What Does Music Therapy Look Like for Persons with AD?

by Amy Clements-Cortes, PhD on 16 November 2018

This blog is a follow-up to the one I published in August 2017, titled “Music Experiences for Persons with AD”. In this piece, I am focusing on one of the experiences: Music Therapy. As an inexpensive, evidence-based, and non-pharmacological treatment, music therapy should highly be considered in the total care package for persons living with AD.

Music therapy can be defined as:
…the professional use of music and its elements as an intervention in medical, educational, and everyday environments with individuals, groups, families, or communities who seek to optimize their quality of life and improve their physical, social, communicative, emotional, intellectual, and spiritual health and wellbeing. Research, practice, education, and clinical training in music therapy are based on professional standards according to cultural, social, and political contexts [1].

A certified music therapist (MTA or MT-BC) is someone who has: completed training in music therapy (Bachelor degree, Master’s or Doctorate), clinical practicum experiences and a 1000-hour music therapy internship, passed a board examination, or fulfilled the certification requirements to practice in their country; and who participates in ongoing professional education [2]. The clinical process of music therapy treatment begins with an assessment, followed by the therapist creating goals and objectives, and devising a treatment plan. The therapist tracks ongoing progress and revises the goals as needed [3]. A variety of music therapy approaches are available to music therapists, and direct the type of interventions and treatment that are provided in either individual or group sessions.

For persons with AD (PWAD), music and music therapy are activities they can engage in, right into the late stages of the disease. According to Dr. Katrina McFerran, through a wide-ranging set of progressions, music engages the brain when other capacities decline [4]. “The brain processes that are activated during singing and listening to music, work at a higher level and can transform dysfunctional processes. This is illustrated most clearly when people who are no longer able to speak are still able to sing.” [4].

Emotional experiences with music are fostered by participating in music [5]. It has been proposed that emotional and physiological reactions to music are shaped through associations learned alongside the music, and these relations are individual collections [6, 7]. In childhood we form these associations, and as we mature we add to these associations which get reinforced in cultural events.

Music Therapy Intervention Examples for PWAD

These are some examples of music therapy interventions for PWAD.

  • Clinical Improvisation: Implementing opportunities for PWAD to express emotions with their voices or melodic or percussion instruments; and/or promoting creative activity through non-verbal expression.
  • Song Composition: Composing an original song: on a relevant subject to the PWAD, and for the PWAD to share with family or friends as part of reminiscence or legacy goals.
  • Music Listening: Encouraging and supporting reminiscence by listening to music and engaging the PWAD with questions and discussion; or using live music to help the PWAD express emotions.
  • Playing Instruments: Facilitating the maintenance of music skills, either vocal or instrumental that the PWAD participated in, in the past.

Examples of Supporting Research for PWAD

  • Music to aid in learning information [8, 9].
  • Music as an enhancer to memory [10].
  • Music therapy to improve cognitive function through singing [11].
  • 40Hz vibroacoustic therapy for PWAD to: increase alertness, clarity and cognition [12].
  • Music to assist in reducing aggression, agitation, irritability, wandering and inappropriate verbal responses in PWAD [13-16]. When PWAD are expressing some of these responses, inviting them to make music can activate the associated memory or emotion; and in turn help change their emotion and/or mood, while providing a sense of safety and connection to those present [17].
  • Music can trigger conversation and memory recall in PWAD in the late stages thorough associated memory or emotions [18].

Concluding Thoughts…
If you are a healthcare provider or caregiver, I encourage you to consider making a referral to music therapy for the PWAD to whom you provide care.

In closing I would like to leave you with two tasks.

  1. Make a list of 10 significant songs in your life. Think about how these songs might be important for you if you developed AD and consider sharing them (in reply to this blog) with our readers.
  2. Share your stories of music therapy sessions you have observed, or write on how you plan to advocate or include music therapy for the PWAD that you care for (in reply to this blog) so others can learn of your ideas.

REFERENCES
[1] WFMT, What is music Therapy. World Federation of Music Therapy. Retrieved from: http://www.wfmt.info/wfmt-new-home/about-wfmt/, Last updated July 2015, Accessed on October 30, 2018.
[2] CAMT, Music therapy scope of practice. Canadian Association for Music Therapists, http://www.musictherapy.ca/about-camt-music-therapy/about-music-therapy/, Last updated June, 2016, Accessed on October 30, 2018.
[3] CAMT, Clinical process. Canadian Association for Music Therapists, http://www.musictherapy.ca/about-camt-music-therapy/about-music-therapy/, Last updated June, 2016, Accessed on October 30, 2018.
[4] AMTA, Music therapy in aged care. Australian Music Therapy Association, https://www.austmta.org.au/resources, Accessed on October 30, 2018.
[5] Juslin PN, Sloboda JA (2001) Music and emotion: Introduction. In Handbook of Music and Emotions: Theory and Research, Juslin PN, Sloboda JA, eds. Oxford University Press, New York, NY, pp. 3-20.
[6] Bartel L (1992) A study of the cognitive-affective response to music (dissertation). University of Illinois, Urbana–Champaign, IL.
[7] Bartel L (2002) Meaning and understanding in music: the role of complex constructs. In Musical Understanding: Perspectives in Theory and Practice, Hanley B, Goolsby T, eds. Canadian Music Educators Association, Victoria, BC, pp. 51-70.
[8] Baird A, Samso S, Miller L, Chalmers K (2017) Does music training facilitate the mnemonic effect of song? An exploration of musicians and nonmusicians with and without Alzheimer’s dementia. J Clin Exp Neuropsychol 39, 9-21.
[9] Moussard A, Bigand E, Belleville S, Peretz I (2014) Music as a mnemonic to learn gesture sequences in normal aging and Alzheimer’s disease. Front Hum Neurosci 8, 294.
[10] Simmons-Stern NR, Budson AE, Ally BA (2010) Music as a memory enhancer in patients with Alzheimer’s disease. Neuropsychologia 48, 3164-3167.
[11] Satoh M, Yuba T, Tabei K-I, Okubo Y, Kida H, Sakuma H, Tomimoto H (2015) Music therapy using singing training improves psychomoto speed in patients with Alzheimer’s disease: A neuropsychological and fMRI study. Dement Geriatr Cogn Dis Extra 5, 296-308.
[12] Clements-Cortés A, Ahonen H, Evans M, Freedman M, Bartel L (2016) Short term effects of rhythmic sensory stimulation in Alzheimer’s disease: An exploratory pilot study. J Alzheimers Dis 52, 651-660.
[13] Jennings B, Vance D (2002) The short-term effects of music therapy on different types of agitation in adults with Alzheimer’s. Act Adapt Aging 26, 27-33.
[14] Koger SM, Chapin K, Brotons M (1999) Is music therapy an effective intervention for dementia? A meta-analytic review of literature. J Music Ther 36, 2-15.
[15] Ledger AJ, Baker FA (2007) An investigation of long-term effects of group music therapy on agitation levels of people with Alzheimer’s disease. Aging Ment Health 11, 330-338.
[16] Raglio A, Bellelli G, Traficante D, Gianotti M, Ubezio MC, Villani D, Trabucchi M (2008) Efficacy of music therapy in the treatment of behavioral and psychiatric symptoms of dementia. Alzheimer Dis Assoc Disord 22, 158-162.
[17] Clements-Cortés A, Bartel L (2018) Are we doing more than we know? Possible mechanisms of response to music therapy. Front Med (Lausanne) 5, 255.
[18] Dassa A, Amir D (2014) The role of singing familiar songs in encouraging conversation among people with middle to late stage Alzheimer’s disease. J Music Ther 51, 131–153.

Last comment on 16 November 2018 by Michael Gordon, MD MSc

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Amy Clements-Cortés has described important elements that distinguish music therapy from other music-based interventions that may provide temporary focus of attention and mood change for PWAD and other forms of dementia. While musicians and others can bring joy to people through familiar and uplifting sounds and songs, music therapists apply evidence-based clinical interventions that engage individuals actively or receptively with music, and work toward specific outcomes that enhance the quality of their lives. Although technological devices and new apps may offer music instantly, the presence of a competent, empathic and knowledgeable music therapist contributes the musical expertise, therapeutic relationship, and customized treatment plan necessary to meet the complex needs of individuals at every stage of AD.

Translating formal music therapy to bedside subjective musical intervention

Much has been written and taught as per the above-mentioned article about the potential benefits of formalized music therapy—as might be provided in institutional settings. I have observed the benefits of group responsiveness to the impact on music on mood and a sense of well-being that is often the result of one type of music therapy or another. Not all the therapy requires the efforts of a specialized music therapist although this can be helpful: I have witnessed competent musicians with a love for their music successfully provide musical programs to groups of elderly frail long-term care residents—using multi-ethnic approaches to their musical presentations

I have utilized music at a personal level when I am providing care in a geriatric medical clinical whose clientele is primarily those living with dementia and for whom PTSD is the main challenge for them and for their families The quest is usually to maintain them at home or in a retirement home for example when their behaviour is causing friction with other residents or with their own family.

The approach I take is first to define with the help of their family of whether or not they have a history of liking music—then trying to define the genre of the music and if possible any ethno-cultural preferences. I then right in my office in real time find an example of the type of music the family and I think might work and find it on a YouTube clip—which usually does not take very long. Then I play some excerpts of the music and observe the reaction of the patient: a tapping of feet and hands, smiling, humming along and sometimes even mouthing of the words are usually indicators that the music we have chosen is resonating with the patient.

If this proves to be the case I discuss with the family the arrangement of what would be a “concert’ on a regular basis for a defined period where the music is being played on a quality amplifier with the patient sitting comfortably so that they can appreciate the music. Within a short period of time or with some experimentation the family will know if the experiment is successful or not. I have had many successes which includes that patient singing along to the music especially those whose mother tongue is not English and to whom the music is meaningful with their recalled and distant memories.

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