Does music therapy affect the global cognitive function of patients with dementia? A meta-analysis

Abstract

BACKGROUND:

Studies have shown that music therapy can improve a variety of symptoms of patients with dementia. The impact of music therapy on the global cognition of patients with dementia is controversial now.

OBJECTIVE:

To explore whether music therapy has an effect on the global cognitive function of patients with dementia.

METHODS:

PubMed, Web of Science, Embase, Google Academy and National Knowledge Infrastructure were systematically searched to collect all literature studies published since the establishment of the database until November 2020. All randomized controlled trials that met the criteria of music therapy in the intervention group and standard care in the control group with outcome measures of Mini-mental State Examination (MMSE) were included. Analysis was performed using Stata 16.0.

RESULTS:

The results showed that compared with the control group, the MMSE score in the music therapy group was generally higher (MD = 0.86, 95% CI: 0.07–1.66, P = 0.03).

CONCLUSIONS:

The result of this study differs from those of previous relevant meta-analyses, suggesting that music therapy is likely to improve the global cognitive function of patients with dementia, but more rigorous clinical trials are still needed to provide more sufficient and real evidence.

Keywords

Music therapy dementia Alzheimer’s disease cognitive function meta-analysis

1 Introduction

Dementia is any decline in cognition that is significant enough to interfere with independent, daily functioning. The causes of dementia are myriad and include primary neurologic, neuropsychiatric, and medical conditions (Gale, Acar, & Daffner, 2018). Alzheimer’s disease (AD) is the most common cause of dementia (Wisniewski,2019). It was estimated that 35.6 million people lived with dementia worldwide in 2010, with numbers expected to almost double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050 (Prince et al., 2013). Dementia not only greatly reduces the quality of life of patients themselves, but also brings great pain to families and burden to society.

It is the limited effectiveness of drug therapies which makes the examination of the role of non-pharmacological treatments (NPTs) on dementia symptoms essential (Gräsel, Wiltfang, & Kornhuber, 2003). NPTs can be effective in the management of clinical symptoms and are likely to play an important role in the primary and secondary prevention of dementia. Advantages of NPTs are that they are generally well accepted, have minimal adverse side effects, and can be combined with other NPTs both serially and simultaneously, and with pharmacological treatments without major concerns around interference (Sikkes et al., 2020).

There are many different ways of music therapy. Broadly, musical activities can be classified as either receptive (listening to music) or participatory (making music) (Mitchell & Agnelli, 2015). There are also no strict requirements for the treatment scenario, either individual music therapy at home or group music therapy by professional music therapists. The therapeutic value of music was explained mainly by music’s cultural role in facilitating social learning and emotional well-being. However, more recently—under the influence of new data in brain research in music—new findings suggest that music can stimulate complex cognitive, affective, and sensorimotor processes in the brain (Thaut, 2005). Studies have explored the effects of music therapy on children with autism spectrum disorders (LaGasse, 2017), depression (Aalbers et al., 2017), Parkinson’s disease (García-Casares, Martín-Colom, & García-Arnés, 2018) and other diseases with seemingly better results.

It is widely acknowledged that music is enjoyed by patients with dementia, even in the late or severe stage when verbal communication skills may be lost. Music activities in various forms can have positive effects on patients with dementia (Baird & Samson, 2015). At present, many studies have shown that music therapy can bring benefits in all aspects of patients with dementia. Han et al. (2010) showed that once-a-week music therapy can improve behavior and depression in patients with dementia. The results of a large meta-analysis (van der Steen et al., 2018) showed that music therapy can improve mood and quality of life and reduce anxiety in patients with dementia.

However, the impact of music therapy on the global cognition of patients with dementia is controversial. Four previous meta-analyses (Chang et al., 2015; Fusar-Poli, Bieleninik, Brondino, Chen, & Gold, 2018; Ueda, Suzukamo, Sato, & Izumi, 2013; van der Steen et al., 2018) studied the effects of music therapy on cognitive function in dementia patients, and the results were negative, but it is worth noting that there is no strict requirement in their study whether the control group is standard care or not. Including the study of entertainment or reading intervention in the control group may cause errors. On the other hand, there was no requirement for a professional music therapist in the study. Therefore, this meta-analysis has strictly formulated the inclusion and screening criteria to explore the impact of music therapy on the global cognitive function of dementia patients, in order to provide valuable reference for clinical practice.

2 Method

2.1 Retrieval

We searched the following databases: PubMed, Web of Science, Embase, Google Scholarship and National Knowledge Infrastructure (CNKI). The electronic searching was supplemented by hand-searching of reference lists of the included review articles to identify any additional sources. All articles published since the establishment of the database until November 2020 were collected. Searches were conducted through the subject words “Dementia”, “Music Therapy” and the free words “Dementias”, “Amentia”, “Amentias”, “Senile Paranoid Dementia”, “Dementias, Senile Paranoid”, “Paranoid Dementia, Senile”, “Paranoid Dementias, Senile”, “Senile Paranoid Dementias”, “Familial Dementia, Familial”, “Dementias, Familial”, “Dementias Therapy”, “Music” joint search.

2.2 Inclusion and exclusion criteria

Inclusion criteria: (1) Type of study: this study was only included in randomized controlled trials (RCTs). (2) Subjects: patients with dementia. (3) Interventions: standard care was used in the control group and music therapy intervention was performed in the experimental group while standard care was given. (4) Outcome indicators: scales containing evaluation of cognitive function of patients: Mini-mental State Examination (MMSE). (5) There are no restrictions on the language of the articles.

Exclusion criteria: (1) One of them (mild, moderate or severe) was selected as the study object according to the severity of dementia. (2) The intervention measures in the experimental group were combined with other treatments (such as exercise therapy, painting therapy, etc.). (3) The control group in the study received other kinds of intervention besides standard care. (4) The intervention process was not conducted by therapists with professional music therapy foundation. (5) Repeated published studies.

2.3 Study screening and data extraction

Two researchers were independently screened and then checked. In case of disagreement, a third researcher was asked to arbitrate. Researchers independently extracted data, including the first author of the article, publication time, sample size of the study subjects, intervention time, etc. After cross-checking, the controversial data were evaluated by the third researcher and unified through discussion.

2.4 Quality evaluation

Methodological quality assessment of articles was performed using the risk of bias assessment tool recommended by Cochrane Handbook. The six items of random allocation method, allocation concealment, implementation of blind method, integrity of outcome data, selective reporting bias and other biases were judged as “low risk”, “high risk” or “unclear”.

2.5 Statistical analysis

We used Stata 16.0 for the meta-analysis. Continuous variables were combined using mean difference (MD) as a statistic. Heterogeneity among included studies was analyzed by Q-test. If I²< 50% and P > 0.1 indicated that there was no statistical heterogeneity among studies, and fixed-effect model was used for analysis. If I²≥50% or P≤0.1, it indicates great heterogeneity among studies, and random effect model was used for analysis. Finally, a sensitivity analysis was conducted, and no publication bias analysis was conducted due to the limited number of included studies. The difference was statistically significant with P < 0.05.

3 Results

3.1 Study identification and selection

A total of 1235 articles were obtained after searching the database, including 1033 in English database and 202 in Chinese database. Endnote was used to exclude duplicate articles and 986 remained. 901 articles were rejected after further reading the title and abstract. 85 articles were rejected after further reading the full text. And 78 articles were rejected after further reading the full text (35 articles whose outcome index was not MMSE, 27 articles whose subjects did not meet the criteria, 16 articles whose interventions did not meet the criteria), and the final number of included studies was 7. The screening process is shown in Fig. 1.

Fig. 1

Specific process of screening study.

3.2 General characteristics included in the study

Seven RCTs (Ceccato et al., 2012; Choi, Lee, Cheong, & Lee, 2009; Chu et al., 2014; Lyu et al., 2018; Satoh et al., 2015; Suzuki, Kanamori, Nagasawa, & Saruhara, 2005; Weiai, Liqing, & Wensa, 2015) were included in this study, including 455 subjects in total. The general characteristics of the included studies are detailed in Table 1. There was no significant difference in baseline data such as age, gender and pre-intervention cognitive level between the experimental group and the control group in all included studies (P > 0.05).

Table 1
Characteristics of the included studies

First author Year Area Number of EG Number of CG Age of EG Age of CG Therapy time (week) MMSE repeated after the experiment (Yes or No)

Ae-Na Choi 2009 South Korea 10(AD:6 Vascular dementia:3 Other type:1) 10(AD:5 Vascular dementia:3 Other type:2) 77.2±6.5 72.6±9.9 5 No

Hsin Chu 2014 Taiwan, China 49 (not report) 51 (not report) 82.0±6.8 6 Yes (1 month later)

Jihui Lyu 2018 China 97 (all AD) 95 (all AD) 68.9±7.1 69.9±7.9 about 12 Yes (3 months later)

Masayuki Satoh 2015 Japan 10 (all AD) 10 (all AD) 78.1±7.0 77.0±6.0 about 24 No

Mizue Suzuki 2005 Japan 8 (AD:6 Vascular dementia:2) 8 (not report) 89.50±4.45 82.75±7.70 about 12 Yes (1 month later)

Weiai Zhong 2015 China 28 (AD:10 Vascular dementia:18) 29 (AD:9 Vascular dementia:20) 78.10±7.70 78.15±6.50 about 24 No

Enrico Ceccato 2012 Italy 27 (not report) 23 (not report) 85.5±5.9 82.7±7.1 12 No

First author	Year	Area	Number of EG	Number of CG	Age of EG	Age of CG	Therapy time (week)	MMSE repeated after the experiment (Yes or No)
Ae-Na Choi	2009	South Korea	10(AD:6 Vascular dementia:3 Other type:1)	10(AD:5 Vascular dementia:3 Other type:2)	77.2±6.5	72.6±9.9	5	No
Hsin Chu	2014	Taiwan, China	49 (not report)	51 (not report)	82.0±6.8	6	Yes (1 month later)
Jihui Lyu	2018	China	97 (all AD)	95 (all AD)	68.9±7.1	69.9±7.9	about 12	Yes (3 months later)
Masayuki Satoh	2015	Japan	10 (all AD)	10 (all AD)	78.1±7.0	77.0±6.0	about 24	No
Mizue Suzuki	2005	Japan	8 (AD:6 Vascular dementia:2)	8 (not report)	89.50±4.45	82.75±7.70	about 12	Yes (1 month later)
Weiai Zhong	2015	China	28 (AD:10 Vascular dementia:18)	29 (AD:9 Vascular dementia:20)	78.10±7.70	78.15±6.50	about 24	No
Enrico Ceccato	2012	Italy	27 (not report)	23 (not report)	85.5±5.9	82.7±7.1	12	No

EG: experimental group; CG: control group; MMSE: Mini-mental State Examination; AD: Alzheimer’s disease.

3.3 Quality evaluation results

3 of the included studies did not adopt a randomized allocation method, and all the included studies were at high risk if blinded entries were used or not because music therapy could not blind the subjects. The results of methodological quality assessment of the included studies are shown in Table 2.

Table 2
Risk of bias assessment of the included studies

Study ID Random sequence generation Blinding of participants and assessors Allocation concealment Incomplete outcome data Selective outcome reporting Other bias

Ae-Na Choi 2009 High High High Low Low Unclear

Hsin Chu 2014 Unclear High Low Low Low Unclear

Jihui Lyu 2018 Low High Low Low Low Unclear

Masayuki Satoh 2015 High High High Low Low Unclear

Mizue Suzuki 2005 High High High Low Low Unclear

Weiai Zhong 2015 Low High Unclear Low Low Unclear

Enrico Ceccato 2012 Low High Unclear Low Low Unclear

Study ID	Random sequence generation	Blinding of participants and assessors	Allocation concealment	Incomplete outcome data	Selective outcome reporting	Other bias
Ae-Na Choi 2009	High	High	High	Low	Low	Unclear
Hsin Chu 2014	Unclear	High	Low	Low	Low	Unclear
Jihui Lyu 2018	Low	High	Low	Low	Low	Unclear
Masayuki Satoh 2015	High	High	High	Low	Low	Unclear
Mizue Suzuki 2005	High	High	High	Low	Low	Unclear
Weiai Zhong 2015	Low	High	Unclear	Low	Low	Unclear
Enrico Ceccato 2012	Low	High	Unclear	Low	Low	Unclear

3.4 Meta-analysis results

MMSE was measured in all studies included in this study. It is a simplified, scored form of cognitive psychological state test that includes 11 questions and takes only 5–10 minutes to perform, so it can be used continuously and routinely. It is “mini” because it only focuses on the cognitive aspects of psychological function, and excludes issues related to mood, abnormal psychological experience and thought forms (Folstein, Folstein, & McHugh, 1975). Therefore, it can better reflect the cognitive status of dementia patients.

All the 7 included studies evaluated the global cognitive function of the patients using the MMSE scale. The MMSE measurement results of all patients included in the studies before and after the experiment are shown in Table 3. The higher the score of the MMSE scale, the better the mental status and cognitive ability of the patients. A total of 229 patients in the experimental group and 226 patients in the control group were included in the study. The heterogeneity among the included studies was small (I₂ = 0.0%, P = 0.49), so the fixed effect model was used to analyze. The results showed that compared with the control group, the MMSE score of the music treatment group was higher overall (MD = 0.86, 95% CI:0.07–1.66, P = 0.03), the difference was significant (P = 0.03 < 0.05), which was beneficial to improve the global cognitive function of patients with dementia. Figure 2 shows the specific result.

Table 3
MMSE scores of all included studies before and after the experiment

Study ID Number Pre-score (Mean±SD) Post-score (Mean±SD)

EG CG EG CG EG CG

Ae-Na Choi 2009 10 10 14.60±2.70 13.70±2.90 15.00±2.60 13.50±2.90

Hsin Chu 2014 49 51 12.80±6.15 13.76±5.36 15.72±6.53 13.82±4.36

Jihui Lyu 2018 97 95 13.45±3.66 13.22±4.01 13.34±3.82 12.99±3.85

Masayuki Satoh 2015 10 10 19.10±3.90 20.90±3.50 18.20±6.60 20.70±3.90

Mizue Suzuki 2005 8 8 15.75±5.65 15.50±6.39 15.63±6.30 13.88±6.01

Weiai Zhong 2015 28 29 20.20±6.50 20.23±6.70 22.51±7.00 19.42±7.51

Enrico Ceccato 2012 27 23 16.93±3.66 16.39±3.90 17.59±3.89 16.39±3.99

Study ID	Number	Pre-score (Mean±SD)	Post-score (Mean±SD)
Ae-Na Choi 2009	10	10	14.60±2.70	13.70±2.90	15.00±2.60	13.50±2.90
Hsin Chu 2014	49	51	12.80±6.15	13.76±5.36	15.72±6.53	13.82±4.36
Jihui Lyu 2018	97	95	13.45±3.66	13.22±4.01	13.34±3.82	12.99±3.85
Masayuki Satoh 2015	10	10	19.10±3.90	20.90±3.50	18.20±6.60	20.70±3.90
Mizue Suzuki 2005	8	8	15.75±5.65	15.50±6.39	15.63±6.30	13.88±6.01
Weiai Zhong 2015	28	29	20.20±6.50	20.23±6.70	22.51±7.00	19.42±7.51
Enrico Ceccato 2012	27	23	16.93±3.66	16.39±3.90	17.59±3.89	16.39±3.99

SD: standard deviation; EG: experimental group; CG: control group.

Fig. 2

Forrest plots of the effect of music therapy on cognitive functions in patients with dementia.

3 of the included studies had follow-up tests, and the MMSE scale was tested in the two groups one month or three months after the end of the experiment. The meta-analysis results are shown in Fig. 3. The results (MD = 0.60, 95% CI: –0.41–1.60, P = 0.24) showed that there was no difference in the scores between the two groups during the later follow-up (P = 0.24 > 0.05).

Fig. 3

Forrest plots of long-term effect of music therapy on cognitive functions in patients with dementia.

Fig. 4

Result of sensitivity analysis.

3.5 Subgroup analysis results

Based on the general characteristics of the study, the study was subdivided according to the following criteria: 1. Age: according to the mean age of the study subjects, the study was divided into≤80 years old group and > 80 years old group; 2. Intervention time: according to the different intervention time of each study, the study was divided into≤12 weeks group and > 12 weeks group; 3. Study subjects: according to the type of study subjects, the study was divided into multiple types of dementia group and only AD group.

According to the results of subgroup analysis, the age of the study subjects, the intervention time and the type of the study subjects were not the sources of heterogeneity. The results of each subgroup analysis are shown in Table 4.

Table 4
Subgroup analysis results

Subgroup n SMD [95% Conf. Interval] % Weight I-squared^† P value

Age(year)

≤80 4 0.149 –0.083 0.381 63.65 20.70% 0.207

> 80 3 0.326 0.02 0.633 36.35 0.00% 0.037^*

Overall 7 0.214 0.029 0.398 100.00 0.00% 0.024^*

Intervention time(week)

≤12 5 0.217 0.014 0.42 83.29 0.00% 0.036^*

> 12 2 0.196 –0.256 0.648 16.71 64.70% 0.396

Overall 7 0.214 0.029 0.398 100.00 0.00% 0.024^*

Disease types of participants

Multiple types of dementia 5 0.367 0.113 0.621 53.01 0.00% 0.005^*

Only AD 2 0.04 –0.229 0.31 46.99 25.70% 0.769

Overall 7 0.214 0.029 0.398 100.00 0.00% 0.024^*

Subgroup	n	SMD	[95% Conf. Interval]	% Weight	I-squared^†	P value
Age(year)
≤80	4	0.149	–0.083	0.381	63.65	20.70%	0.207
> 80	3	0.326	0.02	0.633	36.35	0.00%	0.037^*
Overall	7	0.214	0.029	0.398	100.00	0.00%	0.024^*
Intervention time(week)
≤12	5	0.217	0.014	0.42	83.29	0.00%	0.036^*
> 12	2	0.196	–0.256	0.648	16.71	64.70%	0.396
Overall	7	0.214	0.029	0.398	100.00	0.00%	0.024^*
Disease types of participants
Multiple types of dementia	5	0.367	0.113	0.621	53.01	0.00%	0.005^*
Only AD	2	0.04	–0.229	0.31	46.99	25.70%	0.769
Overall	7	0.214	0.029	0.398	100.00	0.00%	0.024^*

SMD: standard mean difference; AD: Alzheimer’s disease; ^*P value (< 0.05) is statistically significant; ^†I-squared: the variation in SMD attributable to heterogeneity.

3.6 Sensitivity analysis

A sensitivity analysis of the studies included in the meta-analysis of the effects of music therapy on the global cognitive function of patients with dementia suggested that the third study had a greater impact on the overall pooled effect results. After excluding the second study literature, the pooled results were (MD = 1.45, 95% CI: 0.28–2.62, P = 0.01), which showed a slight change compared with the original results, probably due to the larger sample size and negative results of the third study.

4 Discussion

4.1 Methodological quality of included studies

Although all included studies did not use blindness, the outcome was not affected by the absence of blindness. Three studies did not use a random assignment method. There were also three studies that did not assign concealment and rated it as high risk. Most studies did not explicitly report on randomized grouping methods and allocation concealment schemes, so the inclusion of studies of slightly poor quality may lead to a reduction in the reliability of results. The baseline data of age, sex and MMSE score of the subjects included in the study report were homogeneous.

4.2 Analysis of the effect of music therapy on cognitive function of patients with dementia

Music may help prevent or alleviate distressing symptoms of dementia in a number of ways (Scales, Zimmerman, & Miller, 2018). Furthermore, because musical memory is generally retained longer than other memories, music can facilitate reminiscence and potentially reduce anxiety through general mind activation and specific memory triggers (Spiro, 2010).

The default mode network (DMN) is a system of interconnected brain regions that are active during resting state when individuals are awake and alert, but not actively engaged in a directed attentional task (Raichle et al., 2001). Controlling for variables such as age, whole brain volume, and clinical diagnosis, integrity of the DMN is found to correlate with measures of global cognitive function (Spreng, Sepulcre, Turner, Stevens, & Schacter, 2013). There is extensive support in the literature for disrupted functional connectivity of the DMN in patients with AD (Sorg et al., 2007). Recent research demonstrates activation of the DMN when listening to music during moments of high activity where many instruments are simultaneously playing (Alluri et al., 2012).

The finding of Blood et al. (2001) linked music with biologically relevant, survival-related stimuli via their common recruitment of brain circuitry involved in pleasure and reward. They showed music recruits neural systems of reward and emotion similar to those known to respond specifically to biologically relevant stimuli, such as food and sex, and those that are artificially activated by drugs of abuse. The ability of music to induce such intense pleasure and its putative stimulation of endogenous reward systems suggest that, although music may not be imperative for survival of the human species, it may indeed be of significant benefit to our mental and physical well-being. For patients with dementia, despite cognitive impairment, they may still be stimulated by music.

Evidence indicates music and music therapy does work in reducing behavioral and psychological symptoms including agitation, aggression, wandering, restlessness, irritability, social and emotional difficulties and improving nutritional intake. In particular, playing preferred (favorite) music can reduce agitation; playing preferred music during bath time can reduce occurrences of aggressive behavior; and group music activities including listening, singing and playing can reduce wandering behavior (Hulme, Wright, Crocker, Oluboyede, & House, 2010). As a non-drug treatment, music therapy is low cost and has no side effects, so long-term music therapy may be a good choice for patients with dementia.

Although this meta-analysis shows that music therapy appears to have beneficial effects on cognitive function in patients with dementia, there was a subgroup (age≤80, intervention time > 12 weeks, study subjects AD) where the combined results showed no benefit, although the number of combined studies in each subgroup was small and the reliability of the results decreased, but it’s still worth paying attention to. At the same time, the results of sensitivity analysis also indicated that the results of this study were unstable, so the meta-analysis results support the view that more clinical trials need to prove.

The results of this meta-analysis found another problem. Although the analysis concluded that music therapy could improve cognitive function in dementia patients, follow-up tests from three studies found that the differences between the two groups disappeared after one or three months, this suggests that the effects of music therapy may be short lived, a view that needs to be supported by more research because of the small number of studies that conduct follow up testing, but which leads to new thinking: If music therapy is effective in patients with dementia, so how long can its effects last?

At present, some studies have begun to explore the role of music therapy in combination with other treatments. Giovagnoli et al. (2018) combined music therapy with memantine for AD. Although it was found that this approach did not seem to have a beneficial effect on patients’ language ability. But this provided a way to combine music therapy with medicine. Physical exercise seems to prevent and improve cognitive impairment in older adults, and structured, personalized, more intense, longer lasting and multi-component exercise programs show promise in maintaining cognitive ability in older adults. Satoh et al. (2014) combined music therapy with exercise to explore the effect of cognitive function in the elderly, and concluded that music combined with physical exercise can enhance the cognitive function of the elderly. This reminds us that music therapy can be combined with other non-pharmacological interventions to treat patients with dementia, thus achieving a more effective effect. More interestingly, Hsu et al. (2015) not only explored the impact of individual music therapy on dementia patients, but also reported the positive impact of music therapy on caregivers.

4.3 Innovations

This meta-analysis aims to provide a study on the effect of music therapy on cognitive function of dementia patients. First, contrary to the previous four meta-analyses results (Chang et al., 2015; Fusar-Poli et al., 2018; Ueda et al., 2013; van der Steen et al., 2018), this study is the first meta-analysis in favor of the possible beneficial effect of music therapy on the global cognitive function of patients with dementia. This study established strict exclusion criteria, requiring only standard care in the control group and music therapy to be completed by professional music therapists, which reduced the bias caused by other factors on the results of the study. At the same time, this study had no restrictions on the language of the study, so a Chinese article and a Japanese article were included to avoid selection bias and language bias.

4.4 Limitations and recommendations

The limitations of this study include the following four aspects: 1. This meta-analysis only included the MMSE scale in all the studies to reflect the effect of music therapy on cognitive function of patients with dementia, thus leading to incomplete judgment basis of the results. 2. There is no detailed enumeration and classification of music therapy methods in the study. 3. The total number of samples included in this study is small, the results are not universal, and the results of the two included studies showed that the scores of MMSE scale in the music therapy group and the control group were not statistically significant, so more studies are still needed to further confirm the results. 4. Due to the lack of relevant studies, the role of music therapy on cognitive function was not categorized in detail.

At present, there are few studies on the effects of music therapy on patients with dementia, and the mechanism is still unclear. It is hoped that there will be more clinical experiments to explore the impact and mechanism of music therapy on dementia, so as to obtain more clinical evidence. It is also suggested that future meta-analyses should analyze a variety of scales and collect more research samples for a more comprehensive analysis of this topic.

5 Conclusion

The results of this study show that music therapy seems to be effective in improving the global cognitive function of patients with dementia, but more rigorous clinical trials are needed to provide more sufficient and real evidence to prove this view. It is hoped that this study can provide evidence-based evidence for the clinical application of music therapy to improve cognitive function of patients with dementia.

Conflict of interest

The authors have no conflicts of interest to disclose.

Funding

This work was supported by the Provincial Quality Engineering Project of Colleges and Universities in Anhui Province (no. 2019jyxm0999) and the Young Natural Science Foundation of Anhui Medical University (no. 2019xkj036).

References

Aalbers,

, Fusar-Poli,

, Freeman,

R. E.

, Spreen,

, Ket,

J. C.

, Vink,

A. C.

,... Gold,

(2017). Music therapy for depression, Cochrane Database Syst Rev 11(11), Cd004517. https://doi.org/10.1002/14651858.cd004517.pub3

Alluri,

, Toiviainen,

, Jääskeläinen,

I. P.

, Glerean,

, Sams,

, & Brattico,

(2012). Large-scale brain networks emerge from dynamic processing of musical timbre, key and rhythm, Neuroimage 59(4), 3677–3689. https://doi.org/10.1016/j.neuroimage.2011.11.019

Baird,

, & Samson,

(2015). Music and dementia, Prog Brain Res 217, 207–235. https://doi.org/10.1016/bs.pbr.2014.11.028

Blood,

A. J.

, & Zatorre,

R. J.

(2001). Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion, Proc Natl Acad Sci U S A 98(20), 11818–11823. https://doi.org/10.1073/pnas.191355898

Ceccato,

, Vigato,

, Bonetto,

, Bevilacqua,

, Pizziolo,

, Crociani,

,... Barchi,

(2012). STAM protocol in dementia: a multicenter, single-blind, randomized, and controlled trial, Am J Alzheimers Dis Other Demen 27(5), 301–310. https://doi.org/10.1177/1533317512452038

Chang,

Y. S.

, Chu,

, Yang,

C. Y.

, Tsai,

J. C.

, Chung,

M. H.

, Liao,

Y. M.

,... Chou,

K. R.

(2015). The efficacy of music therapy for people with dementia: A meta-analysis of randomised controlled trials, J Clin Nurs 24(23-24), 3425–3440. https://doi.org/10.1111/jocn.12976

Choi,

A. N.

, Lee,

M. S.

, Cheong,

K. J.

, & Lee,

J. S.

(2009). Effects of group music intervention on behavioral and psychological symptoms in patients with dementia: a pilot-controlled trial, Int J Neurosci 119(4), 471–481. https://doi.org/10.1080/00207450802328136

Chu,

, Yang,

C. Y.

, Lin,

, Ou,

K. L.

, Lee,

T. Y.

, O’Brien,

A. P.

, & Chou,

K. R.

(2014). The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study, Biol Res Nurs 16(2), 209–217. https://doi.org/10.1177/1099800413485410

Folstein,

M. F.

, Folstein,

S. E.

, & McHugh,

P. R.

(1975). Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician, J Psychiatr Res 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6

10.

Fusar-Poli,

, Bieleninik,

Ł.

, Brondino,

, Chen,

X. J.

, & Gold,

(2018). The effect of music therapy on cognitive functions in patients with dementia: a systematic review and meta-analysis, Aging Ment Health 22(9), 1097–1106. https://doi.org/10.1080/13607863.2017.1348474

11.

Gale,

S. A.

, Acar,

, & Daffner,

K. R.

(2018). Dementia, Am J Med 131(10), 1161–1169. https://doi.org/10.1016/j.amjmed.2018.01.022

12.

García-Casares,

, Martín-Colom,

J. E.

, & García-Arnés,

J. A.

(2018). Music Therapy in Parkinson’s Disease, J Am Med Dir Assoc 19(12), 1054–1062. https://doi.org/10.1016/j.jamda.2018.09.025

13.

Giovagnoli,

A. R.

, Manfredi,

, Schifano,

, Paterlini,

, Parente,

, & Tagliavini,

(2018). Combining drug and music therapy in patients with moderate Alzheimer’s disease: a randomized study, Neurological Sciences 39(6), 1021–1028. https://doi.org/10.1007/s10072-018-3316-3

14.

Gräsel,

, Wiltfang,

, & Kornhuber,

(2003). Non-drug therapies for dementia: an overview of the current situation with regard to proof of effectiveness, Dement Geriatr Cogn Disord 15(3), 115–125. https://doi.org/10.1159/000068477

15.

Han,

, Kwan,

, Chen,

, Yusoff,

S. Z.

, Chionh,

H. L.

, Goh,

, & Yap,

(2010). A controlled naturalistic study on a weekly music therapy and activity program on disruptive and depressive behaviors in dementia, Dement Geriatr Cogn Disord 30(6), 540–546. https://doi.org/10.1159/000321668

16.

Hsu,

M. H.

, Flowerdew,

, Parker,

, Fachner,

, & Odell-Miller,

(2015). Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study, BMC Geriatr 15, 84. https://doi.org/10.1186/s12877-015-0082-4

17.

Hulme,

, Wright,

, Crocker,

, Oluboyede,

, & House,

(2010). Non-pharmacological approaches for dementia that informal carers might try or access: a systematic review, Int J Geriatr Psychiatry 25(7), 756–763. https://doi.org/10.1002/gps.2429

18.

LaGasse,

A. B.

(2017). Social outcomes in children with autism spectrum disorder: a review of music therapy outcomes, Patient Relat Outcome Meas 8, 23–32. https://doi.org/10.2147/prom.s106267

19.

Lyu,

, Zhang,

, Mu,

, Li,

, Champ,

, Xiong,

,... Li,

(2018). The Effects of Music Therapy on Cognition, Psychiatric Symptoms, and Activities of Daily Living in Patients with Alzheimer’s Disease, J Alzheimers Dis 64(4), 1347–1358. https://doi.org/10.3233/jad-180183

20.

Mitchell,

, & Agnelli,

(2015). Non-pharmacological approaches to alleviate distress in dementia care, Nurs Stand 30(13), 38–44. https://doi.org/10.7748/ns.30.13.38.s45

21.

Prince,

, Bryce,

, Albanese,

, Wimo,

, Ribeiro,

, & Ferri,

C. P.

(2013). The global prevalence of dementia: a systematic review and metaanalysis, Alzheimers Dement 9(1), 63–75.e62 https://doi.org/10.1016/j.jalz.2012.11.007

22.

Raichle,

M. E.

, MacLeod,

A. M.

, Snyder,

A. Z.

, Powers,

W. J.

, Gusnard,

D. A.

, & Shulman,

G. L.

(2001). A default mode of brain function, Proc Natl Acad Sci U S A 98(2), 676–682. https://doi.org/10.1073/pnas.98.2.676

23.

Satoh,

, Ogawa,

, Tokita,

, Nakaguchi,

, Nakao,

, Kida,

, & Tomimoto,

(2014). The effects of physical exercise with music on cognitive function of elderly people: Mihama-Kiho project, PLoS One 9(4), e95230. https://doi.org/10.1371/journal.pone.0095230

24.

Satoh,

, Yuba,

, Tabei,

, Okubo,

, Kida,

, Sakuma,

, & Tomimoto,

(2015). Music Therapy Using Singing Training Improves Psychomotor Speed in Patients with Alzheimer’s Disease: A Neuropsychological and fMRI Study, Dement Geriatr Cogn Dis Extra 5(3), 296–308. https://doi.org/10.1159/000436960

25.

Scales,

, Zimmerman,

, & Miller,

S. J.

(2018). Evidence-Based Nonpharmacological Practices to Address Behavioral and Psychological Symptoms of Dementia, Gerontologist 58(suppl_1), S88–s102. https://doi.org/10.1093/geront/gnx167

26.

Sikkes,

S. A. M.

, Tang,

, Jutten,

R. J.

, Wesselman,

L. M. P.

, Turkstra,

L. S.

, Brodaty,

,... Bahar-Fuchs,

(2020). Toward a theory-based specification of non-pharmacological treatments in aging and dementia: Focused reviews and methodological recommendations. Alzheimers Dement. https://doi.org/10.1002/alz.12188

27.

Sorg,

, Riedl,

, Mühlau,

, Calhoun,

V. D.

, Eichele,

, Läer,

,... Wohlschläger,

A. M.

(2007). Selective changes of resting-state networks in individuals at risk for Alzheimer’s disease, Proc Natl Acad Sci U S A 104(47), 18760–18765. https://doi.org/10.1073/pnas.0708803104

28.

Spreng,

R. N.

, Sepulcre,

, Turner,

G. R.

, Stevens,

W. D.

, & Schacter,

D. L.

(2013). Intrinsic architecture underlying the relations among the default, dorsal attention, and frontoparietal control networks of the human brain, J Cogn Neurosci 25(1), 74–86. https://doi.org/10.1162/jocn_a_00281

29.

Spiro,

(2010). Music and dementia: observing effects and searching for underlying theories, Aging Ment Health 14(8), 891–899. https://doi.org/10.1080/13607863.2010.519328

30.

Suzuki,

, Kanamori,

, Nagasawa,

, & Saruhara,

(2005). Behavioral, stress and immunological evaluation methods of music therapy in elderly patients with senile dementia], Nihon Ronen Igakkai Zasshi 42(1), 74–82. https://doi.org/10.3143/geriatrics.42.74

31.

Thaut,

M. H.

(2005). The future of music in therapy and medicine, Ann N Y Acad Sci 1060, 303–308. https://doi.org/10.1196/annals.1360.023

32.

Ueda,

, Suzukamo,

, Sato,

, & Izumi,

(2013). Effects of music therapy on behavioral and psychological symptoms of dementia: a systematic review and meta-analysis, Ageing Res Rev 12(2), 628–641. https://doi.org/10.1016/j.arr.2013.02.003

33.

van der Steen,

J. T.

, Smaling,

H. J.

, van der Wouden,

J. C.

, Bruinsma,

M. S.

, Scholten,

R. J.

, & Vink,

A. C.

(2018). Music-based therapeutic interventions for people with dementia, Cochrane Database Syst Rev 7(7), Cd003477. https://doi.org/10.1002/14651858.cd003477.pub4

34.

Weiai,

, Liqing,

, & Wensa,

(2015). Effects of group music therapy on patients with senile dementia. Medical Journal of Chinese People’s Health, (03), 82, 85.

35.

Wisniewski,

(2019). Alzheimer’s Disease. Codon Publications https://doi.org/10.15586/alzheimersdisease.2019