The effects of the music-with-movement intervention on the cognitive functions of people with moderate dementia

Abstract

Background: Dementia is a clinical syndrome caused by physical changes in the brain that affects memory and other cognitive abilities. However, the cognitive functions of older adults with dementia may be further compromised by anxiety, symptoms of depression, and agitated behaviour. Music intervention is considered suitable for people with dementia. Its effects on improving affective states and reducing agitated behaviour have been acknowledged in the literature. However, its effect on cognitive functions had not been adequately investigated. Music-with-Movement (MM) is an active approach in music intervention. It has been advocated as a more suitable approach for people with moderate-stage dementia. However, no culturally relevant and evidence-based MM intervention protocol had thus far been available. It is essential to systematically develop such a protocol and test its effectiveness in enhancing cognitive functions. Aims: There were two research objectives in this study. The primary objective was to examine the effects of the MM intervention on the cognitive functions of people with moderate-stage dementia over time, as compared with two comparison groups, namely the Music Listening (ML) and Social Activity (SA) groups. The secondary objective was to examine the direct and mediated effects of the activities (MM, ML, and SA) as a whole on the cognitive functions of people with moderate dementia. Design: This is a prospective, single-blinded, randomized controlled trial. The study protocol was developed by drawing on the literature and expert input, and refined by conducting three pilot studies. One hundred and sixty five participants were recruited from 12 care and attention homes in Hong Kong. The participants were randomly allocated into three groups: the MM, ML, and SA groups. The outcome variables included global cognition, memory, attention, verbal fluency, anxiety, depressive symptoms, and agitated behaviour. Anxiety, depressive symptoms, and agitated behaviour were regarded as mediators of the effects of the intervention on cognitive functions. The participants were assessed on the outcome variables at baseline, immediately after the intervention (T1), and at six weeks post-intervention (T2). Results: A mixed multivariate analysis was adopted to test the effect of the MM intervention over time on the all outcome variables as compared with the ML and SA groups. There were no significant interaction group by time effect, group effect, and time effect. A univariate analysis and pairwise comparisons between the three time points of the three individual groups were also conducted. The results of the univariate analysis revealed that the MM group differed significantly from the ML and SA groups over time in memory function (both memory storage and delayed recall) and depressive symptoms. The effects of the MM intervention on memory function could last for at least six weeks post-intervention (T2). The results of the pairwise comparison between the three time points of the MM intervention showed that the MM intervention could also lead to improvements in global cognition, verbal fluency, anxiety, and agitated behaviour as well. The effects on anxiety and agitated behaviour also lasted for at least six weeks post-intervention. The results of the SEM analysis showed that the activities (MM, ML and SA) had no direct or indirect effects on any of the cognitive outcomes. However, anxiety had a positive effect on agitation and memory, and agitation had a negative effect on memory but a positive effect on attention. Conclusion: This was a pioneer study investigating the effects of the evidence-based MM intervention on the cognitive functions of people with moderate-stage dementia, guided by a conceptual model with theoretical underpinnings. There is insufficient evidence to show that the effects of the MM intervention on outcome variables over time significantly different from those of the comparison groups because of the insignificant interaction of group by time effects in the multivariate analysis. However, the univariate and pairwise comparisons are favourable to the MM intervention. The findings of this study provide insights for further research, and implications for both theory and practice on caring for people with moderate dementia.