Music therapy in the treatment of dementia: Benefits, types and its impact on the brain.

Neuropsychologist Diego Alvarado shares in this article the main effects of music therapy on people affected by dementia, while also comparing the two most widely used types of music therapy in the context of musical therapies, along with their advantages and benefits.

What is dementia or major neurocognitive disorder?

Dementia, currently referred to as a major neurocognitive disorder by the DSM-5, is considered one of the most serious global health issues due to its high prevalence and significant economic and social costs. Worldwide, there are more than 55 million people currently living with some form of dementia, with 60% residing in low- and middle-income countries; over ten million new cases emerge each year (World Health Organization [WHO], 2023).

Its prevalence doubles after age 65, affecting 5–8% of individuals between 65 and 70 years old, 15–20% of those over 75, and 25–50% of those over 85 (Custodio et al., 2017). Although age is the greatest risk factor for dementia, it is not an inevitable consequence of aging nor does it affect only older adults (Alzheimer Europe, 2019).

This condition is a chronic progressive neurodegenerative process, and the psychological and behavioral symptoms of dementia cause great suffering for both patients and caregivers, who are often in fragile physical and social environments that worsen cognitive and functional decline and ultimately lead to institutionalization (Mazorra, 2022).

Although pharmacological treatment has been the first-line approach, the high economic cost, slow patient improvement, and consistently low quality of life during treatment have highlighted the need for parallel approaches that supplement interventions with a quality-of-life-focused strategy aimed at improving patients’ emotional well-being.

The impact of music on the brain

Neuroimaging shows that music can activate various areas of both brain hemispheres, and that this activation occurs even when a person is not actually listening to music but simply imagining it.

• The frontal lobe, responsible for functions such as decision-making, thinking, and planning, is stimulated by listening to music.
• The temporal lobe processes and analyzes musical patterns such as tone, melody, and rhythm.
• The cerebellum coordinates movements and stores muscle memory (like playing the piano). These memories often remain intact in people with dementia.
• The corpus callosum enables communication between the two brain hemispheres, allowing coordinated body movements, such as using both hands to play an instrument.

Overall, each structure is involved in one or more tasks, leading to the conclusion that there is widespread activation suggesting that music is a rich and meaningful stimulus for brain function (Sacks, 2006).

Considering this and within the clinical context, music therapy emerges as an alternative that leverages the strong impact of music on brain physiology through structured programs of stimulation using sounds, rhythms, and melodies to improve symptoms of anxiety and depression, impulse control, and social adaptation in people with dementia. It is a promising approach due to the better cost-benefit ratio compared to traditional pharmacological therapies, which can cost more than €37,000 per person annually in Spain (Ministry of Health and Consumer Affairs, 2017).

Music therapy for dementia treatment

What is music therapy?

Music therapy is defined as the use of musical elements such as rhythm, melody, and tones for rehabilitation and/or relaxation purposes. It can be categorized as either active or passive.

Music therapy treatment for dementia should be personalized according to individual preferences. While cognitive stimulation through music generally shows short-term effects, recent studies on the effectiveness of music therapy indicate that adherence plays a key role in maintaining those effects over the long term. It is also important to determine whether a person is more suited to active music therapy (which involves movement) or passive music therapy (which involves listening).

Types of Music Therapy

1. Active Music Therapy

It requires qualified professionals and that participants have intact motor skills and no conditions that limit movement.

Its benefits are numerous:

1. Increased self-esteem;
2. better impulse control;
3. enhanced socialization skills in group dances;
4. and greater cognitive flexibility by improvising dance steps and various movements.

Active music therapy has notable effects on cognitive activation, while passive music therapy fosters greater self-control, calmness, and self-regulation. This suggests that each type of music therapy can be useful depending on the stage of the disease a person is going through. Factors such as personal characteristics and previous experience with listening to or creating music may influence therapeutic success. Still, positive effects are present in both dimensions, making both types of music therapy applicable in dementia care.

2. Passive Music Therapy

It requires virtually no external resources, facilitates abstraction, and invites aesthetic reflection, which creates a powerful experience of cognitive stimulation through music, requiring only a sustained attention capacity within the normative range.

Benefits of Music Therapy for Dementia Treatment

When compared, both offer significant benefits in behavioral, emotional, psychological, and social improvement. Moreover, both have a positive impact on affective symptoms at the clinical level, promoting a positive emotional state that lasts even after the intervention programs have ended.

Active music therapy has notable effects on cognitive activation, while passive music therapy fosters greater self-control, calmness, and self-regulation. This suggests that each type of music therapy can be useful depending on the stage of the disease a person is going through. Factors such as personal characteristics and previous experience with listening to or creating music may influence therapeutic success. Still, positive effects are present in both dimensions, making both types of music therapy applicable in dementia care.

Active music therapy has notable effects on cognitive activation, while passive music therapy fosters greater self-control, calmness, and self-regulation.

This suggests that each type of music therapy can be useful depending on the stage of the disease a person is going through. Factors such as personal characteristics and previous experience with listening to or creating music may influence therapeutic success. Still, positive effects are present in both dimensions, making both types of music therapy applicable in dementia care.

Recent studies on the effectiveness of music therapy in dementia indicate that listening to music can be both a protective factor and a therapeutic tool (Witte, 2022). Its effects on cognitive functions have been documented for hundreds of years, even in Eastern cultures, where music aimed to nourish ideas, promote reflection, and improve mental clarity—effects similar to what cognitive stimulation seeks to achieve in many dementia cases.

This is undoubtedly also applicable to active music therapy, where body movement enhances awareness of the environment, stimulates communication with others, and reduces cortisol levels, whose prolonged elevation affects planning and organization functions typically managed by the brain’s frontal areas.

Dementia is characterized by significant frontal lobe deterioration. However, with the application of music therapy, this area is stimulated, and the decline appears to slow down. Evidence of this is seen in the improvements some patients achieve in areas such as reasoning, becoming able to adapt to dance steps, anticipate rhythm continuation, and process song lyrics more fluently (Bleibel, 2023).

In later interventions, patients show more relaxation during activities, increased willingness to participate, and positive changes in functional personality traits, resulting in greater efficiency in daily activities as well as improvements in quality of life.

Initial effects vary. Some patients report positive outcomes from the first music therapy sessions, while others show no change. Prior relationship with music appears to be a relevant factor. Nevertheless, as the interventions progress, most patients report one or more positive effects regardless of the style of music, rhythms, or melodies used. Finally, caregivers report that in the long term, the activity is perceived positively, whether due to the social component of the music therapy routine or the direct effects of the music itself.

Equally significant is the impact on caregivers’ lives, as they report improved communication quality with patients and a more positive perception of their caregiving role. They are able to connect on an emotionally closer level when no anxiety or depression triggers are present. In this sense, engaging in other mutually enjoyable activities between caregiver and patient helps strengthen the relationship and ease difficulties that may arise in caregiving contexts.

Music Therapy or Complementary Therapies for Dementia Treatment

Like music therapy, there are other therapies that use elements such as scent (aromatherapy), acupuncture, herbal medicine, or relaxation techniques to address symptoms like memory loss in Alzheimer’s disease (AD), depression, and impulsivity. These therapies are reported to bring subjective improvements and partially alleviate psychological discomfort during the course of dementia.

The main difference lies in the quality of the research evidence behind these therapies, where there tends to be low rigor regarding dosage and timing of application, or a lack of guidelines for optimal patient monitoring. On the other hand, music therapy has shown that with proper structure, timing, and adherence, its effects can be studied in a quantifiable and concise manner.

Another advantage is that music is universal, meaning most people already have some prior exposure to certain elements included in therapy programs, making it easier to adapt to the implemented dynamics and encouraging participation.

How to Implement Music Therapy in Cognitive Stimulation for People with Dementia

Music therapy is an effective tool for people with dementia, as it activates areas such as:

• The hippocampus, part of the limbic system, responsible for information retrieval and storage;
• the limbic system, associated with emotional responses;
• and the prefrontal area, which is involved in higher-order cognitive functions.

In the early stages, activation activities such as singing, dancing, playing instruments, and listening to music can be performed. In moderate to advanced stages, these same activities can be carried out with a focus on sensory stimulation, prioritizing music that is meaningful to the patient.

Strategies may also include:

1. Identifying songs that have been meaningful in the patient’s life (traditional music, religious songs, hymns, etc.).
2. Creating curated playlists in collaboration with family members.

To reinforce interventions, it is important to incorporate music into daily routines. For example, using upbeat, lively rhythms in the morning and relaxing music at night.

It is also important to complement this with multisensory interventions, physical exercise, and other types of cognitive stimulation based on the patient’s needs.

An interesting strategy involves recalling the lyrics of a meaningful song and associating it with a lived event, which serves as a practical memory exercise. Similarly, group singing or completing the lyrics of familiar songs is useful for language stimulation.

To stimulate attention and motor coordination, guided playing of musical instruments can be used. This is effective whether or not the person has prior musical experience. The same can be applied in a free-play format when addressing motor agitation or anxiety symptoms.

Conclusions

Music therapy is an emerging discipline that requires continued study and assessment alongside other intervention variables. While current evidence shows high effectiveness when included in treatment programs for people with dementia, it is essential that its application occurs within an interdisciplinary framework in coordination with occupational and neuropsychological therapies.

Caregiver reinforcement is also crucial, as integrating music into daily life helps maintain the focus of the intervention and strengthens what has been achieved through therapy.

References

• Alzheimer Europe. (2019). Dementia in Europe. Yearbook 2019: Estimating the prevalence of dementia in Europe. Alzheimer Europe. https://www.alzheimer-europe.org
• Bleibel, M., El Cheikh, A., Sadier, N. S., & Abou-Abbas, L. (2023). The effect of music therapy on cognitive functions in patients with Alzheimer’s disease: A systematic review of randomized controlled trials. Alzheimer’s Research & Therapy, 15(1), 65. https://doi.org/10.1186/s13195-023-01214-9
• Mazorra Ruiz, D. (2022). Alzheimer’s and Parkinson’s Treatment, Limitations. Search for new therapeutic targets and drugs [Master’s thesis, Universidad Nacional de Educación a Distancia]. UNED Repository. http://creativecommons.org/licenses/by-nc-nd/4.0info:eu-repo/semantics/openAccess
• Ministry of Health and Consumer Affairs. (2017). Comprehensive Plan for Alzheimer’s and Other Dementias (2017–2023). Ministry of Health and Consumer Affairs.
• World Health Organization. (2023). [Document title if available]. World Health Organization. https://www.who.int
• Sacks, O. (2006). The power of music. Brain, 129(10), 2528–2532. https://academic.oup.com/brain/article-abstract/129/10/2528/292982
• Witte, M., Pinho, A. D. S., Stams, G. J., Moonen, X., Bos, A. E. R., & van Hooren, S. (2022). Music therapy for stress reduction: A systematic review and meta-analysis. Health Psychology Review, 16(1), 134–159. https://doi.org/10.1080/17437199.2020.1846580

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