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

Cecilia Wong, TT

doi:10.2478/fon-2022-0020

Figures & Tables

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

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 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 4^th & 6^th 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 4^th & 6^th weeks after treatment	CMAI-C- to assess agitated behaviors	CMAI-C mean score:Intervention group: Pretest: 36.26 Posttest:33.59 (at 4^th week) Posttest: 32.70 (at 6^th week)Control group: Pretest: 35.79 Posttest: 33.54 (at 4^th week) Posttest: 31.00 (at 6^th 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 1^st 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 1^st 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 1^st week) Posttest: 84.3 (at 4^th week)Control group: Pretest: 64.2 Posttest: 56.2 (at 1^st week) Posttest: 79.0 (at 4^th 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 7^th & 14^th 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 7^th & 14^th 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 7^th week) Posttest: 28.0 (at 14^th week)Control group: Pretest:30.98 Posttest:32.12 (at 7^th week) Posttest:26.09 (at 14^th 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 3^rd and 6^th 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 3^rd and 6^th months after start of treatment	NPI -to assess behavioral, mood	NPI mean score:Intervention groups: Pretest:16.37 Posttest:13.52 (at 3^rd month) Posttest:13.01 (at 6^th month)Control group: Pretest test:15.77 Posttest:15.14 (at 3^rd month) Posttest:15.42 (at 6^th 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 3^rd, 5^th, and 7^th 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 3^rd, 5^th, and 7^th 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 3^rd month) Posttest: 12.33 (at 5^th month) Posttest: 8.67 (at 7^th month)Control group: Pretest: 17.57 Posttest: 24.29 (at 3^th month) Posttest: 26.57 (at 5^th month) Posttest: 34.43 (at 7^th 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 6^th and 12^th 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 6^th and 12^th 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 12^th 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, 6^th and 12^th 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

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

Figures & Tables

Figure 1

Figure 2

Figure 3

JADAD scale for reporting RCTs_

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

Classification of the measurement tools to assess cognitive function included RCT studies_

Classification of the measurement tools to assess neuropsychiatric symptoms included RCT studies_

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

Paradigm

My account