Effect of Music Therapy Versus Recreational Activities on Neuropsychiatric Symptoms in Elderly Adults with DementiA: An Exploratory Randomized Controlled Trial
To the Editor: Neuropsychiatric symptoms are commonly found in people with dementia and are a great burden for them and their caregivers.1, 2 Generally, neuropsychiatric symptoms are treated using pharmacological approaches, but these are only moderately effective in persons with dementia, at the cost of major side effects.3
In recent years, more attention has been given to the effectiveness of nonpharmacological approaches in dementia care, such as music therapy. In music therapy, residents are actively engaged in music making and singing or listening to the music that the therapist plays or sings. Music therapy has been reported to be an effective intervention to reduce behavioral problems.4, 5 The present study compared music therapy with recreational activities and failed to show a superior effect on agitation.6 The aim of this letter was to compare the effect on reduction of neuropsychiatric symptoms.
A randomized controlled design was employed comparing music therapy with general recreational activities. Subjects were nursing home residents with a diagnosis of dementia with above average behavioral problems from six nursing homes in the Netherlands. In each setting, all eligible residents were randomized to music therapy or recreational activities. Over a period of 4 months, residents participated in small-group sessions with a maximum of five residents. Each music therapy session lasted for 40 minutes and was provided twice weekly by a trained music therapist with at least 5 years of experience working in a nursing home setting. Recreational day activities (also 40 minutes) consisted of participation in general recreational activities, such as crafts and games.
The Neuropsychiatric Inventory Questionnaire (NPI-Q) was administered to study the effects of the interventions. The NPI-Q assesses the presence of 12 neuropsychiatric symptoms such as hallucinations, agitation, and depression.7 The total NPI-Q score can range between 0 (no symptoms) and 36 (all 12 symptoms present, most severely).
Trained nurses administered the NPI-Q every 2 weeks during the 4-month treatment period. The first assessment was at the start of the treatment, and the last assessment was at the end of treatment-period, comprising eight assessments. Because of a copying error, the apathy item was separately assessed just after the intervention period in two of the six nursing homes.
Mixed-model analysis for repeated measures was used to analyze the differential effects of music therapy versus general activities on NPI-Q score. The assessment number, ranging from 1 to 8, was used as the time variable of the repeated measures. An intention-to-treat analysis was conducted including data from all residents with data on at least one NPI posttreatment assessment.
Residents (n = 94) were randomized to music therapy (n = 47) or general activities (n = 47). Five residents (4 general activities, 1 music therapy) died during the study, and 15 had missing data on all eight assessments (4 music therapy, 11 general activities). This left 74 residents for the intention-to-treat analysis (42 music therapy, 32 general activities). The two intervention groups did not differ on baseline characteristics (sex, age, dementia type, dementia stage, psychotropic drug use) before the start of the treatment.
Figure 1 shows the mean total NPI-Q score for all 74 residents in both arms. The mixed-model analysis showed that NPI-Q scores were significantly lower in the music therapy arm than in the general activities arm (F = 6.753, P = .01).
The effects of music therapy and recreational activities on neuropsychiatric symptoms in older people with dementia were compared in a randomized controlled trial. Residents receiving music therapy showed significantly greater reductions in neuropsychiatric symptoms from the start to the end of the treatment than those receiving recreational activities.
The main outcome in this study confirms the findings of other recent studies that have been conducted to study the effect of music therapy with people with dementia using the NPI as an outcome measure.8-10 The results of the present study add to those of three previous studies that the effect of music therapy is not from extra attention only, but the study was not large enough to demonstrate the effect of music therapy on individual neuropsychiatric symptoms.
The authors thank all participating nursing homes, residents, and personnel for their participation in this study.
Conflict of Interest: The authors declare that they have no conflicts of interest.
This research was made possible thanks to the financial support of ZonMW, Alzheimer Nederland, Menzis, het Innovatiefonds Zorgverzekeraars, the Triodos Foundation, the Rens Holle Foundation, the former Buma Stemra Music Therapy fund, and the Burgerweeshuisfonds Meppel.
Author Contributions: Vink: study concept and design, acquisition of subjects and data, analysis and interpretation of data, preparation of manuscript. Zuidersma, Boersma, de Jonge, Zuidema: analysis and interpretation of data, preparation of manuscript. Slaets: study concept and design, analysis and interpretation of data, preparation of manuscript.
Sponsor's role: The funding sources are all nonprofit associations financed by public and private sectors and did not influence the study content in any way.