Effects of Music on Agitation in Dementia: A Meta-Analysis

Siv K A Pedersen, Per N Andersen, Ricardo G Lugo, Marita Andreassen, Stefan Sütterlin, Siv K A Pedersen, Per N Andersen, Ricardo G Lugo, Marita Andreassen, Stefan Sütterlin

Abstract

Agitation is a common problem in patients suffering from dementia and encompasses a variety of behaviors such as repetitive acts, restlessness, wandering, and aggressive behaviors. Agitation reduces the probability of positive social interaction and increases the psychological and organizational burden. While medical interventions are common, there is need for complementary or alternative methods. Music intervention has been brought forward as a promising method to reduce agitation in dementia. While interventions, target groups and research designs differ, there has so far not been a systematic overview assessing the effect of music intervention for agitation in patients with dementia. A meta-analysis was conducted in order to investigate possible effects of music interventions. Twelve studies met inclusion criteria. Music intervention had a medium overall effect on agitation in dementia, suggesting robust clinical relevance. While the moderate number of studies does not allow for further differentiation between sub-types of music intervention, the sub-group comparisons indicated promising pathways for future systematic reviews. This meta-analysis is the first systematic and quantitative overview supporting clinically and statistically robust effects of music intervention on agitation in dementia. The analysis provides further arguments for this non-pharmacological approach and highlights needs for future systematic research reviews for the investigation of intervention types.

Keywords: agitation; dementia; meta-analysis; music intervention; therapy.

Figures

Figure 1
Figure 1
Flow chart process of study selection and categorization.
Figure 2
Figure 2
Forest plot on the effect of music intervention in demented people. The center point reflects the mean effect size between a confidence interval of 95%.
Figure 3
Figure 3
Funnel plot illustrating proneness to publication bias for the included studies. Mean effect size is d = 0.61 (CI 0.38, 0.84).)

References

    1. American Music Therapy Association (2006). Music Therapy and Alzheimer's Disease. Available online at: (Accessed Dec 19, 2016).
    1. Azermai M., Elseviers M., Petrovic M., Van Bortel L., Stichele R. V. (2011). Geriatric drug utilisation of psychotropics in Belgian nursing homes. Hum. Psychopharmacol. 26, 12–20. 10.1002/hup.1160
    1. Caltagirone C., Bianchetti A., Di Luca M., Mecocci P., Padovani A., Pirfo E., et al. . (2005). Guidelines for the treatment of Alzheimer's disease from the Italian Association of Psychogeriatrics. Drugs Aging 22, 1–26. 10.2165/00002512-200522001-00002
    1. Cerejeira J., Lagarto L., Mukaetova-Ladinska E. B. (2012). Behavioral and psychological symptoms of dementia. Front. Neurol. 3:73. 10.3389/fneur.2012.00073
    1. *. Clark M. E., Lipe A. W., Bilbrey M. (1998). Use of music to decrease aggressive behaviors in people with dementia. J. Gerontol. Nurs. 24, 10–17. 10.3928/0098-9134-19980701-05
    1. Cohen J. (1992). A power primer. Psychol. Bull. 112, 155–159. 10.1037/0033-2909.112.1.155
    1. Cohen-Mansfield J. (2008). Agitated behavior in persons with dementia: the relationship between type of behavior, its frequency, and its disruptiveness. J. Psychiatr. Res. 43, 64–69. 10.1016/j.jpsychires.2008.02.003
    1. Cohen-Mansfield J., Billing N. (1986). Agitated behaviors in the elderly: a conceptual review. J. Am. Geriatr. Soc. 34, 711–721. 10.1111/j.1532-5415.1986.tb04302.x
    1. Cohen-Mansfield J., Marx M., Rosenthal A. S. (1989). A description of agitation in a nursing home. J. Gerontol. 44, 77–84. 10.1093/geronj/44.3.M77
    1. Cooke M. L., Moyle W., Shum D. H. K., Harrison S. D., Murfiled J. E. (2010). A randomized control trial exploring the effect of music on quality of life and depression in older people with dementia. J. Health Psychol. 15, 765–766. 10.1177/1359105310368188
    1. Cummings J., Mega M., Gray K., Rosenberg-Thompson S., Carusi D. A., Gornbein J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 44, 2308–2314. 10.1212/WNL.44.12.2308
    1. Easterbrook P. J., Gopalan R., Berlin J. A., Matthews D. R. (1991). Publication bias in clinical research. Lancet 337, 867–872. 10.1016/0140-6736(91)90201-Y
    1. Egger M., Davey Smith G., Schneider M., Minder C. (1997). Bias in meta-analysis detected by a simple, graphical test. Br. Med. J. 315, 629–634. 10.1136/bmj.315.7109.629
    1. El Haj M., Postal V., Allain P. (2012). Music enhances autobiographical memory in mild Alzheimer's disease. Educ. Gerontol. 38, 30–41. 10.1080/03601277.2010.515897
    1. Finkel S. I., Lyons J. S., Anderson R. L. (1992). Reliability and validity of the Cohen-mansfield agitation inventory in institutionalized elderly. Int. J. Geriatr. Psychiatry 7, 487–490. 10.1002/gps.930070706
    1. Guétin S., Portet F., Picot M. C., Pommié C., Messaoudi M., Djabelkir L., et al. . (2009). Effect of music therapy on anxiety and depression in patients with Alzheimer's type dementia: randomised, controlled study. Dement. Geriatr. Cogn. Disord. 28, 36–46. 10.1159/000229024
    1. Hallam S., Cross I., Thaut M. (2009). The Oxford Handbook of Music Psychology. New York, NY: Oxford University Press.
    1. Hansen R. A., Gartlehner G., Lohr K. N., Kaufer D. I. (2007). Functional outcomes of drug treatment in Alzheimer's disease. Drugs Aging 24, 155–167. 10.2165/00002512-200724020-00007
    1. Higgins J. P. T., Thompson S. G., Deeks J. J., Altman D. G. (2003). Measuring inconsistency in meta-analyses. Br. Med. J. 327, 557–560. 10.1136/bmj.327.7414.557
    1. *. Janata P. (2012). Effects of widespread and frequent personalized music programming on agitation and depression in assisted living facility residents with Alzheimer-type dementia. Music Med. 4, 8–15. 10.1177/1943862111430509
    1. *. Lin Y., Chu H., Yang C. Y., Chen C. H., Chen S. G., Chang H. J., et al. . (2011). Effectiveness of group music intervention against agitated behavior in elderly persons with dementia. Int. J. Geriatr. Psychiatry 26, 670–678. 10.1002/gps.2580
    1. MacDonald R. A. R. (2013). Music, health, and well-being: a review. Int. J. Qual. Stud. Health Well Being 8:20635 10.3402/qhw.v8i0.20635
    1. Morris S. B. (2008). Estimating effect sizes from pretest-posttest-control group designs. Organ. Res. Methods 11, 364–386. 10.1177/1094428106291059
    1. National Institute for Clinical Excellence (2006). Guidance for Dementia: Supporting People with Dementia and Their Carers in Health and Social Care. Clinical Guideline. National Institute for Clinical Excellence. 42.
    1. Orwin R. G. (1983). A fail-safe N for effect size in meta-analysis. J. Educ. Stat. 8, 157–159. 10.3102/10769986008002157
    1. *. Raglio A., Bellelli G., Traficante D., Gianotti M., Ubezio M. C., Villani D., et al. . (2008). Efficacy of music therapy in the treatment of behavioral and psychiatric symptoms of dementia. Alzheimer Dis. Assoc. Disord. 22, 158–162. 10.1097/WAD.0b013e3181630b6f
    1. Raglio A., Bellelli G., Traficante D., Gianotti M., Ubezio M. C., Villani D., et al. . (2010). Efficacy of music therapy treatment based on cycles of sessions: a randomised controlled trial. Aging Ment. Health 14, 900–904. 10.1080/13607861003713158
    1. *. Raglio A., Bellelli G., Traficante D., Gianotti M., Ubezio M. C., Villani D., et al. . (2015). Effect of active music therapy and individualized listening to music on dementia: a multicenter randomized controlled trial. J. Am. Geriatr. Soc. 63, 1534–1539. 10.1111/jgs.13558
    1. Reisberg B., Auer S. R., Monteiro I. M. (1996). Behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale. Int. Psychogeriatric 8, 301–308.
    1. Reisberg B., Borenstein J., Salob S. P., Ferris S. H., Franssen E. H., Georgotas A. (1987). Behavioral symptoms in Alzheimer's disease: phenomenology and treatment. J. Clin. Psychiatry 48, 9–15.
    1. Reisberg B., Ferris S. H., de Leon M. J., Crook T. (1982). The global deterioration scale for assessment of primary degenerative dementia. Am. J. Psychiatry 139, 1136–1139. 10.1176/ajp.139.9.1136
    1. *. Remington R. (2002). Calming music and hand massage with agitated elderly. Nurs. Res. 51, 317–325. 10.1097/00006199-200209000-00008
    1. Ridder H. M., Stige B., Qvale L. G., Gold C. (2013). Individual music therapy for agitation in dementia: an exploratory randomized controlled trial. Aging Ment. Health 17, 667–678. 10.1080/13607863.2013.790926
    1. Rosenthal R. (1979). The “file drawer problem” and tolerance for null results. Psychol. Bull. 86, 638–641. 10.1037/0033-2909.86.3.638
    1. Rothstein H. R., Sutton A. J., Borenstein M. (eds.). (2006). Publication Bias in Meta-Analysis: Prevention, Assessment and Adjustments. New York, NY: John Wiley & Sons.
    1. *. Sakamoto M., Ando H., Tsutou A. (2013). Comparing the effects of different individualized music interventions for elderly individuals with severe dementia. Int. Psychogeriatr. 25, 775–784. 10.1017/S1041610212002256
    1. Schulz R., Williamson G. M. (1991). A two-year longitudinal study of depression among Alzheimer's caregivers. Psychol. Aging 6, 569–578. 10.1037/0882-7974.6.4.569
    1. Sourial R., McCusker J., Cole M., Abrahamowicz M. (2001). Agitation in demented patients in an acute care hospital: prevalence, disruptiveness, and staff burden. Int. Psychogeriatr. 13, 183–197. 10.1017/S1041610201007578
    1. *. Sung H. C., Chang A. M., Abbey J. (2006b). The effects of preferred music on agitation of older people with dementia in Taiwan. Int. J. Geriatr. Psychiatry 21, 999–1000. 10.1002/gps.1585
    1. *. Sung H. C., Chang S. M., Lee W. L., Lee M. S. (2006a). The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan. Complement. Ther. Med. 14, 113–119. 10.1016/j.ctim.2006.03.002
    1. *. Sung H. C., Lee W. L., Li T., Watson R. (2012). A group music intervention using percussion instruments with familiar music to reduce anxiety and agitation of institutionalized older adults with dementia. Int. J. Geriatr. Psychol. 27, 621–627. 10.1002/gps.2761
    1. Svansdottir H. B., Snaedal J. (2006). Music therapy in moderate and severe dementia of Alzheimer's type: a case–control study. Int. Psychogeriatr. 18, 613–621. 10.1017/S1041610206003206
    1. Ueda T., Suzukamo Y., Sato M., Izumi S. (2013). Effects of music therapy on behavioral and psychological symptoms of dementia: a systematic review and meta-analysis. Ageing Res. Rev. 12, 628–641. 10.1016/j.arr.2013.02.003
    1. Vasionyte L., Madison G. (2013). Musical intervention for patients with dementia: a meta-analysis. J. Clin. Nurs. 22, 1203–1216. 10.1111/jocn.12166
    1. Vink A. C., Bruinsma M. S., Scholten R. J. P. M. (2004). Music therapy for people with dementia. Cochrane Database Syst. Rev. 4:CD003477 10.1002/14651858.cd003477
    1. Vink A. C., Bruinsma M. S., Scholten R. J. P. M. (2011). Music therapy for people ewith dementia (review). Cochrane Database Syst. Rev. 9, 1031–1038.
    1. World Federation of Music Therapy (WMFT) (2011). What is Music Therapy? Available online at:

Source: PubMed

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