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Effectiveness of music intervention on cognitive function and neuropsychiatric symptoms in the elderly with dementia: a meta-analysis

TT Cecilia Wong
TT Cecilia Wong
   | Aug 03, 2022
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Article Category: Review
Published Online: Aug 03, 2022
Page range: 143 - 153
Received: Nov 14, 2020
Accepted: Feb 28, 2021
DOI: https://doi.org/10.2478/fon-2022-0020
Keywords
© 2022 Cecilia Wong TT, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

PRISMA flow diagram of the selection procedure. Abbreviations: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
PRISMA flow diagram of the selection procedure. Abbreviations: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Forrest plots of the effect of music therapy on cognitive function in patients with dementia. Abbreviation: CI, confidence interval.
Forrest plots of the effect of music therapy on cognitive function in patients with dementia. Abbreviation: CI, confidence interval.

Figure 3

Forrest plots of the effect of music therapy on neuropsychiatric symptoms in patients with dementia. Abbreviation: CI, confidence interval.
Forrest plots of the effect of music therapy on neuropsychiatric symptoms in patients with dementia. Abbreviation: CI, confidence interval.

JADAD scale for reporting RCTs.

Items Maximum points of included studies
Randomization Blinding An account of all patients
Chen & Pei 201813 2 2 1
Lyu et al. 201812 2 2 1
Thornley et al. 201618 2 2 1
Hsu et al. 201517 2 2 1
Raglio et al. 201519 2 2 1
Chu et al. 201411 2 2 1
Ridder et al. 201315 2 2 1
Sung et al. 201214 2 2 1
Ceccato et al. 201216 2 2 1

Characteristics of the included randomized controlled trials of music therapy on the neuropsychiatric symptoms of dementia patients.

Study/year country Study design Patient & characteristic Description of intervention (type, frequency, time, duration) Music therapist (Yes/No) Control group(s) Measurement tool(s) Neuro Psychiatric symptom(s) outcome(s) Neuro psychiatric symptoms results/findings/outcomes
Chen & Pei, Taiwan, China 201813 RCTs Intervention group (n = 15), F:M = 9:6, (mean age = 77.3) Control group (n = 13), F:M = 5:8, (mean age=77.3) Singing with percussion instrument × 60 min weekly for 8 weeks and follow-up after 8 weeks (with music therapist) Control group (Yes) Self-choose activities e.g. chess games, playing cards, reading, writing, mathematical exercise and walking exercises × 60 min for 8 weeks and follow-up after treatment CMAI-C- to assess agitated behaviors CMAI-C mean score:Intervention group: Pretest: 44.3 Posttest: 41.9Control group: Pretest: 34.7 Posttest: 39.0 The results of the study showed music therapy can improve agitation. The posttest mean score of intervention group is lower pretest mean score.
Sung et al., Taiwan, China 201214 RCTs Intervention group (n = 27), F:M = no data (mean age = 81.37) Control group (n=28), F:M=no data (mean age=79.5) Percussion instruments with familiar music × 30 min delivered in the afternoon twice a week × 6 weeks (total 12 sessions) and follow-up at 4th & 6th weeks after treatment (no involvement of music therapist) Control group (No) Usual care: e.g., TV watching, family visiting and parties, basic nursing care, meal provision for 6 weeks and follow-up at 4th & 6th weeks after treatment CMAI-C- to assess agitated behaviors CMAI-C mean score:Intervention group: Pretest: 36.26 Posttest:33.59 (at 4th week) Posttest: 32.70 (at 6th week)Control group: Pretest: 35.79 Posttest: 33.54 (at 4th week) Posttest: 31.00 (at 6th week) The results of the study reported the level of anxiety, agitated behaviors can be reduced. The mean score of CMAI-C are consistent with low level of agitated behavior.
Thornley, Canada 201618 RCTs Intervention group (n = 10), F:M = no data, (mean age = 83.5) Control group (n = 6), F:M=no data, (mean age=68.4) Singing and playing simple instruments, including maracas and small drums × 30 min biweekly for 4 weeks (total 8 sessions) and follow-up at 1st week of treatment and the end of treatment (no involvement of music therapist) Control group (No) Active engagement and attention intervention using “online randomization program” for 4 weeks and follow-up at 1st week of treatment and the end of treatment CMAI-to assess agitated behaviors CMAI mean score:Intervention group: Pretest:67.8 Posttest: 54.3 (at 1st week) Posttest: 84.3 (at 4th week)Control group: Pretest: 64.2 Posttest: 56.2 (at 1st week) Posttest: 79.0 (at 4th week) The results of the study show agitated behavior items with music therapy can improve. The posttest CMAI mean score in intervention group was greater than pretest mean score
Ridder et al., 2013 Denmark and Norway15 RCTs Intervention group Participants (n = 20) F:M = 14:7, (mean age=82.17) Control group: Participants (n=20) F:M=14:7, (mean age=80.20) Singing songs, dancing/moving for biweekly × 6 weeks (total 12 sessions) and follow up at 7th & 14th weeks after end of treatment no data on duration of each session. (with music therapist) Control group (No) Standard care: Talking, walking for 6 weeks and follow up at 7th & 14th weeks after end of treatment CMAI-fr -to assess agitated behaviors frequency CMAI-fr mean score:Intervention group: Pretest: 30.21 Posttest: 29.05 (at 7th week) Posttest: 28.0 (at 14th week)Control group: Pretest:30.98 Posttest:32.12 (at 7th week) Posttest:26.09 (at 14th week) This study showed that 6 weeks of music therapy can reduce agitation frequency. The mean score of CMAI-fr is consistent with low agitation frequency.
Lyu et al., 2018 China12 RCTs Intervention groups: (n=32), F:M=17:15 (mean age=68.9) Control group (n = 30), F:M = 17:13, (mean age = 69.9) Singing song twice daily for 180 sessions × 40 min for 3 months and follow up after the 3rd and 6th months after start of treatment (with music therapist) Control group (No) Routine care × 40 min × 180 sessions for 3 months and follow-up at the 3rd and 6th months after start of treatment NPI -to assess behavioral, mood NPI mean score:Intervention groups: Pretest:16.37 Posttest:13.52 (at 3rd month) Posttest:13.01 (at 6th month)Control group: Pretest test:15.77 Posttest:15.14 (at 3rd month) Posttest:15.42 (at 6th month) The results of the study showed improvement over time in behavioral, mood symptoms by the consistent reduction in NPI mean score. The posttest of NPI mean score in intervention is lower than pretest
Raglio et al., 2015 Italy19 RCTs Intervention group: (n = 40), F:M = 29:11 (mean age = 81.0) Control group (n = 40), F:M = 33:7, (mean age = 82.4) Listening to music with playing instrument × 30 min twice a week for 10 weeks (total 20 sessions) and follow up after treatment and at 2 months after end of treatment (with music therapist) Control group (No) Standard care, e.g. Reading the newspaper, playing cards, personal care and physical activities for 10 weeks and follow-up after treatment and at 2 months after treatment NPI -to assess behavioral, mood NPI mean score:Intervention group: Pretest: 33.1 Posttest: 23.7 (after treatment) Posttest: 22.4 (at 2 months)Control group: Pretest: 36.7 Posttest: 28.9 (after treatment) Posttest:26.8 (at 2 months) The results of the study showed improvement over time in behavioral, mood symptoms by the consistent reduction in NPI mean score of intervention group.
Hsu et al., 2015 United Kingdom17 Mixed method trial design: RCTs, intervein and observation Intervention group (n = 6), F:M = 5:1 (mean age = 84.56) Control group (n=7), F:M=7:0, (mean age = 82.5) Singing along with instrument playing and talking × 30mins weekly for 7 months (total 22 sessions), and 15min pre & post resting time at the 3rd, 5th, and 7th months of treatment and no follow-up after end of treatment (with music therapist) Control group (No) Standard care, e.g., Chaplaincy service, entertainment and leisure activities × 30 min at 3rd, 5th, and 7th months of treatment and no follow-up after end of treatment NPI -to assess behavioral, mood NPI mean score:Intervention group: Pretest: 17.33 Posttest: 10.83 (at 3rd month) Posttest: 12.33 (at 5th month) Posttest: 8.67 (at 7th month)Control group: Pretest: 17.57 Posttest: 24.29 (at 3th month) Posttest: 26.57 (at 5th month) Posttest: 34.43 (at 7th month) The results of the study showed music therapy can improve neuropsychiatric symptoms of dementia. The mean score of NPI is consistent with low level of neuropsychiatric symptoms.
Raglio et al., 2015 Italy RCTs Intervention group: (n = 40), F:M = 29:11 (mean age = 81.0) Control group (n=40), F:M=33:7, (mean age=82.4) Listening to music with playing instrument × 30 min twice a week for 10 weeks (total 20 sessions) and follow up after treatment and at 2 months after end of treatment (with music therapist) Control group (No) Standard care e.g. Reading the newspaper, playing cards, personal care and physical activities for 10 weeks and follow-up after treatment and at 2 months after treatment CSDD -to assess depression symptoms CSDD mean score:Intervention group: Pretest: 9.0 Posttest: 6.5 (after treatment) Posttest: 7.0 (at 2 months)Control group: Pretest: 8.0 Posttest: 7.0 (after treatment) Posttest: 7.0 (at 2 months) The results of the study showed improvement in depression symptoms and reduced posttest mean score in intervention group.
Chu et al., 2014 Taiwan, China11 RCTs Intervention group (n = 49), F:M = 26:23, (mean age=82) Control group (n = 51), F:M = 27:24, (mean age = 82) Listening, singing with playing instrument ×30mins twice a week for 6 weeks (total 12 sessions) and follow-up at the 6th and 12th sessions and 4 weeks after treatment (with music therapist) Control group (No) Usual care: e.g., watching television, afternoon tea and taking walks for 6 weeks and as follow-up at 6th and 12th sessions and 4 weeks after treatment CSDD -to assess depression symptoms CSDD mean score:Intervention group: Pretest: 17.39 Posttest: 11.47 (at 6th session) Posttest: 8.22 (at 12th session) Posttest: 11.23 (at 4weeks)Control group: The mean score of CSDD in control group: 15.70, 14.66, 13.78 and 11.43 (at baseline, 6th and 12th sessions & 4 weeks after treatment) The results of the study showed improved in depression. The mean scores of CSDD in intervention group was consistent low levels of depression.

Classification of the measurement tools to assess cognitive function included RCT studies.

Study/year Use of measurement tool(s) Outcome measures
MMSE (CDR) The WHO-UCLA AVLT TMT To assess cognitive function To assess attention control
Ceccato (2012)16 √ √
Thornley (2016)18 √ √
Chu et al. (2014)11 √ √
Lyu et al. (2018)12 √ √
Chen & Pei (2018)13 √ √
Ridder et al. (2013)15 √ √
Raglio et al. (2015)19 √ √
Thornley (2016)18 √ √
Chen & Pei (2018)13 √ √
Raglio et al. (2015)19 √ √
Lyu et al. (2018)12 √ √
Chen & Pei (2018)13 √ √

Classification of the measurement tools to assess neuropsychiatric symptoms included RCT studies.

Study/year Use of measurement tool(s) Outcome measures
Chen & Pei (2018)13 CMAI-C/CMAI/CMAI-fr/CMAI-di To assess agitated behaviors
Ridder et al. (2013)15 CMAI-C/CMAI/CMAI-fr/CMAI-di To assess agitated behaviors
Thornley (2016)18 CMAI-C/CMAI/CMAI-fr/CMAI-di To assess agitated behaviors
Sung (2012)14 CMAI-C/CMAI/CMAI-fr/CMAI-di To assess agitated behaviors
Ceccato (2012)16 CMAI-C/CMAI/CMAI-fr/CMAI-di To assess agitated behaviors
Ceccato (2012)16 GDS To assess depression symptoms
Ridder et al. (2013)15 GDS To assess depression symptoms
Raglio et al. (2015)19 CSDD To assess depression symptoms
Chu et al. (2014)11 CSDD To assess depression symptoms
Chu et al. (2014)11 Salivary Cortisol To assess depression symptoms
Sung et al. (2012)14 RAID scale To measure anxiety levels
Hsu et al. (2015)17 DCM To observe behavior, mood, and engagement
Hsu et al. (2015)17 NPI/NPI-NH To assess behavioral, mood, and quality of life
Lyu et al. (2018)12 NPI/NPI-NH To assess behavioral, mood, and quality of life
Raglio et al. (2015)19 NPI/NPI-NH To assess behavioral, mood, and quality of life
Thornley (2016)18 NPI/NPI-NH To assess behavioral, mood and quality of life
Lyu et al. (2018)12 BI To assess behavioral, mood, and quality of life
Raglio et al. (2015)19 BI To assess behavioral, mood, and quality of life
Ridder et al. (2013)15 QOL-AD To assess quality of life
Raglio et al. (2015)19 CBS-QoL/(CBS) To assess behavioral and psychological outcomes and quality of life

The clinical burning question with Population (P), Intervention (I), Comparison (C), Outcome (O), Timeframe (T) (PICOT).

Items PICOT Keywords
Population (P) Dementia people “Dementia„ “Alzheimer's disease”
Intervention (I) Music intervention or music therapy (listening, singing songs, and playing musical instrument) “Music therapy,” “Music intervention,” “Musical therapy”
Comparison (C) Without music intervention (usual daily activity or usual care, e.g., reading newspaper, bathing, physical exercise, etc.) Not available
Outcome (O) Improve cognition or reduce anxiety or depression or agitation and/or improve quality of life “Cognitive function,” “Cognition function,” “Neuropsychiatric symptoms”
Time frame (T) More than 4 weeks can be included Not available
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