Music-based therapy may benefit people living with dementia

A new Cochrane review has found evidence that music-based therapy may benefit people living with dementia, particularly by improving symptoms of depression.

Dementia is a collective term for progressive degenerative brain syndromes that affect memory, thinking, behavior and emotion. Alzheimer's Disease International reported that there were 55 million people with dementia worldwide in 2019, a figure predicted to increase to 139 million by 2050. While some medicines are available, the therapeutic use of music is considered a relatively simple and inexpensive approach that remains accessible even in the later stages of dementia. 

The research team from several institutions in the Netherlands examined evidence from 30 studies involving 1,720 people. The studies investigated the effects of music-based therapeutic interventions on emotional well-being including quality of life, mood disturbance, behavioral problems, social behavior, and cognition. Most participants were in care homes, with interventions delivered either individually or in group settings.

The trials were primarily conducted in high-income countries, including Australia, Taiwan, the US, and various European countries. Almost all the therapies included active elements (such as playing instruments), often combined with receptive elements (such as listening to live music provided by a therapist).

This review increases our understanding of the effects of music therapy and strengthens the case for incorporating music in dementia care, particularly in care home settings. Music therapy offers benefits beyond those of other group activities, helping to support mood and behavior in a way that is engaging and accessible, even in later stages of dementia. Care home managers should consider integrating structured musical sessions as part of a person-centered approach to dementia care."

Jenny van der Steen, lead author from Leiden University Medical Center and Radboudumc Alzheimer Center

The findings suggest that music-based therapy probably improves depressive symptoms and may improve overall behavioral problems by the end of treatment. Music therapy is unlikely to significantly impact agitation, aggression, emotional well-being, or cognition but, when compared to other interventions, there is some evidence that it may improve social behavior and could decrease anxiety.

Long-term effects, beyond four weeks after treatment, may be smaller but remain uncertain due to the limited number of trials monitoring effects after treatment ends.

The review also highlights the growing recognition of non-pharmacological interventions in dementia care.

"Music therapy is a drug-free way of helping people feel less sad and less anxious," says co-author Annemieke Vink from ArtEZ University of the Arts who has first-hand experience delivering music therapy to people with dementia. "We hope that the higher quality of recent studies and increasing evidence-base will result in more attention being given to music therapy and other non-pharmacological approaches."

She continues, "Looking at the effect sizes, music therapy is a reasonable alternative to pharmacological approaches and is much more person-centered."

The review underscores the need for further research into the long-term effects of music-based therapy particularly in community settings. Much of the existing evidence comes from care homes, so expanding studies to community-based environments could provide valuable insights into how music therapy can be integrated into everyday life for people living with dementia.