The Impact of Music Therapy on Alzheimer's Disease Patients Contributed by Nicole Forgeron (3/99) Introduction In Canada, Alzheimer's disease affects 8.0% of the population aged 65 and over, and 34.5% aged 85 and over. Worldwide, roughly 5.1% of persons aged 65 and older, and 26% of those aged 85 and over are diagnosed with this disease (Forbes, 1998). Alzheimer's disease (AD) involves a progressive deterioration of brain cells. Affected individuals experience intellectual decline (with respect to memory, judgement, language, and decision-making ability), as well as a number of behavioral disturbances, including withdrawal, depression, aggression, and agitation. With the progression of Alzheimer's disease comes serious disorientation, confusion, and anxiety. Although, currently, there is no definitive cure for AD, alleviation of its associated behavioral problems can contribute to an improvement in the patients' quality of life, thereby reducing their stress level. Several treatment interventions have been used to manage, decrease, and prevent aggressiveness and agitation in people with Alzheimer's disease, the most prevalent being medication. However, given the negative side-effects of many of the existing drug treatments, the need for alternative approaches is evident. Music therapy has become an increasingly popular intervention strategy for Alzheimer's disease patients, particularly for those in nursing homes who display disruptive behaviors (Clark, Lipe, & Bilbrey, 1998). How Might Music Influence Behavior The majority of the existing studies on the effects of music therapy emphasize its therapeutic role in decreasing agitated behaviors. Music has been introduced into therapy to promote feelings of acceptance and belonging: playing favorite songs is often used to calm down anxious AD patients (Beck, 1998). Alzheimer's disease patients can continue to participate in organized music activities, even though they exhibit deteriorating levels of functioning; also, Alzheimer's sufferers may be able to retain musical perception, and learn new information when presented in a musical context. Hence, music may offer an alternative way of communicating for people with AD, when their ability to express and interpret language has significantly declined (Brotons & Pickett-Cooper, 1996). Research Findings The use and benefits of music therapy is acknowledged in recent literature. A study conducted by Clark, Lipe, & Bilbrey (1998) examined the effects of recorded, preferred music in decreasing occurrences of aggressive behavior among Alzheimer's patients during bathing episodes (the care-giving routine during which disruptive behaviors were reported by nursing staff to be the most problematic). Eighteen adults, aged 55-95, with severe levels of cognitive impairment, participated in the study. They were randomly scheduled for observation during bath-time under either a control (no music) condition or an experimental condition in which recorded selections of preferred music were played. After a two-week period, participants reversed conditions. A significant difference was found between the music and no music condition -- during the music condition, decreases occurred in 12 of the 15 previously observed aggressive behaviors. Care-givers noticed that, during the music condition, patients showed improvements in mood, evidenced by an increase in smiling, dancing, and clapping to the music. Also, some were reported as being more calm and cooperative during the bathing routine. Brotons & Pickett-Cooper (1996) investigated the impact of live music therapy in agitation behavior of Alzheimer's disease patients before, during, and after the music intervention. Twenty subjects, aged 70-96, from four nursing homes, were used for the analysis. The music therapy session included different musical activities designed according to the subjects' functioning ability (e.g. singing, dancing, playing musical games or instruments). Results indicated that subjects were significantly less agitated during and after music therapy than before music therapy. Movements and behaviors that were seen as unintentional and uncontrollable before music therapy now seemed more purposeful, more rhythmical, as though they were moving with the music. Subjects appeared to gain some control over these actions. In addition, informal reports from staff proposed that this decrease in agitation continued for the rest of the afternoon and into evening periods. Forbes (1998) conducted a systematic overview to summarize research findings for managing the behavioral problems associated with Alzheimer's disease. The most commonly used form of intervention was found to be music therapy. A study by Rugneskog et al. (1996) showed that AD patients ate more when music was played; music also resulted in the subjects eating by themselves more often. Irritability, anxiety, and depression declined as well. Lindenmuth et al. (1992) found that music increased the number of hours of productive sleep in people with AD. Although Forbes rated this investigation as weak, the results remain assuring. Conclusions The results of these studies suggest that music therapy may be a creative and effective behavioral intervention in the management of disruptive behaviors displayed by people with Alzheimer's disease. Although AD causes progressive brain deterioration, musical activity can be modified for even the most severely demented patients. Because of the extreme variability among AD patients, their reactions to intervention strategies may be different. As a result, it is important to individualize these approaches according to the patients' personal needs. Further research is needed in this area in order to understand, in greater detail, how music therapy can work to enhance the lives of people with dementia. However, behavioral interventions, such as music therapy, have "great potential for improving the quality of life and well-being of both family caregivers and patients (Beck, 1998, pp. 45-46)". References Beck, C. (1998). "Psychosocial and behavioral interventions for Alzheimer's disease patients and their families." American Journal of Geriatric Psychiatry, 6(2), 41-48. Brotons, M. and Pickett-Cooper, P. (1996). "The effects of music therapy intervention on agitation behaviors of Alzheimer's disease patients." Journal of Music Therapy, 33(1), 2-18. Clark, M., Lipe, A., and Bilbrey, M.(1998). "Use of music to decrease aggressive behaviors in people with dementia." Journal of Gerontological Nursing, 24(7), 10-17. Craig, G. (1996). Human Development. 7th ed. New Jersey: Prentice Hall. Forbes, D. (1998). "Strategies for managing behavioral symptomatology associated with dementia of the Alzheimer type: a systematic overview." Canadian Journal of Nursing Research, 30(2), 67-86. Web Links of Interest Canadian Association for Music Therapy: Music Therapy Information American Psychological Association: Information on Alzheimer's Disease   Back to Health Web Project Page