Friday, February 26, 2010

Music Therapy for Alzheimer's Patients

What is Music Therapy?

Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.

Music Therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals.  After assessing the strengths and needs of each client, the qualified music therapist provides the indicated treatment including creating, singing, moving to, and/or listening to music.  Through musical involvement in the therapeutic context, clients' abilities are strengthened and transferred to other areas of their lives.  Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words.  Research in music therapy supports its effectiveness in many areas such as: overall physical rehabilitation and facilitating movement, increasing people's motivation to become engaged in their treatment, providing emotional support for clients and their families, and providing an outlet for expression of feelings.

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Music Therapy and Alzheimer’s

Music therapy, the use of music to calm and heal, cannot slow or reverse dementia. But it may improve quality of life for both a person with Alzheimer's disease and their caregiver. Clinical reports suggest that music therapy may reduce wandering and restlessness and increase chemicals in the brain that enhance sleep and ease anxiety. For example, the chemicals melatonin, norepinephrine, and epinephrine increased in the brains of people with Alzheimer's after they listened to live music regularly. Mood also improved after listening to the music.

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Clark, Lipe, & Biblrey Research

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.

Brontons & Pickett-Cooper Study

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, and 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.

Research Institute of the Hebrew Home Study

Although many patients with advanced AD are unable to communicate with language, music therapy has shown promise as a way for patients to express themselves, and such sensory stimulation might even slow the decline of physical, psychological, and cognitive processes. Jiska Cohen-Mansfied, a psychologist of the Research Institute of the Hebrew Home of Greater Washington, has studied the manifestations of AD and reported her results in Science (1031).  She observed that the violent behaviors of patients with AD occurred when their room was dark and they were alone. The results of her investigation found that one-third of her patients decreased their violent behavior in response to music, a greater response than with psychotropic drugs, restraint, or passive neglect. Cohen-Mansfied believes that music is an effective therapy because it reduces the social isolation experienced by demented patients. While not offering a cure for AD, music therapy can clearly decrease the agitation some patients manifest. In the past, such behaviors were thought to be the result of psychosis (Barinaga 1031), but are now considered to stem from the social isolation caused by the dementia, something that music therapy is designed to target.

Miami Veterans Administration Medical Center Research

The study indicated that listening to music affects the release of powerful brain chemicals that can regulate mood, reduce aggression and depression, and improve sleep.

"Many patients with Alzheimer's disease have behavior problems of aggression and agitation," said Dr. Ardash Kumar, study co-author and research associate professor in the department of psychiatry and behavioral sciences at the University of Miami School of Medicine in Florida. He told Reuters Health "we wanted to test the theory that a structured music therapy program has a calming effect, and we thought that agitated or aggressive patients with (Alzheimer's disease) might benefit from this natural therapy."

Kumar and colleagues studied the effect of music therapy on the levels of five brain chemicals (melatonin, norepinephrine, epinephrine, serotonin, and prolactin) that work in combination to influence mental state. "Different areas of the brain are stimulated by certain situations and release chemicals into the blood. We can measure the levels of those chemicals to see which situations promote a sense of well-being," said Kumar.
The study was conducted at the Miami Veterans Administration Medical Center. Twenty male patients with Alzheimer's disease participated in a music therapy program for 30 to 40 minutes five times a week for 4 weeks. As the program progressed, patients became more able to identify with the songs and could request their music preferences.

Blood samples from the group were obtained before the program began, at the end of 4 weeks of therapy, and 6 weeks after the therapy ended. Blood analyses indicated that a significant increase in blood melatonin levels occurred after participation in music therapy sessions and that the increase continued even after the therapy had been discontinued for 6 weeks. Levels of epinephrine and norepinephrine increased significantly after the music therapy sessions but had returned to pretherapy levels 6 weeks after the sessions had been stopped. Levels of serotonin and prolactin were not influenced by music therapy.

Perhaps because of the increased levels of melatonin, the patients who participated in music therapy became more active, slept better, and were more cooperative with nurses.

The study results, which were published in a recent issue of Alternative Therapies, may have broader applications too. "Relaxation with the type of music that calms you down is very beneficial," said Kumar. "To promote a sense of calm and well-being, you can listen to your favorite soothing music when you eat, before you sleep, and when you want to relax. Music therapy might be a safer and more effective alternative to many psychotropic medications. Like meditation and yoga, it can help us maintain our hormonal and emotional balance, even during periods of stress or disease."

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How to Use Music Therapy to Fight Alzheimer’s

There are several practical recommendations on how to use the music therapy for the better possible outcomes, while fighting Alzheimer’s:
  • Identify music that’s familiar and enjoyable to the listeners.
  • Use live music, tapes or CDs; radio programs, interrupted by too many commercials, can cause confusion.
  • Use music to create the mood you want.
  • Link music with other reminiscence activities; use photographs to help stir memories.
  • Encourage movement (clapping, dancing) to add to the enjoyment.
  • Avoid sensory overload; eliminate competing noises by shutting windows and doors and by turning off the television.
  • Try to listen to about 30-40 minutes of music a day, for at least five days each week.

Sources and Additional Information:
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