to standard therapy with cholinesterase inhibitors. Benefits such as enhancements in cognitive function, mood and potentially behavior and quality of life. While the magnitude of these effects may vary and more research is needed to fully understand the extent of these benefits, the clinical significance lies in the potential for music therapy to complement traditional treatment approaches and improve overall well-being in individuals with dementia. Integrating music therapy into care plans could provide a holistic approach to addressing the complex needs of patients living with dementia, offering a non-pharmacological intervention that may enhance their quality of life.
