The effects of individual music therapy in nursing home residents with dementia to improve general well-being: study protocol of a randomized controlled trial.

BACKGROUND: Dementia is often associated with Neuropsychiatric Symptoms (NPS) such as agitation, depression, hallucinations, anxiety, that can cause distress for the resident with dementia in long-term care settings and can impose emotional burden on the environment. NPS are often treated with psychotropic drugs, which, however, frequently cause side effects. Alternatively, non-pharmacological interventions can improve well-being and maintain an optimal quality of life (QoL) of those living with dementia. Other QoL related outcomes, such as pain, discomfort and sleep disruption are relevant outcomes in music trials as well. Music therapy is a non-pharmacological intervention that can reduce NPS and improve well-being, and its associated symptoms in dementia. METHODS: The research will be conducted at eight nursing home facilities of a health care organization in the Netherlands. A sample size of 30 in each group (experimental and control group) is required, totalling 60 residents increased to 80 when considering expected drop out to follow up. The participants in the intervention group receive 30 min of individual music therapy (MT) in their own room by a music therapist twice a week for 12 weeks. The participants in the control group will receive 30 min of individual attention in their own room by a volunteer twice a week for 12 weeks. Assessments will be done at baseline, 6 weeks and 12 weeks. An independent observer, blinded for the intervention or control condition, will assess directly observed well-being (primary outcome) and pain (secondary outcome) before and after the sessions. Nurses will assess other secondary outcomes unblinded, i.e., perceived quality of life and NPS, both assessed with validated scales. The sleep duration will be indirectly assessed by a wrist device called MotionWatch. Information about psychotropic drug use will be derived from electronic medical chart review. DISCUSSION: The main purpose of this study is to assess the effects of individual music therapy on directly observed well-being controlled for individual attention in nursing home residents with dementia with NPS. The outcomes refer to both short-term and long-term effects consistent with therapeutic goals of care for a longer term. We hope to overcome limitations of previous study designs such as not blinded designs and music facilitators that were not only music therapists but also occupational therapists and nurses. This study should lead to more focused recommendations for practice and further research into non-pharmacological interventions in dementia such as music therapy. TRIAL REGISTRATION: The trial is registered at the International Clinical Trials Registry Platform (ICTRP) search portal in the Netherlands Trial Registration number NL7708, registration date 04-05-2019.

Study protocol: randomized controlled trial of an individualized music intervention for people with dementia in the home care setting.

BACKGROUND: Studies suggest that individualized music listening is an effective, non-pharmacological intervention for improving the quality of life of people with dementia in the institutional care setting. Noting that most people with dementia live at home, we conduct a randomized controlled trial to assess the feasibility and effectiveness of an app-based individualized music listening intervention for people with dementia in the home care setting. The intervention is delivered by family caregivers. METHODS: We will recruit N = 130 dyads consisting of one person with dementia living at home and their family caregiver. After a baseline assessment, dyads are randomly assigned by gender to either the intervention or control group. People with dementia in the intervention group listen to individualized music playlists for 20 min every other day for six weeks via the self-developed Individualized Music and Dementia app. The control group receives standard care. All dyads complete paper-and-pencil questionnaires six weeks before the start of the intervention (T0), directly before the intervention (T1), directly after the intervention (T2), and six weeks later (T3). During the intervention period, all caregivers also complete daily ecological momentary assessments via the app. During three home visits, a trained project member will observe the dyads and collect hair samples. After the intervention, semi-structured interviews will be conducted to collect information about participants' experiences with the app and intervention. The primary outcome is the attainment of individual goals established during the baseline assessment. Secondary outcomes are the well-being, physiological stress and quality of life of people with dementia and their caregivers; people with dementia's behavioural and psychological symptoms of dementia, resistance during care, and reactions to the music; caregivers' burden of care, positive aspects of care, and caregiving self-efficacy; and the quality of the caregiver-care recipient interaction. DISCUSSION: Our study will assess the extent to which an app-based individualized music listening intervention is feasible and effective for enhancing the well-being and quality of life of people with dementia living at home and their family caregivers. TRIAL REGISTRATION: German Clinical Trials Register DRKS00025502 and ISRCTN registry ISRCTN68084105, https://doi.org/10.1186/ISRCTN68084105.

Smellscape as a healing factor in institutional gardens to enhance health and well-being for older people with dementia: A scoping review.

BACKGROUND: There is mounting evidence for the health benefits of aromatic scents for the older people with dementia. However, existing research has focused on indoor aromatherapy using essential oils. It is necessary to explore the health benefits of smellscapes in the outdoor environment for older people with dementia. AIMS AND OBJECTIVES: This scoping review aims to examine existing evidence for smellscape as a healing factor in institutional garden for older people with dementia, try to bridge the knowledge gaps between outdoor sensory garden scents and aromatherapy to develop green care techniques that incorporate outdoor activities. METHODS: Seven databases (Scopus, PubMed, PsycINFO, CINAHL, MEDLINE, Embase and Web of Science) were searched with English language articles published between 1990 and 2022. The PRISMA-ScR Checklist was used. RESULTS: Out of 1013 articles, 11 meet the inclusion criteria. The comprehensive health outcomes include five aspects: mental health; physical health; reduced agitation behaviour; improved cognitive function; and well-being. These aspects are part of the rehabilitation model comprising the person (older people with dementia), environment (garden smellscapes) and outdoor activities (active or passive interventions or a combination). CONCLUSIONS: The smellscape, as a healing factor in the garden, not only benefits from evidence on indoor aromatherapy but also creates a sensory environment for older people with dementia by compensating for functional impairment, activity support and environmental creation, thereby promoting enhanced health and well-being. RELEVANCE TO CLINICAL PRACTICE: The research on the healing effects of smellscapes presented in this review offers a novel environmental intervention technique for transferring evidence on essential oils to outdoor sensory gardens. This green care technique is suggested to assist in the creation of healing environments and interventions for people with dementia who cannot be cured. NO PATIENT OR PUBLIC CONTRIBUTION: This scoping review did not directly involve patient or public contributions to the manuscript.

Exploring the interplay between dementia, multiple health conditions and couplehood: A qualitative evidence review and meta-ethnography.

Background: On average, people with dementia live with 4.6 additional health conditions. Additionally, two thirds of carers of people with dementia are spouses, and are also likely to live with multimorbidity, given that older age is strongly associated with an increase in health conditions. Consequently, living with dementia and multimorbidity is often a shared experienced as a couple. However, research has not explored how living with both dementia and multimorbidity may impact on couplehood. Method: We conducted a qualitive evidence review using a meta-ethnographic approach, to answer the following question: In what way (if any) does living with dementia and multimorbidity impact on couplehood? No papers were found on couplehood, dementia and multimorbidity, therefore the review consists of a meta-synthesis of couples' experiences of living with dementia in relation to couplehood, with an additional search for any data related to health within the qualitative findings. Findings: Two major reciprocal themes and five subthemes were identified from the 14 study findings. 1. Change and adjustment in the relationship, which included themes around a sense of 'togetherness', change in roles and identity and developing shared coping strategies and 2. Commitment, which was encapsulated by themes on unconditional love and commitment to wedding vows. Health-related findings were limited but included the impact on emotional wellbeing and how other health conditions, rather than dementia, were attributed to a loss in physical sexual intimacy. Conclusion: This review found that couplehood was threatened when dementia symptoms progressed and couples experienced feelings of loss of independence and identity. However, a strong foundation of commitment, love and loyalty to each other developed over the course of the relationship, was the 'glue' that helped couples face dementia together. However, further research is needed to explore couples' experiences of living with both multimorbidity and dementia in relation to couplehood in order to develop holistic, relationship-centred interventions.

Sounds of Difference: A Typology of Reactions of People With Dementia to Individualized Music in the Presence of a Monitoring Person.

BACKGROUND AND OBJECTIVES: Despite promising effects of individualized music listening (IML) for people with dementia, the individualized nature and heterogeneity of reactions to IML remain underexplored. We aimed to develop an empirically derived typology of directly observed reactions of people with dementia to IML and propose recommendations for tailoring the intervention to the respective types. RESEARCH DESIGN AND METHODS: An ideal-type analysis was conducted on 108 video recordings of 45 people with mainly severe dementia (78% female, mean age of 83.02 years, all White participants) listening to recorded individualized music. Dimensions were identified for capturing similarities and differences between types. RESULTS: The analysis yielded 10 types of reactions ("expressing and sharing joy," "self-disclosure stimulated by music," "concentrated, absorbed listening," "blissful enjoyment," "experience of the music as bittersweet," "sharing memories," "releasing tension," "tensing up and rejecting," "predominant search for social exchange," "no interpretable reaction") and 3 dimensions ("valence" from negative to positive, "arousal" from calm to activated, "communicative activity" from defensive/resistant to proactive), resulting in a three-dimensional coordinate system, providing a holistic representation and facilitating a systematic contrast of identified reaction types to IML. DISCUSSION AND IMPLICATIONS: Reactions to IML were influenced by the interaction with the project staff, who monitored the sessions. Based on these observations, we propose recommendations for tailoring both the behavior of the monitoring person (e.g., engaging in synchronous activities like clapping along) and the setup of the intervention (e.g., communal vs individual listening) to each type, which may improve the effects of IML.

Nonpharmacological interventions in dementia and diversity of samples: A scoping review.

BACKGROUND: A public health priority is the increasing number of people with dementia (PwD), and nonpharmacological interventions (NPIs) might offer support. We sought to synthesize types of NPIs tested among PwD and explore sample characteristics. METHODS: This study was a scoping literature review. Eligible articles were identified using the search terms "nonpharmacological intervention" and "dementia". RESULTS: 36 articles were included. Psychosocial NPIs were implemented the most (n=24) and music-based interventions were found to be the most effective. Gender, race, and ethnicity were not consistently reported (n=30, n=24, and n=6, respectively). White PwD had higher representation, with only 62.5% of studies including Black participants and 25% including Hispanic/Latino participants. Women made up a majority (>50%) of the sample in a greater number of studies (n=20). CONCLUSION: Findings suggest that future studies need to be intentional about improving diversity of the sample, particularly with respect to including persons identifying as Black or Hispanic/Latino.

The impact of music listening intervention on Asia elderly with dementia: a systematic review.

From an initial pool of 2303 studies, ten eligible and potential studies were selected through rigor inclusion and exclusion criteria for this systematic review to examine music therapy's effect on dementia. The review included 967 participants, with the majority being female. A significant number of studies were conducted in Taiwan. Although several cognitive ability assessment methods were employed in the selected studies, the Mini-Mental State Examination (MMSE) was the most commonly used tool for evaluating the effects of music therapy on dementia. Overall, the current review demonstrates that music therapy can be a valuable strategy for treating patients with dementia, with its outcomes including improved cognitive function and potentially slowing the progression of the disease's severity. Therefore, this study can significantly contribute to future studies and practices aimed at using music therapy to treat dementia.

Effectiveness of dyadic sensory art therapies for People with dementia and their caregivers:A systematic review and meta-analysis.

BACKGROUND: The need for dyadic intervention is enhanced with increasing numbers of older adults with dementia. Studies have shown that sensory art therapies are essential for dementia patients and their caregivers. The effects of dyadic sensory art therapies for people with dementia and their caregivers require further exploration. OBJECTIVES: This review aimed to assess the efficacy of dyadic sensory art therapies on neuropsychiatric symptoms and mental function for dementia patients, caregiver burden and psychological state for caregivers, dyad relationship quality for dyads, and evaluate the potential effects of dyadic sensory art therapies on quality of life for both dementia patients and caregivers. METHODS: An electronic literature search of the PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, PsycINFO and three Chinese databases (CNKI, Wanfang and CBM) was conducted up to November 2022. Two reviewers (SZ and QG) worked independently to identify relevant studies. Risk of bias was assessed by the Cochrane's and Joanna Briggs Institute's tool. Meta-analyses were conducted using RevMan software 5.4. RESULTS: This systematic review included 15 studies (7 RCTs and 8 quasi-experimental studies). The meta-analysis showed that dyadic sensory art therapies significantly ameliorated neuropsychiatric symptoms (SMD = -0.90, 95% CI -1.61 to -0.20, P = .01), caregiver burden (SMD = -0.75; 95% CI -1.03 to -0.47; P < .001). No significant improvements were found in caregiver depression and quality of life for both patients and caregivers. CONCLUSIONS: Dyadic sensory art therapies are generally effective at ameliorating neuropsychiatric symptoms, and caregiver burden. Future studies are encouraged to design large-scale randomized controlled trials with high-quality study to examine and confirm the effectiveness of dyadic sensory art therapies for these dyads composed of dementia patients and their caregivers. TRIAL REGISTRATION: PROSPERO CRD 42023393577; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023393577.

Self-Administered Gentle Yoga and Yoga Breathing Intervention Improves Burden and Stress Biomarkers in Caregivers of Persons Living with Dementia.

Family caregivers of adults with Alzheimer's disease and related dementias (ADRD) are the fastest growing group of informal healthcare providers in the United States. These individuals experience high levels of stress and physical and psychosocial symptoms related to their caregiving role. We provided 20 ADRD caregivers (≥ 55 years of age) with training and access to a mobile health app for at-home practice of gentle yoga and yoga breathing exercises. Here, we report secondary outcomes, including changes in caregiver physical and mental function, burden, fatigue, sleep, and biological stress markers (salivary cortisol and 1,5-anhydroglucitol [1,5-AG] assays) from Baseline (Week 1) to Study End (Week 12). Self-reported questionnaire data were collected online via the Research Electronic Data Capture system, and biomarker data were collected via saliva samples. Results supported indications for slight improvement in outcomes of caregiving burden among ADRD caregivers using the gentle yoga and yoga breathing app. Furthermore, slight improvements in mental health were observed; the greatest gains were made by those reporting higher burden and having family members with more severe dementias. Findings indicate that those experiencing the greatest improvement in caregiver burden scores spent the most time doing gentle yoga and yoga breathing exercises. Salivary stress biomarkers moved in a favorable direction (decreased cortisol; increased 1,5-AG) among caregivers practicing the exercises most often. This is among the first studies of gentle yoga and yoga breathing exercises for relieving ADRD caregiver burden and the first we are aware of to incorporate stress biomarker measurement.

Personalized Music Playlists and Headphones in People with Dementia: A Literature Review.

According to the World Health Organization (WHO), around 55 million people worldwide have dementia, and Alzheimer's Disease International (2019) estimates that by 2050 this number is expected to rise to 152 million. With no available cure (WHO, 2021), non-pharmacological interventions have become a popular alternative in the treatment of the cognitive, behavioral, and psychological symptoms of dementia (Dementia Australia, 2020). A widely adopted option that come in different forms is music interventions and while the basic means remains music, some choose a more personalized approach and even less deliver music through over-ear headphones. A number of studies regarding the latter approach report positive outcomes; however, solid evidence on its benefits is scarce.The aim of this literature review was to locate the organizations and initiatives around the world that use the specific approach, explore the different methodologies, search for existing evidence on the interventions' efficacy and the symptoms they address, and look for any ongoing research on the subject. Furthermore, we aimed at investigating if there are any relevant initiatives in Greece.We systematically searched 16 databases and from 276 eligible records, we located 18 relevant studies that met our inclusion criteria and 1 literature review on music interventions for people with dementia. Our examination and analysis of those studies suggested that music interventions utilizing personalized music playlists and headphones result in positive outcomes, including mood improvement and a significant decrease of behavioral and psychological symptoms of dementia. However, our analysis also pointed the need for further and more focused research.

Online gallery facilitated art activities for people with dementia during the COVID-19 pandemic and beyond: A narrative review.

Art activities for people with dementia have a range of therapeutic benefits including psychosocial wellbeing and enhanced quality of life. Successful art programs promote social engagement, are inclusive and empowering, and enable opportunity for people with dementia to express themselves verbally and non-verbally. The COVID-19 pandemic and associated social distancing precautions have impacted the capacity of art galleries and museums to deliver in-person programs. However, they have also provided a new opportunity. This paper explores the potential benefits, challenges, and future directions for research relating to the online delivery of gallery-facilitated art activities for people with dementia. The evidence revealed that increased digitisation of programs increased access for participants, however, the majority of the research was published before the pandemic. Nevertheless, COVID-19 has necessitated many museums and galleries to engage with people with dementia online. Future research is needed to improve the usability of online delivery platforms and a comparison of online and onsite delivery is recommended, particularly to evaluate benefits to people living in rural and remote areas where access to museums and galleries may be limited.

Utilising Emotion Monitoring for Developing Music Interventions for People with Dementia: A State-of-the-Art Review.

The demand for smart solutions to support people with dementia (PwD) is increasing. These solutions are expected to assist PwD with their emotional, physical, and social well-being. At the moment, state-of-the-art works allow for the monitoring of physical well-being; however, not much attention is delineated for monitoring the emotional and social well-being of PwD. Research on emotion monitoring can be combined with research on the effects of music on PwD given its promising effects. More specifically, knowledge of the emotional state allows for music intervention to alleviate negative emotions by eliciting positive emotions in PwD. In this direction, the paper conducts a state-of-the-art review on two aspects: (i) the effect of music on PwD and (ii) both wearable and non-wearable sensing systems for emotional state monitoring. After outlining the application of musical interventions for PwD, including emotion monitoring sensors and algorithms, multiple challenges are identified. The main findings include a need for rigorous research approaches for the development of adaptable solutions that can tackle dynamic changes caused by the diminishing cognitive abilities of PwD with a focus on privacy and adoption aspects. By addressing these requirements, advancements can be made in harnessing music and emotion monitoring for PwD, thereby facilitating the creation of more resilient and scalable solutions to aid caregivers and PwD.

[Research Progressin the Application of Creative Arts Therapy to Behavioral and Psychological Symptoms of Dementia].

Behavioral and psychological symptoms of dementia (BPSD) are common in the patients with dementia.Creative arts therapies (CAT) are one of the safe and effective non-pharmacological interventions for BPSD.This paper elaborates on the therapeutic effects of four common CAT,including art therapy,music therapy,dance therapy,and drama therapy,on BPSD.Despite the shortcomings,CAT offer a new gateway for the safe and noninvasive treatment of BPSD.

Does music intervention relieve depression or anxiety in people living with dementia? A systematic review and meta-analysis.

BACKGROUND: This study aimed to summarize the available evidence on music intervention alleviating depression or anxiety in dementia. METHODS: A comprehensive literature search was performed to analyze the effects of music intervention on depression or anxiety. Subgroups were created to explore the effect of intervention period, duration, and frequency on efficacy. The effect size was reported as a mean standardized difference (SMD) with 95% confidence interval (CI). RESULTS: The analysis included 19 articles involving 614 samples. Thirteen studies for relieving depression revealed that, with an increase in intervention period, the efficacy decreased and then increased, whereas with an increase of intervention duration, the effect became better. A weekly intervention is ideal. Seven studies verifying the impact on anxiety relief revealed that the effect of intervention within 12 wk is significant; with an increase of intervention duration, the effect became better. A weekly intervention is ideal. Collaborative analysis showed that long low-frequency interventions are more efficient than short high-frequency interventions. CONCLUSIONS: Music intervention can relieve depression or anxiety in people living with dementia. Weekly short interventions of more than 45 min are effective for emotional regulation. Future research should concentrate on severe dementia and follow-up impact.

Factors influencing access to nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia: An integrative review.

WHAT IS KNOWN ON THE SUBJECT: Research has shown effectiveness of nonpharmacological interventions in improving or maintaining cognition, mood, functioning, self-efficacy and quality of life for persons with mild-to-moderate dementia (PWDs). These interventions are critical during the earlier stages of dementia. However, Canadian and international literature report underutilization of and difficulty accessing the interventions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: To our knowledge, this is the first review that explored factors influencing seniors' utilization of nonpharmacological interventions in the earlier stages of dementia. This review contributed to the discovery of unique factors such as PWDs' beliefs, fears, perceptions, and acceptability of nonpharmacological interventions and environmental influences on intervention provision. PWDs' intervention uptake may appear as a matter of personal choices related to individuals' knowledge, beliefs and perceptions. However, the analysis of the research evidence suggests that PWDs' choices are shaped by environmental factors such as formal and informal caregiver support, acceptability and accessibility of nonpharmacological interventions, dementia care workforce, community's attitudes towards dementia and funding. The complex interplay among factors highlights the importance of targeting health promotion strategies at both individuals and their environments. WHAT ARE THE IMPLICATIONS FOR PRACTICE: The review findings feature opportunities for healthcare practitioners, including mental health nurses, in advocating for PWDs' evidence-informed decision-making and access to desired nonpharmacological treatments. Involvement of patients and families in care-planning through ongoing assessment of health and learning needs, as well as enablers and barriers to using interventions, continuing information provision, and personalized referrals to appropriate services can promote PWDs' rights to healthcare. ABSTRACT: INTRODUCTION: Despite the significance of nonpharmacological interventions in optimal management of mild-to-moderate dementia, it remains unclear in the literature how persons with mild-to-moderate dementia (PWDs) view, understand and access nonpharmacological interventions. AIM: The purpose of this review was to explore the extent and nature of evidence concerning factors that influence the use of nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia. METHOD: An integrative review was undertaken following Toronto and Remington (A step-by-step guide to conducting an integrative review, 2020)'s instruction which expanded Torraco (Human Resource Development Review, 2016, 15, 404)'s and Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546)'s guidance. RESULTS: The review of 16 studies suggests that PWDs' use of nonpharmacological interventions is shaped by a complex interplay of various personal, interpersonal, organizational, community and political influences. DISCUSSION: The findings highlight the complex, interrelated relationships among multiple factors and subsequent limitations of behaviour-oriented health promotion strategies. To assist PWDs in making healthier choices, health promotion strategies need to direct attention to both individuals' behaviours and environmental conditions impacting the behaviours. IMPLICATIONS FOR PRACTICE: The findings of this review can inform multidisciplinary health practitioners' (including mental health nurses) practice with seniors living with mild-to-moderate dementia. We recommend actionable ways in which they can empower patients and their families in dementia management.

The arts in dementia: instrumental and experiential perspectives.

The indirect experience of dementia mediated through the arts shapes our preconceptions, educating us to understand dementia, gaining a deeper appreciation of how it may affect an individual. By contrast dementia research has largely regarded the arts through an 'instrumental' lens. They are treated as complex psychosocial interventions. Evidence from research on the arts and dementia remains piecemeal because most studies are small and not all are well designed. For numerous reasons the arts warrant further evaluation and investigation in relation to their potential impact on people with dementia. That research needs to be better-designed and adequately funded if it is to advance knowledge in this field. This is fraught with difficulties: the arts are dynamic and interactive; the medium (intervention) can be affected unpredictably by those people who engage with it. Many creative activities are deliberately participatory; think of group singing or stand-up comedy. The influence of human variability in relation to arts interventions means that large studies are necessary to control for individual differences. Moreover, few studies of the arts in dementia have been designed adequately to account for the intra-group interaction that is characteristic of many arts activities. Then, there is a lack of clarity around the purpose of the arts in dementia. There is scope for the development and adoption of comprehensive theoretical frameworks to guide research into the arts and dementia. This editorial sets out to clarify some aspects of the arts in dementia in order to pave way for further work.

Initial evidence regarding the neurobiological basis of psychological symptoms in dementia caregivers.

Mood symptoms and disorders are common in dementia caregivers, who can be exposed to a myriad of potential stressors including their care recipient's neuropsychiatric symptoms. Existing evidence indicates that the effects of potentially stressful exposures on mental health depend on the caregiver's individual characteristics and responses. Specifically, prior studies indicate that risk factors measured on psychological (e.g., emotion-focused/behaviorally disengaged coping responses) and behavioral (e.g., sleep and activity restriction) levels of analysis may confer the effects of caregiving exposures on mental health. Theoretically, this process from caregiving stressors and other risk factors to mood symptoms is neurobiologically mediated. This article reviews recent studies that used brain imaging to identify neurobiological factors that are related to psychological outcomes in caregivers. Available observational data indicate that psychological outcomes in caregivers are related to differences in the structure/function of regions involved in socio-affective information processing (prefrontal), autobiographical memory (the posterior cingulate), and stress (amygdala). In addition, two small randomized controlled trials using repeated brain imaging showed that Mentalizing Imagery Therapy (a mindfulness program) increased prefrontal network connectivity and reduced mood symptoms. These studies raise the possibility that, in the future, brain imaging may be useful to detect the neurobiological basis of a given caregiver's mood vulnerability and guide the selection of interventions that are known to modify it. However, there remains a need for evidence on whether brain imaging improves on simpler/inexpensive measurement modalities like self-report for identifying vulnerable caregivers and matching them with efficacious interventions. In addition, to target interventions, more evidence is needed regarding the effects that both risk factors and interventions have on mood neurobiology (e.g., how persistent emotion-focused coping, sleep disruption, and mindfulness affect brain function).

Music Therapy Increases Social and Emotional Well-Being in Persons With Dementia: A Randomized Clinical Crossover Trial Comparing Singing to Verbal Discussion.

The number of people living with Alzheimer's disease and related dementias (ADRD) is growing proportional to our aging population. Although music-based interventions may offer meaningful support to these individuals, most music therapy research lacks well-matched comparison conditions and specific intervention focus, which limits evaluation of intervention effectiveness and possible mechanisms. Here, we report a randomized clinical crossover trial in which we examined the impact of a singing-based music therapy intervention on feelings, emotions, and social engagement in 32 care facility residents with ADRD (aged 65-97 years), relative to an analogous nonmusic condition (verbal discussion). Both conditions were informed by the Clinical Practice Model for Persons with Dementia and occurred in a small group format, three times per week for two weeks (six 25-minute sessions), with a two-week washout at crossover. We followed National Institutes of Health Behavior Change Consortium strategies to enhance methodological rigor. We predicted that music therapy would improve feelings, positive emotions, and social engagement, significantly more so than the comparison condition. We used a linear mixed model approach to analysis. In support of our hypotheses, the music therapy intervention yielded significant positive effects on feelings, emotions, and social engagement, particularly for those with moderate dementia. Our study contributes empirical support for the use of music therapy to improve psychosocial well-being in this population. Results also highlight the importance of considering patient characteristics in intervention design and offer practical implications for music selection and implementation within interventions for persons with ADRD.

Traditional Chinese medicine Jia Wei Gui Pi Tang improves behavioural and psychological symptoms of dementia and favourable positive emotions in patients.

BACKGROUND: Behavioural and psychological symptoms of dementia (BPSD) are challenging to manage, leading to caregiver burden and often to subsequent transfer of patients to a nursing home or psychiatric hospital for treatment. Eliciting favourable positive emotions should be an important goal in the treatment of negative emotions associated with BPSD. To date, no data have indicated that antipsychotic medications can improve positive emotions. BPSD are known to be associated with anxiety in patients with dementia. The traditional Chinese medicine Jia Wei Gui Pi Tang is officially indicated and approved for anxiety treatment in Japan. METHODS: Here, we performed a multicentre, randomised, observer-blind control study of the effect of Jia Wei Gui Pi Tang on BPSD in Alzheimer's disease (AD) patients. Patients with AD or AD with cerebral vascular disease were randomly divided into the Jia Wei Gui Pi Tang treatment group and the control group that received no traditional Chinese medicine. BPSD were scored using the Neuropsychiatric Inventory Nursing Home Version (NPI-NH) and by favourable positive emotions using the Delightful Emotional Index (DEI). RESULTS: A total of 63 participants (18 male and 45 female; mean age: 83.3 ± 6.0 years) were included in the study. Changes in NPI-NH scores differed significantly between the two groups (one-way analysis of variance, P < 0.001). Within the treatment group, there was a significant improvement in the NPI-NH score from 29.8 ± 17.3 at baseline to 13.2 ± 9.4 at the endpoint (paired t-test, P < 0.001), whereas there was no statistically significant change in the control group. Changes in DEI scores differed significantly between the two groups. Within the treatment group, there was a significant improvement in the DEI score from 24.3 ± 23.0 at baseline to 32.5 ± 21.2 at the endpoint (paired t-test, P = 0.001), whereas there was no statistically significant change in the control group. CONCLUSION: The traditional Chinese medicine Jia Wei Gui Pi Tang significantly improved both BPSD and positive emotions.