Key messages
· Compared to usual care (i.e. without specific activities), providing people with dementia with music-based therapy sessions probably improves depression, and may improve overall behavioural problems.
· Compared to other activities, music-based therapy may improve social behaviour, but we are unsure if it improves anxiety.
· These effects may not last beyond the end of treatment.
· There is no evidence that music-based therapy makes a difference to the emotional well-being, agitation or cognition (e.g. thinking and remembering) of people with dementia, although there is uncertainty about this.
· There is uncertainty in the evidence for long-term effects, but no long-term effects were observed in the studies.
· Adverse effects (unwanted side effects) may be rare, but the studies were inconsistent in their reporting, so we need more evidence before we can reach reliable conclusions.
Why offer music-based therapy to people with dementia?
People with dementia gradually develop increasing difficulty with thinking and daily activities. Dementia is often associated with emotional and behavioural problems and may decrease a person's quality of life. In the later stages of dementia, it may be difficult for people to communicate with words, but even when they can no longer speak, they may still be able to hum or play along with music. Therapy involving music may therefore be especially suitable for people with dementia to improve their lives.
Who provides music-based therapy?
Music therapists are certified to work with individuals or groups of people, using music to try to help meet their physical, psychological and social needs. Other professionals may also be trained to provide similar therapies.
What did we want to find out?
We wanted to find out if, for people with dementia, music-based therapy works better than usual care or other activities, such as painting. We were interested in whether the therapy changed these outcomes at the end of treatment:
· emotional well-being including quality of life;
· depression and anxiety;
· agitation or aggression and overall behavioural problems;
· social behaviour; and
· cognition (e.g. thinking and remembering).
We also wanted to find out if there were any long-term effects after therapy ended or any unwanted effects.
What did we do?
We searched for studies in which people with dementia were randomly allocated to receive music-based therapy (of at least five sessions) or to a comparison group with no activities or different activities. We combined the results of the studies to estimate the effects of music-based therapy as accurately as possible. We also rated our level of confidence in the findings.
What did we find?
We found 30 studies performed in 15 countries. The studies involved 1720 people with dementia of varying severity. In most of the studies, the participants lived in nursing homes. Seven studies delivered the music-based therapy to individuals; the other studies delivered the intervention to groups. We were able to use results from 28 studies involving 1366 people with dementia for one or more outcomes at the end of treatment. Ten studies contributed information about long-term results.
Main results
At the end of treatment
Music-based therapy probably improves depression and may improve overall behavioural problems, compared with providing usual care.
Music-based therapy may improve social behaviour compared to other activities. We were less confident about the effects of music-based therapy on anxiety compared to other activities.
The available evidence does not suggest any benefit of music-based therapy for emotional well-being (including quality of life), agitation and aggression, or cognition, but the evidence is limited and there is uncertainty about this.
In the longer term
Some studies measured outcomes four weeks or more after treatment ended. We did not find any lasting effects, but there were fewer results measured in the longer term, and we are uncertain about this evidence. Further studies are likely to have a significant impact on what we know about the effects of music-based therapy for people with dementia, so it is important that research continues.
What are the limitations of the evidence?
There was variation in the quality of the studies and how well they were reported. In all studies, participants and personnel might have known which treatment participants were getting, and in some, the assessors might have known this as well. This could have affected the results. Regarding effects at the end of music-based therapy, we are moderately confident in the evidence for the beneficial effect on depression compared to usual care. We have little confidence in the effects or lack of effects on any of the other outcomes. Adverse effects were rarely reported.
How up to date is this evidence?
This review updates our previous review. We added eight new studies and reached new conclusions. The evidence is current to 30 November 2023.