Literature review

Impact of Music Therapy in
managing aggressive
behaviours in Alzheimer's
Disease : A literature review

Table of Contents
Literature review..............................................................................................................................3
Theme 1: The concept of Music therapy in treatment of Alzheimer's disease............................3
Theme 2: Impact of Music therapy on aggressive behaviour in Alzheimer's patients................5
Theme 3: Barriers to music therapy for Alzheimer's Patients.....................................................8
REFERENCES..............................................................................................................................10
APPENDIX....................................................................................................................................12

Literature review
Theme 1: The concept of Music therapy in treatment of Alzheimer's disease
Zucchella & et al., (2018) describes Alzheimer's disease as a neurodegenerative disease
involving multiple manifestations of progressive loss of memory, deterioration of language,
cognitive functions and other brain functions accompanied by other behavioural disorders. As
per Rosenberg, K. (2020) there are strong evidences of results in improvement of the symptoms
through non-pharmacological treatments and therapies.
According to Bunt, Hoskyns & Swami, (2013) music therapy is the usage of music for
addressing the emotional, cognitive, physical and social needs of an individual or a group of
people and is one the most successful methods in the treatment of dementia symptoms,
behavioural disorders and depression. The major intervention techniques include improvisation,
therapeutic singing and instrument playing, reminiscence and relaxation techniques facilitated by
music, songwriting and lyric analysis.
In a quantitative study by Raglio and Sospiro, (2010), the aim was to define the music
therapy and underline the primary differences between therapeutic and generic usage of music in
the treatment of dementia. The data collection method was primary through a randomized
controlled study which was conducted for the assessment of MT or music therapy scheme in
administration. The sample size was 60 persons with severe dementia being enrolled and with 30
in controlled group and another 30 in experimental. All the patients received standard care,
where the experimental group got three cycles of 12 active music therapy sessions thrice every
week.
Raglio & Sospiro, (2010) observed that the MT treatment was more effective than
standard care for reducing behavioural disturbances and general aggressive behaviours. A
reduction in NPI global scores of both the groups was noted (F 7,357 = 9.06, p < 0.001) along
with a difference between the groups with (F 1,51 = 4.84, p < 0.05). The analysis showed that
agitation, delusions and apathy noticeably improved in the experimental group of patients but not
in controlled group. Therefore, the author suggested that in working cycles, MT approach helps
in significant improvement of behavioural disorders in patients with severe dementia.
According to Holland & Rees, (2010) P values that are less than 0.05 indicate a chancen
of 5 in 100, and P which is less than 0.01 indicate a chance of 1 in 100. The best result is

indicated by P value of less than 0.001 which means a chance of 1 in 1000, remarkably denoting
a relationship between cause and effect (Holland & Rees, 2010).
The primary strength of the study conducted by Raglio and Sospiro, (2010) was the use
of regression analysis denoting a significant P value. The difference in the effect of treatment
between the experimental and controlled group resulted in less than 0.05, and it strongly
represents evidence against the null hypothesis. Because the probability that null hypothesis in
correct is less than 5% and alternative hypothesis is accepted (Gupta, 2012). However, the study
had limitations when it came to the sample size used in the analysis, which was very small. A
larger sample size of the patients would have been more reliable and extensive, showing more
accurate mean of the average population and would have shown a small margin of error as well.
(Tam, Lo, & Woo, 2020). The preciseness of the musical interventions is also not stated in the
study and a variety of therapeutic interventions were not conducted, which is a major weakness
for determining which type of intervention is accurately successful for the treatment of
Alzheimer's patients.
A similar study conducted by Ray & Götell, (2018) the aim was to find out the impact of
music therapy in decreasing behavioural and depression symptoms in dementia patients. The
total number of 62 residents of nursing homes with moderate dementia were selected and
administered a 2-week music therapy and 2-weeks of music activities with movements and
singing by credentialed music therapists.
Ray & Götell, (2018) found from a sampled t-test and video analysis that a slight
improvement in residents' moods who enraged in music therapy was noted with p being 0.003
and a significant improvement was noted in residents who engaged in singing activities where p
was 0165. Author concluded that music therapy decreases symptoms of behavioural disorders
and improve well-being of dementia patients.
The main strength of the study by Ray & Götell, (2018) was the diversity in the sample
size of the dementia patients according to gender, race, ethnicity and language. Ethical
considerations were appropriate and informed consent was taken from legal representatives
before the participation. The study was approved from the Medicine institutional review board of
New york university. However, the sample size was small similar to Raglio and Sospiro, (2010)
and the Alzheimer's patients constituted of only 22.6% of the total dementia patients with 32.3%