Tuesday, October 20, 2009

Effects of individualized vs classical ‘relaxation’ music on the frequency of agitation in elderly persons with Alzheimer’s disease and related disord

Tautenschilager, Nicola T. “Top Cited Papers in International Psychogeriatrics: 4. Effects of individualized vs classical ‘relaxation’ music on the frequency of agitation in elderly persons with Alzheimer’s disease and related disorders.” International Psychogeriatrics (2009), 21:4, 667-671.

 This article is largely based on research by L.A. Gerdner. While working in a long term care facility the writer observed frequent agitation in elderly people suffering from dementia. This problem is quite widespread and has negative effects on patients and caregivers. During the 1980’s most of the research on dementia involved drug treatments. After enrolling in graduate school the writer found that personalized music could be effectively used to treat agitation. This treatment is particularly favorable since it is relatively easy to implement in a facility and is inexpensive. Personalized music is based on the patient’s experience and taste, unlike classical “relaxation” music. Cognitive impairment, a symptom of dementia, is a “decreased ability to receive and process stimuli resulting in the progressive decline in a patient’s stress threshold” (Tautenschilager 667). Music can be used to communicate with patients who are unable to understand language and do not process stimuli. Personalized music can stimulate memories and can override excessive stimuli that patients are unable to interpret. Thus, the music creates a calming effect. A series of questions called an “Assessment of Personal Music Preference” is filled by either the patient or close relative so that care takers can select music for treatment. In trials personalized music has been played at regular intervals and before expected agitation. Patients have shown a significant improvement in mood and are more communicative. Tools like the Cohen-Mansfield Agitation Inventory an are used to measure agitation. More concrete research needs to be gathered on individualized music treatment, however it is a field that is full promise.     

I really enjoyed reading this article. My grandfather suffered from Alzheimer’s so I have witnessed the challenges this disease presents. I am very aware that it is not only the patient who suffers, but their caretakers as well. Agitation in seniors, particularly those suffering from dementia is difficult to deal with. Unfortunately elder abuse is very common. I am not surprised that personalized music can connect to distant memories and help ease agitation. I often listen to a favorite song to relax or elevate my mood when I’m feeling lethargic. The personalized music approach is unique, because it addresses the individuality of the patient. Some patients may like the rock n roll they heard during their youth while others prefer Barber’s Adagio. In her commentary on the article Lautenschlager notes, “Never lose sight of the essential questions: who is the person suffering from BPSD and what life has he or she lived?” Levels of agitation and overall mood are difficult to quantify, so I understand why people maybe skeptical about this treatment. However, I think the benefits of individualized music therapy outweigh the potential flaws of the treatment. From my own experience volunteering at long term care facilities I have observed that music improves patients’ overall mood. Also, the treatment is relatively inexpensive, it does not require a lot of additional training and can be administered by a trained nurse or a family member. 



1 comment:

rnorman said...

My elderly grandmother has a particularly severe form of dementia. While she is not argumentative or violent in any way, she is severely and cognitively impaired in her dealings with her family and with her caregivers. She has trouble recognizing her family, especially her grandchildren (who are continuously growing and changing), and she is very distrustful of any strangers. My question is, would she be able to benefit from a personalized music therapy approach?

Firstly, if the music therapist were someone she didn’t know, then she wouldn’t take to the treatment very well. But what I like the idea of a music therapist working through a family member. My grandmother would recognize her children, and trust them, so the therapy might go a bit more smoothly that way. That would mean, perhaps, developing a standard method for dealing with patients suffering from dementia, and their family members. But, then again, who knows my grandmother and her personality better than the children she raised?

Unfortunately, my grandmother’s personality has changed quite a bit since she became cognitively impaired. Would this affect the treatment? Would my grandmother be able to recall what she used to like and listen to as a younger woman, or would she simply gravitate toward music that she enjoys in the present? And, if she did gravitate to her “newer” tastes, would the treatment still be as effective in reaching out to my grandmother?

My other issue is that my grandmother is quite deaf in her old age. So how would hearing loss affect a person’s perception of music? My grandmother can still hear, but I doubt she would be able to listen to a symphony orchestra and hear all of the subtle elements. So would hearing loss in old age cause more belligerence and unwillingness in a patient? Would listening to music with damaged and aged auditory equipment prove as a further frustration to the patient? And, if so, how would a music therapist get around this? Would vibro-acoustics using familiar music be effective?

I really liked this posting. I am a firm believer that music is a very powerful art form. It elicits emotion, triggers memories, and requires a listener to be actively involved. I agree with Vasana and with the author of the article that the benefits of this music therapy approach are immense. And perhaps it would be interesting to do brain scans on Alzheimer’s patients as they listened to music, to show which areas of the brain the activity involves, and how that might potentially help the effects of this disease.