User:Gurleyneu/Music therapy for Alzheimer's disease


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Neuroplasticity and Music

It had been shown that music and rhythm can affect neuroplasticity. One study showed

that beat finding and tapping recruited largely overlapping auditory, motor, and prefrontal

regions (STG, premotor cortex, VLPFC). Tapping to complex rhythms recruited working

memory retrieval mechanisms in VLPFC and interact with the BG, as it showed greater activity

during tapping than listening (Kung et al., 2013). It has also been demonstrated that those who

undergo low intensity drumming sessions show increased functional connectivity (FC) in the

brain. Drum groups showed increased FC between right pSTG and the left precentral and

postcentral gyri (vPMC and primary motor cortex). Left and right pSTG showed increased FC

with the left and right SPL, respectively. Increased FC between left pSTG and inferior frontal

gyrus (IFG). pSTG decreased FC with bilateral cerebellum (Amad et al., 2017). Those who

undergo 6 weeks of piano training showed an improvement of task performance in musical

cognition tasks. Resting fMRI showed training related increases of activity in premotor and

dorsolateral prefrontal cortex, bilateral posterior parietal cortex (intraparietal sulcus). Increased

activity in bilateral cerebellum, decreased activity in lateral occipital cortex (Herholz et al.,

2016). Kung et al. (2013) demonstrated that beat finding and tapping regions of the brain are not

unique to music processing, but rather utilize more general active memory retrieval neural

mechanisms. Amad et al. (2017) showed the ability of musical rhythm in drumming to affect

functional connectivity, and Herholz et al. (2013) showed evidence for musical piano training to

promote neuroplasticity. These studies have shown the possible effects of music and rhythm on

xthe brain, and so more recently studies have explored the efficacy of MBIs for AD and related

neurodegenerative diseases.

Music-based Interventions

MBIs are relatively new approaches to treating neurodegenerative diseases, and as such

one of the biggest issues is the large variation in methods. Not only that, but with this budding

field comes a lack of attention, thus it is important to explore various studies as to see the

differences in approaches and to inspire future research. For example, Cohen et al. (2020) began

their study with a small sample size of n=5 at the Columbia Health Care Center in Wyocena,

Wisconsin. Their goal was to test the efficacy of music as a means of treating dysphagia in those

with advanced dementia and did so by having them listen to an iPod individualized playlist at

4:30 p.m. daily before their 5 p.m. supper. One patient had to be removed from the study due to

overstimulation with the iPod, and thus the results stemmed from 4 participants. They found

indications of enhanced swallowing mechanism, less choking during supper, improved overall

nutritional status and reduced weight loss, reduced need for speech interventions, and ultimately

and enhanced quality of life (Cohen et al., 2020).

Parajuli et al. (2021) used a similar approach with their 31 participants in person-centered

approach to select personalized songs for the patients to listen to in efforts to reduce

psychotropic medication use. These persons with dementia listened to their preferred songs for

20-30 minutes twice a day in the morning and afternoon for 8 weeks. At the 4-week mark, 45-

50-minute group music activity was added for 2 hours a week during the remaining 4 weeks.

They found a reduction of 22.4% overall psychotropic use; however, their results were not

statistically significant with p = 0.106 (Parajuli et al., 2021).

Ratovohery et al. (2019) sought to test the efficacy of using musical mnemonics for

verbal episodic memory in patients with Alzheimer’s. They tested 26 healthy older adults and 13

AD patients by presenting them with 3 different sets of verbal information in different valences.

Beethoven’s Ode to Joy was selected to elicit a positive valence, Chopin’s Funeral March a

negative valence, and a neutral tone control. They found that immediate recall was highest with

the positive music, but both musical conditions still led to better recall than the neutral spoken

one (Ratovohery et al., 2019).

Wang et al. (2020) tested 47 healthy controls, 47 patients with MCI, and 11 patients with

AD (n = 105) for resting state functional connectivity within and between auditory and reward

systems. Through resting state fMRI they found that overall the AD group had lower network

connectivity. Interestingly, they found MCI individuals to be similar or even higher than healthy

controls in clustering, local efficiency, and betweenness centrality. The MCI group had

consistently high clustering within the reward network compared to both controls and AD

participants (Wang et al., 2020).

Cohen et al. (2020) and Parajuli et al. (2021) show key potential for the successes of

MBIs for neurodegenerative diseases, but are weighed down by small sample sizes and, in the

latter, a lack of statistical significance. Even so, the results of all these studies indicate the role

music can play in ebbing the effects of AD and dementia. The results of Wang et al. (2020)

highlight that it may be best to target those with MCI to take advantage of their heightened

auditory-reward connectivity, proactively treating patients before their neurodegeneration

progresses farther.

Individualization

The efficacy of these interventions differs depending on the individual. When participants

underwent the 6-week piano training, individual learning rates during melody training were

predicted by stronger activity in multiple areas pre-training (Herholz et al., 2016). As mentioned

before, some patients may be overstimulated by the music and thus not be able to participate in

MBIs (Cohen et al., 2020).

Baird et al. (2020) compared music evoked autobiographical memories (MEAMs) and

photo evoked autobiographical memories (PEAMs) in 6 patients with probable behavioral

variant frontotemporal dementia (Bv-FTD), 10 patients with AD, and 10 age matched healthy

elderly controls. They found similar frequency of MEAMs between Bv-FTD and AD patients,

both less than healthy controls. In fact, two Bv-FTD patients showed a complete absence of

MEAMs whereas there was no such case in any AD patients. This observed absence of MEAMs

in those with Bv-FTD indicates that the use of MBIs and mnemonic music devices varies in

efficacy between patients with differing kinds of dementia (Baird et al., 2020).

Maguire (2021) studied 43 elderly female Americans in 3 East coast rehabilitation centers

for dementia who went through a 5-week individualized singing intervention. The results of the

study highlight the importance of individualization when it comes to MBIs and dementia.

High participation individuals showed a much greater cognitive, functional, and narrative

improvements than those that did not participate as much. The individualized selection of

familiar, nostalgic, and novel combined with a personalized tonal key and rhythm that best fit the

patient’s vocal and physical abilities was vital to realizing these improvements (Maguire, 2021).

Future Directions

Recently, novel combinations of MBIs with other noninvasive interventions have been

proposed as to bolster the efficacy of treatment. One such proposal was published by Tichko et

al. (2020), in which they proposed a novel clinical framework of combining MBIs with more

recent Gamma-frequency sensory stimulation approaches as to noninvasively treat

neurodegenerative disorders. They theorize that such a combination could enhance MBIs through

the targeting of multiple biomarkers of dementia while activating auditory-reward networks.

Again, like the results of Wang et al. (2020) suggested, they theorize that such interventions

would be most effective at the MCI stage for slowing/reversing cognitive decline (Tichko et al.,

2020).