and “music therapy” - ASP Città di Bologna

Il ruolo della musicoterapia nei servizi assistenziali per anziani Sabato 27 Settembre 2014 – SALA POLIVALENTE CENTRO SERVIZI CARDINALE G. LERCARO Quando la musica diventa terapia: l’efficacia della musicoterapia nelle demenze Dr. Alfredo Raglio alfredo.raglio@unipv.it www.alfredoraglio.it Dr. Alfredo Raglio, ASP Città di Bologna 2014
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Clinical Psychology Review 29 (2009) 193–207
Contents lists available at ScienceDirect
Clinical Psychology Review
Dose–response relationship in music therapy for people with serious mental
disorders: Systematic review and meta-analysis
Christian Gold a,⁎, Hans Petter Solli b,c, Viggo Krüger b, Stein Atle Lie a
a
b
c
Unifob Health, Bergen, Norway
University of Bergen, Norway
Lovisenberg Diakonale Hospital, Oslo, Norway
“…Music therapy is a special type of psychotherapy where forms of musical interaction and communication are r t i c c
l ommunication. e i n f o
b b
s een t r ad
c efined t
used alongside averbal It haas as “a systematic process of intervention wherein the Serious
mental m
disorders
considerable individual
and
societal
impact, and traditional
may
therapist helps the client to promote health, using usic have
experiences and the relationships dtreatments
eveloping through show limited effects. Music therapy may be beneficial in psychosis and depression, including treatmentresistant cases. The aim of this review was to examine the benefits of music therapy for people with serious
them as dynamic forces of change” (Bruscia, 1998). The types of ‘music experiences’ used in music therapy can mental disorders. All existing prospective studies were combined using mixed-effects meta-analysis models,
allowing to examine the influence of study design (RCT vs. CCT vs. pre-post study), type of disorder
include free and structured improvisation, other types of active music-‐making by patients, and listening (psychotic vs. non-psychotic), and number of sessions. Results showed that music therapy, when added to
standard care, has strong and significant effects on global state, general symptoms, negative symptoms,
to music. Improvisation is perhaps the depression,
most panxiety,
rominent orm of engagement.
musical interaction in music functioning, fand
musical
Significant
dose–effect relationships
were therapy… identified for general, negative, and depressive symptoms, as well as functioning, with explained variance
Music therapists are specifically trained to from
intervene therapeutically wareithin he 3 tom10,edium, for ranging
73% to 78%. Small
effect sizes for these outcomes
achieved t
after
large effects after
16example to to 51 sessions. The findings suggest that music therapy is an effective treatment which helps people with
support by providing rhythmical or tonal gpsychotic
rounding, to clarify, to cdisorders
onfront or to challenge the lient's expression in and non-psychotic
severe mental
to improve
global
state, symptoms,
and c
functioning.
Slight improvements can be seen with a few therapy sessions, but longer courses or more frequent sessions
the music (Bruscia, 1987; Wigram, 2004). Oarether of m
usic ebenefits.
xperiences in music therapy include playing neededm
to odes achieve more
substantial
© 2009 Elsevier Ltd. All rights reserved.
composed music on instruments, singing and writing or improvising songs (Baker & Wigram, 2005), and listening to Contents
music (Grocke &
Wigram, 2006)… All these different modes of ‘music experiences’ become therapeutic by 1.
. .o
. f . a
. .therapeutic . . . . . . . . . . . r
. elationship. . . . . . . . . . . . .V
. erbal . . . . . d
. iscussions, . . . . . . . . . . r. eflections, . . . . . . . . . o
. r . .interpretations . .
194
being used in the cIntroduction
ontext 1.1.
Music therapy in mental health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
194
1.2.
Music
therapy—the
evidence
to date
. . c
. lients . . . . . e
. xplore . . . . . . t
. he . . .p. otential . . . . . . . m
. . eaning . . . . . . o
. f . a
. n . .e
. xperience, . . . . . .
195 and to relate a connected to the music a
re i
mportant t
o h
elp 1.3.
Research questions addressed in this review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
195
Method
. . . . . . .to . . s.ituations . . . . . . . . in . . t. he . . c
. lient's . . . . . . l.ife. . . .T
. he . . .d. egree . . . . . t.o . w
. .hich . . . . t.he . . m
. . usic . . . .e
. xperience . .
196
new experience w2. ithin t
herapy itself, 2.1.
Criteria for selecting studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
196
2.1.1.
Study design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
196
versus the verbal reflection cStudy
onnected to it, is seen as the active agent of change may vary between m
odels of music 2.1.2.
quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
196
2.1.3.
Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
196
therapy (Garred, 2004), 2.1.4.
as wInterventions
ell as between clients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
196
2.1.5.
Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
196
However, treatments t
hat r
ely s
olely o
n t
he d
irect e
ffects o
f m
usic a
lone, w
hich d
o n
ot “
involve or depend 2.2.
Search strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
196
2.3.
Selection of studies and data extraction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
196
upon a process of i2.4.ntervention Data analysis . . . a. nd . . . c. hange . . . . . . w
. .ithin . . . . . a. c
. lient–therapist . . . . . . . . . . . . . . . r. elationship” . . . . . . . . . . . . (.“auxiliary . . . . . .
196 level”, 2.4.1.
Individual study results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
196
Bruscia, 1998, p. 195), a2.4.2.
re nCombination
ot music therapy. such of study
results . . . T
. he . . . t.erm . . . .‘music . . . . . .m
. .edicine’ . . . . . . .is . .sometimes . . . . . . . . . .u.sed . . . t. o . d
. istinguish 197
3.
Description of studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
197
treatments from music therapy.”… 3.1.
Selection
process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
197
Dr. Alfredo Raglio, ASP Città
di Bologna 2014
Article history:
Received 30 June 2008
Received in revised form 6 January 2009
Accepted 12 January 2009
Keywords:
Psychosis
Depression
Psychotherapy
Dose–effect relationship
Mixed-effects meta-analysis
3.2.
3.3.
3.4.
3.5.
General study characteristics . . .
Interventions: Music therapy. . .
Comparison conditions . . . . .
Data extraction and preprocessing
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197
197
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200
Differences between “music” and “music therapy” interventions in dementia.
(Raglio & Gianelli, Current Alzheimer Research, 2009, 6, 293-301).
MUSIC
MUSIC THERAPY
Presence of a professional of the music area
Presence of a professional of the musictherapeutic area with specific relational and
musical competences
Absence of a specific therapeutic setting
Presence of a structured therapeutic setting
Absence of a specific intervenion model
Presence of a music-therapeutic referential
model grounded on theoretical and
methodological criteria
Aims: temporary well-being, improving mood,
promoting socialization, memories and
stimulation of frames of mind, relaxation, etc.
Aims (aspiring to become stable and longlasting over time): attenuation of behavioral and
psychiatric symptoms and prevention/
stabilization of complications; increase in
communication and relationship skills
Contents: structured musical initiatives
(rhythmic use of instruments, singing,
movement associated to music, etc.) and
listening to music (classical music, favourite
music, etc.)
Contents: sonorous-musical improvisation;
listening activities that involve verbal and
elaborative competences (preferably at initial
stages of dementia)
Dr. Alfredo Raglio, ASP Città di Bologna 2014
after initiation of trazodone, and the headache disaped
when the
the agent
agent was
was discontinued.
discontinued. The
The temporal
temporal
d when
onship suggested
suggested that
that the
the headache
headache could
could be
be the
the adverse
adverse
onship
t of
of trazodone
trazodone use.
use. The
The possibility
possibility of
of the
the headache
headache caused
caused
rotonin syndrome
syndrome is
is not
not likely
likely due
due to
to the
the lack
lack of
of clinically
clinically
rotonin
ciated
findings of
of mental
mental status
status change,
change, autonomic
autonomic hyperhyperiated findings
ity
or neuromuscular
neuromuscular abnormalities.
abnormalities.
ty or
he
most common
common side-effects
side-effects that
that lead
lead to
to discontinuation
discontinuation
e most
azodone for
for treatment
treatment of
of insomnia
insomnia are
are sedation,
sedation, dizzidizziazodone
2
and
psychomotor
impairment.
2 To our knowledge,
and psychomotor impairment. To our knowledge,
are few reports of severe headache as an adverse effect
are few reports of severe headache as an adverse effect
d to trazodone use. In 1992, Workman et al. reported
d to trazodone use. In 1992, Workman et al. reported
a 35-year-old patient who possessed a genetic predisa 35-year-old patient who possessed a genetic predision toward migraine suffered from severe migraine
ion toward migraine suffered from
severe migraine
ache after trazodone treatment.3 The mechanism of
ache after trazodone treatment.3 The mechanism of
done-induced headache is not clear. Serotonin-releasing
done-induced headache is not clear. Serotonin-releasing
r and serum serotonin increase during headache attacks
r and serum serotonin increase during headache attacks
cerebral vessels are highly innervated by serotonin fibers
cerebral vessels4,5are highly innervated by serotonin fibers
raphe nuclei. Workman et al. indicated that migraine
raphe nuclei.4,5 Workman et al. indicated that migraine
ache may be evoked by trazodone through its active
ache
may be evoked by trazodone through its active
bolite, m-chlorophenylpiperazine, which is a potent
bolite,
is a potent
elective m-chlorophenylpiperazine,
serotonin receptor agonist.which
In addition,
this
elective serotonin receptor agonist. In addition, this
Operatore
formato
Received 14 June 2011; revised 8 August 2011;
accepted 23
23 September
September 2011.
2011.
accepted
Issue
When music
music becomes
becomes music
music therapy
therapy
When
doi:10.1111/j.1440-1819.2011.02273.x
doi:10.1111/j.1440-1819.2011.02273.x
Psychiatry and Clinical Neurosciences 2011; 65: 679–683
S
CIENTIFIC LITERATURE PROVIDES evidence of the
CIENTIFIC LITERATURE PROVIDES evidence of the
unquestionable effects of music both in pathological coneffects
of music
boththerapeutic
in pathological
conIunquestionable
personally
that
music
embodies
potentialion the
texts
and uponsee
individuals
generally
speaking.11 Also
Also on the
texts
and
upon individuals
generally speaking.
ties
as
suggestive
–
but
not
scientifically
proven.
physiological, neurophysiological, biological and neurochemiphysiological,
neurophysiological,
biological
and neurochemiexample,
‘Mozart’s
music’
is an
concept:22
calFor
levels,
confirmation
of such
effects
hasinsufficient
been forthcoming.
cal
levels,
confirmation
of suchoreffects
hasfrom
beenDon
forthcoming.
which
Mozart?
The
Requiem
an
aria
Giovanni?
Empirically, all individuals can experience well-being and
Empirically, all individuals can experience well-being and
positive
emotions
when
that has
parWhy Mozart
and not
thelistening
Beatles ortoB.music
McFerrin?
Andsome
addresspositive emotions when listening to music that has some particular
significance
forwhat?
them,How?
or can derive pleasure from
ing
whom?
Producing
ticular significance for them, or can derive pleasure from
socializing
a musical
experience
(making
or listening tomusicmusic
With these
queries
in mind,
the international
socializing
a musical
experience
(making
or listening
to music
Psychiatry
and
Clinical
2011;
65:
679–683
together
with
others), Neurosciences
buthas
allintroduced
the above,
while
emphasizing
the
therapeutic
community
–
as
an
essential
comtogether
with others),
but
all therefers
above,
while emphasizing
the
potentialities
of music,
usually
to momentary
effects that
3,4
ponent
of
therapy
by
music
–
the
concept
of
‘relationship’.
potentialities
of music,
elude therapeutic
logic.usually refers to momentary effects that
Thetherapeutic
above thoughts
elude
logic. can help re-model music-therapeutic
I personally
see that music
potentialipractices
by introducing
theembodies
followingtherapeutic
aspects (Evidence
Based
tiesMusic
as suggestive
but not
scientifically
proven. 5,6 musical and
Therapy–and
Evidence
Based Practice):
For example, ‘Mozart’s music’ is an insufficient concept:
relational
training of music therapists, presence of a therapeu011 The Authors
which Mozart? The Requiem or an aria from Don Giovanni?
011 The Authors
tic
setting,
a theoretical/methodological
background, aims
Why Mozart
and not the
or B. McFerrin? And addresshiatry and Clinical Neurosciences © 2011 Japanese Society
of Psychiatry
andBeatles
Neurology
to the achievement
hiatry and Clinical Neurosciences © 2011 Japanese Society
of Psychiatry
and
Neurology
ingoriented
whom?
Producing
what?
How? of stable and longlasting
improvements
(according
to type
gravity of pathologies
With these queries
in mind,
theand
international
musicconsidered),
contenthas
(active
and/or
techniques)
therapeutic
community
introduced
– asreceptive
an essential
com3,4
facilitating
intra-by and
inter-personal
with
the
ponent
of therapy
music
– the conceptrelationships
of ‘relationship’.
The
above
thoughts
can
help
re-model
music-therapeutic
patient/client and rigorous assessment criteria.
practices
by introducing
the following
aspects
Based
I believe
that neither
music nor
the(Evidence
sonorous-musical
5,6
and if
Music
Therapy
andtoEvidence
Based
Practice):
element
can fail
keep these
concepts
in due musical
consideration
relational
training
of
music
therapists,
presence
of
a
therapeuthey are to assume a potential therapeutic value. In therapeutic
tic setting, a theoretical/methodological background, aims
applications it is of essential importance that the individual’s
oriented to the achievement of stable and longlasting
musicality and musical potential should emerge: this can only
improvements (according to type and gravity of pathologies
happen through
the(active
relationship
between
the music
therapist
considered),
content
and/or
receptive
techniques)
and the patient/client
mediated by the
power of music.
This is
facilitating
intra- and inter-personal
relationships
with the
what definesand
therigorous
therapeutic
specificity
of music and contextupatient/client
assessment
criteria.
I believe that neither music nor the sonorous-musical
element can fail to keep these concepts in due consideration if
they are to assume a potential therapeutic value. In therapeutic
applications it is of essential importance that the individual’s
musicality and musical potential should emerge: this can only
happen through the relationship between the music therapist
and the patient/client mediated by the power of music. This is
what defines the therapeutic specificity of music and contextu-
Modello di
riferimento
Setting
terapeutico
strutturato
Obiettivi
terapeutici
Contenuti
specifici
(tecniche)
Letters to the Editor 683
alizes the various possible interventions through music. Music
can be the source of deep pleasure, it can stimulate relationships and attentive and cognitive functions, but it becomes
therapeutic practice only in the presence of the essential components mentioned above.
REFERENCES
Psychiatry
and683Clinical Neuroscien
Letters to the Editor
1. Sacks O. The power of muisc. Brain 2006; 129: 2528–2532.
2. Koelsch S. TowardsVolume
a neural basis
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emotions.
65,of Issue
7, (/doi/10.1111/pcn.2011.65.issue-7/i
Trends
Cogn.possible
Sci. 2010;
14: 131–137.
alizes the
various
interventions
through music. Music
C. All those
things
with music
J. Music
can 3.beGold
the source
of deep
pleasure,
it can(Editorial).
stimulate Nord.
relationInformation
ships and
cognitive functions,
but it becomes
Ther.attentive
2009; 18:and
1–2.Additional
therapeutic
only
in theVpresence
of the essential
com- in
, Kruger
et al. Dose-response
relationship
4. Gold practice
C, Solli HP
ponents
mentioned
muisc
therapy above.
for people with serious mental disorders: systemHow toClin.
Cite
atic review and meta-analysis.
Psychol. Rev. 2009; 29: 193–
207.
REFERENCES
5. Vink A, Bruinsma M. Evidence based music therapy. Music
1. Sacks O. The power of muisc.
BrainA.
2006;
129: 2528–2532.
Raglio,
(2011),
When
music becomes music therapy.
Ther. Today 2003; 4:
1–26. Available
from URL:
http://www.
2. Koelsch S. Towards a neural basis of music-evoked emotions.
musictherapyworld.de
(last
accessed
4
July
2004).
doi: 10.1111/j.1440-1819.2011.02273.x
Trends Cogn. Sci. 2010; 683.
14: 131–137.
6. Edwards
J. Possibilities
and
problems
for evidence-based
3. Gold
C. All those
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(Editorial).
Nord. J. Musicpracin music
therapy. Arts Psychother. 2005; 32: 293–301.
Ther.tice
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18: 1–2.
V et al. Dose-response
relationship in
4. Gold C, Solli HP, Kruger
Author
Information
Alfredo
Raglio,
MA (Music
Therapy)
muisc therapy for people with serious
mental
disorders:
systematic review and meta-analysis. Clin.
Psychol.
Rev. 2009;Cremona,
29: 193– Italy
Sospiro
Foundation,
207.
Email: raglioa@tin.it
M. Evidence
based
therapy.
Music2011;
5. Vink A, BruinsmaReceived
25 July
2011;music
revised
22 August
Ther. Today 2003; 4: 1–26. Available from URL: http://www.
accepted
23
September
2011.
musictherapyworld.de (last accessed 4 July 2004).
6. Edwards J. Possibilities and problems for evidence-based practice in music therapy. Arts Psychother. 2005; 32: 293–301.
Sospiro Foundation, Cremona, Italy, Email: raglio
Publication History
Alfredo
Raglio,
MA (Music Therapy)
1.
Issue
published
online: 19 DEC 2011
Sospiro Foundation, Cremona, Italy
2. ArticleEmail:
firstraglioa@tin.it
published online: 19 DEC
Received 25 July 2011; revised 22 August 2011;
accepted 23 September 2011.
2011
http://onlinelibrary.wiley.com.bibliosan.cilea.it/doi/10.1111/j.1440-1819.2011.0227
Rigorosi criteri
di verifica
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Global Music Approach in Dementia (GMA-D)
(Raglio et al., Clinical Interventions in Aging, 2014, in press)
•  Active Music Therapy (psychological and rehabilitative
• 
• 
• 
• 
• 
approaches, AMT-PA and AMT-RA)
Active Music Therapy with Family-Caregivers and PWD
(AMT-FC)
Individualized Listening to Music (ILM)
Music-based Interventions (MBI)
Caregivers Singing (CS)
Background Music (BM)
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Music therapy in the field of
dementia…
"   Improves the behavioural and psychological symptoms
"   Improves the relational and communicative skills
"   Improves the organization/regulation of the emotional
components of the personality
"   Promotes the maintenance/recovery of a sense of identity
"   Induces a better adaptation of the person to social environment
"   Stimulates cognitive functions (attention, memory, executive
functions, etc.)
"   Improves the quality of life
"   …
Dr. Alfredo Raglio, ASP Città di Bologna 2014
EVIDENCE BASED MEDICINE ê
EVIDENCE BASED MUSIC THERAPY (Edwards, 2002; 2004; Vink & Bruinsma, 2003) Dr. Alfredo Raglio, ASP Città di Bologna 2014
LEVEL OF EVIDENCE
"
Systematic review that is based on RCT's "   RCT or CCT studies "
Patient-‐series with or without controls "   Case studies "   Expert opinions
"   Qualitative research Dr. Alfredo Raglio, ASP Città di Bologna 2014
Music therapy for people with dementia (Review)
Vink AC, Bruinsma MS, Scholten RJPM
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2011, Issue 3
http://www.thecochranelibrary.com
Music therapy for people with dementia (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Cochrane Review
(2003: 5 studies)
Vink AC, Birks JS, Bruinsma MS, Scholten RJS. Music therapy for people with dementia. The Cochrane Database of Systematic Reviews: Reviews 2003 Issue 4 John Wiley & Sons, Ltd Chichester, UK DOI: 10.1002/14651858.CD003477 "
Groene, 1993 (active music therapy, behavioral problems) "   Lord et al., 1993 (active music therapy, emotional functioning) "   Clark et al., 1998 (pre-‐recorded music, behavioral problems) "
Gerdner, 2000 (pre-‐recorded music, behavioral problems) "
Brotons et al., 2000 (active music therapy, cognitive functioning) Dr. Alfredo Raglio, ASP Città di Bologna 2014
Updating of COCHRANE
REVIEW
(2011:5 new studies)…
"
Sung et al., 2006 (active music therapy, behavioral problems)
"
Svansdottir et al., 2006 (active music therapy, behavioral problems)
"   Raglio et al., 2008 (active music therapy, behavioral problems)
"
Guétin et al., 2009 (pre-‐recorded music, emotional functioning)
"   Raglio et al., (2010) (active music therapy, behavioral problems) Dr. Alfredo Raglio, ASP Città di Bologna 2014
Updating of Cochrane Review
by Vink et al., 2011
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Vink AC, Bruinsma MS, Scholten RJPM. Music therapy for people with dementia. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003477. DOI: 10.1002/14651858.CD003477.pub2. Author’s conclusions
-  Methodological limitations
-  Poor statistical analysis
-  Little information about the
randomization
-  Small sample sizes
-  Short interventions period
-  …
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Vink AC, Bruinsma MS, Scholten RJPM. Music therapy for people with dementia. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003477. DOI: 10.1002/14651858.CD003477.pub2. Implications for research
CONSORT guidelines for RCTs
Adequate methods of randomization
Blind evaluation
Reliable and validated outcome measures
To assess medium and long-term effects
To differentiate music therapy approaches
(active vs receptive techniques)
-  To compare music therapy with listening to
music
- 
- 
- 
- 
- 
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Dr. Alfredo Raglio, ASP Città di Bologna 2014
Author's personal copy
Maturitas 72 (2012) 305–310
Contents lists available at SciVerse ScienceDirect
Maturitas
journal homepage: www.elsevier.com/locate/maturitas
Review
Music, music therapy and dementia: A review of literature and the
recommendations of the Italian Psychogeriatric Association
A. Raglio a,b,∗ , G. Bellelli c,d , P. Mazzola c , D. Bellandi a , A.R. Giovagnoli e , E. Farina f ,
M. Stramba-Badiale g , S. Gentile h , M.V. Gianelli i , M.C. Ubezio a , O. Zanetti l , M. Trabucchi m,d
a
Sospiro Foundation, Sospiro (Cr), Italy
Maugeri Foundation I.R.C.C.S., Pavia, Italy
Milano-Bicocca University, Monza, Italy
d
Geriatric Research Group, Brescia, Italy
e
I.R.R.C.S. Neurological Institute Carlo Besta, Milan, Italy
f
I.R.C.C.S. Don Gnocchi Foundation, Milan, Italy
g
I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy
h
Alzheimer’s Evaluation Unit, Ancelle della Carità Hospital, Cremona, Italy
i
University of Genoa, Genoa, Italy
l
I.R.C.C.S. S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
m
Tor Vergata University, Rome, Italy
b
c
a r t i c l e
i n f o
Article history:
Received 24 May 2012
Accepted 31 May 2012
Keywords:
Music therapy
Music
Dementia
Scientific perspectives
Recommendations
Contents
1.
2.
a b s t r a c t
This study reviews the most recent (from 2000 to 2011) Clinical Controlled Trials (CCT) and Randomized
Controlled Trials (RCT) concerning the use of music and music-therapy (MT) in the context of dementia
and related issues.
Studies which explored the efficacy of music and MT on behavioral and psychological symptoms of
dementia (BPSD) are prevalent, while those aiming at assessing a potential effect of these approaches
on cognitive and physiological aspects are scant. Although with some limitations, the results of these
studies are consistent with the efficacy of MT approach on BPSD. In this context, the ability of the music
therapist to directly interact with the patients appears to be crucial for the success of the intervention.
This review was endorsed by the Italian Psychogeriatric Association (AIP) and represents its view about
the criteria to select appropriate music and MT approaches in the field of dementia. Accordingly, we have
developed a list of recommendations to facilitate the current use of these techniques in the context of
non-pharmacological treatments for patients with dementia.
© 2012 Elsevier Ireland Ltd. All rights reserved.
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Methods: selection criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Music/Music Therapy and
Dementia
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Association (AIP) and represents its view on the use of music and MT
approaches for patients with dementia. Accordingly, we developed
et al. / Maturitas 72 (2012) 305–310
a listA.ofRaglio
recommendations.
Concerning the clinical practice the AIP recommends:
Refe
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2
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ctive music or MT approaches.
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s showed an improvement of
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e or no treatment. Studies with
of success.
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d by the Italian
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References
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BPSD
view on the useagement
of musicof
and
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s
therapist/patient
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ntia. Accordingly, we developed
[1] Gold C. All those things with music (Editorial). Nordic
[6]Jou
R
3. The preferential use of MT 2009;18:1–2.
to make the treatment more tailored
o
[2] Gold
C, Solli
HP, Kruger
V, Lie and
SA. Dose–response
2
the AIP recommends:
to meet the patients’ needs,
and
to improve
BPSD
commu- relation
for people with serious mental disorders: systematic[7]
reviS
nicative skills in particular Clinical
in moderate–severe
dementia.
Psychology Review
2009;29:193–207.
i
[3] Brandes
V. listening
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4. as
Also
use ofpreindividualized
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basedtherapy
on preferred
music or MT
thethe
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i
Psychosomatics 2011;80:305.
[8] S
and/or familiar music as
background
music did not prove its
[4] Gold C, Erkkilä J, Ole Bonde L, Trondalen G, Maratos A
a
efficacy.
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in the mantherapy or music medicine? Psychotherapy and Psychos
N
[5]
Raglio
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Psychiat
tandard care5.asThe
theintroduction
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[9] S
sciences 2011;65:682–3.
pears to be the and
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the conduction of[6]the
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and MTMV.
treatment.
Raglio
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Music therapy for individuals i
a
ke the treatment more tailored
of interventions and
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perspectives.
Dr. Alfredo
Raglio, ASP Città
di Bologna 2014 Current
2
2009;6:293–301.
to improve BPSD and commu-
5. The introduction of Evidence Based Practice [39,40] in the choice
and in the conduction of the music and MT treatment.
[9]
A. Raglio et al. / Maturitas 72 (2012) 305–310
[10]
Concerning
the research
activity inand
the field
music and MT in
ive music or
MT approaches.
peer of
review
Provenance
the AIP recommends:
showeddementia
an improvement
of
[11]
Commissioned and externally peer reviewed.
or no treatment. Studies with
controversial
results
in BPSD
1. A more
rigorous
methodology including a more accurate definiby the Italian
tionPsychogeriatric
of the population of patients and of the type of interventions.
[12]
References
ew on the
music and MT
2. use
Theofconduction
of studies aimed at identifying which types of
a. Accordingly,
we developed
dementia
have the greatest
chances
of improvement
to dif[1] Gold
C. All those
things with musicdue
(Editorial).
Nordic Journ
[13]
2009;18:1–2.
ferent kinds of music and MT interventions.
[2] Gold C, Solli HP, Kruger V, Lie SA. Dose–response relationsh
e AIP recommends:
dose–effect relationship of the dif3. The assessment of a possible
for people with serious mental disorders: systematic review
[14]
ferent interventions.
Clinical Psychology Review 2009;29:193–207.
[3] Brandes and
V. Reply
to music therapy
or music
evaluation
of the cognitive
physiological
aspects,
bymedicine?
usic or 4.
MTThe
as the
surest prePsychosomatics 2011;80:305.
identifying adequate assessment
tools. J, Ole Bonde L, Trondalen G, Maratos A, C
[4] Gold C, Erkkilä
[15]
herapy 5.
approach
in the manThe conduction
of the comparative
studies
on the
effects of the
therapy or music
medicine?
Psychotherapy
and Psychosom
[5] Raglio A. When music becomes music therapy. Psychiatry
ndard careMT
as the
direct
music
versus
music.
sciences 2011;65:682–3.
ars to be the most effective.
[6] Raglio Dr.
A, Alfredo
Gianelli
MV.
Music
therapy
for individuals[16]
wi
Raglio, ASP
Città
di Bologna
2014
e the treatment more tailored
of interventions and research perspectives. Current A
5. BPSD
Conclusion
2009;6:293–301.
o improve
and commu-
Musicoterapia e demenze
D Villani, A Raglio
G Gerontol 2004; 52:423-428
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Musicoterapia e demenze: teoria,
applicazione e ricerca
Raglio A, Villani D
G GERONTOL, 2005; 53:528-532
Dr. Alfredo Raglio, ASP Città di Bologna 2014
L’EFFICACIA DEL TRATTAMENTO
MUSICOTERAPICO IN PAZIENTI CON
DEMENZA DI GRADO MODERATO-SEVERO
Raglio A, Ubezio MC, Puerari F, Gianotti M,
Bellelli G, Trabucchi M, Villani D
G Gerontol 2006; 54:164-169
Fondazione Sospiro (CR)
Gruppo Ricerca Geriatrica (BS)
Unità Valutazione Alzheimer, Ancelle della Carità (CR)
RSA Salò (BS)
Fondazione Piccinelli (BG)
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Efficacy Of Music Therapy In The Treatment Of
Behavioral And Psychiatric Symptoms Of Dementia
Raglio A, Bellelli G, Traficante D, Ubezio MC, Gianotti M, Villani D,
Trabucchi M,
Alzheimer Dis Assoc Disor, 2008; 22:158-162
Fondazione Sospiro (CR)
Gruppo Ricerca Geriatrica (BS)
Unità Valutazione Alzheimer, Ancelle della Carità (CR)
RSA Salò (BS)
Fondazione Piccinelli (BG)
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Efficacy of music therapy treatment based on
cycles of sessions: a randomized controlled trial.
Raglio A, Bellelli G, Traficante D, Gianotti M, Ubezio MC,
Gentile S, Villani D, Trabucchi M
Aging and Mental Health, 2010, 14, 900-904
Fondazione Sospiro (CR)
Gruppo Ricerca Geriatrica (BS)
Unità Valutazione Alzheimer, Ancelle della Carità (CR)
RSA Salò (BS)
Fondazione Piccinelli (BG)
Fondazione S. Chiara (BG)
IRCCS Don Gnocchi (MI)
Dr. Alfredo Raglio, ASP Città di Bologna 2014
MUSIC THERAPY FOR INDIVIDUALS
WITH DEMENTIA:
AREAS OF INTERVENTION AND
RESEARCH PERSPECTIVES
Raglio A, Gianelli MV
Current Alzheimer Research, 2009, 6, 293-301
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Nova Science Publishers, Inc. New York, 2010 Non-‐Pharmacological Therapies in Dementia,, 2010, 1, 1, 1-‐14 Dr. Alfredo Raglio, ASP Città di Bologna 2014
Effects of Music Therapy on Psychological Symptoms and Heart Rate Variability in Patients with Dementia. A Pilot Study. Current Aging Science, 2010, 3, 242-‐246 Raglio*,§, O. Oasi^, M. Gianotti*, V. Manzoni**, S. Bolis^, M.C. Ubezio*, S. Gentile*, D. Villani* and M. Stramba-‐ Badiale** *Sospiro Foundation, Cremona, Italy, **Department of Rehabilitation Medicine, IRCCS Istituto Auxologico Italiano, Milano, Italy, §Interdem Group (Psycho-‐ Social Intervention in Dementia), ^Department of Psychology, Università Cattolica, Milano, Italy Dr. Alfredo Raglio, ASP Città di Bologna 2014
Raglio A, Bellandi D, Baiardi P, Gianotti M, Ubezio MC, Granieri E. Music therapy in frontal temporal dementia: a case report. J Am Geriatr Soc. 2012;60(8):1578-‐9. Dr. Alfredo Raglio, ASP Città di Bologna 2014
Music and music therapy in the
management of behavioral
disorders in dementia
Raglio A, Gianelli MV
Neurodegenerative Disease Management, 2013,
3(4), 295-298
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Raglio A, Bellandi D, Baiardi P, Gianotti M, Ubezio MC, Granieri E. Listening to Music and Active Music Therapy in Behavioral Disturbances in Dementia: a Crossover Study. J Am Geriatr Soc. 2013; 61(4): 645-‐647. Dr. Alfredo Raglio, ASP Città di Bologna 2014
Music and music therapy in the
management of behavioral
disorders in dementia
Raglio A, Filippi S, Bellandi D, Stramba-Badiale M
Neurodegenerative Disease Management, 2014,
in press
Dr. Alfredo Raglio, ASP Città di Bologna 2014
Fondazione Istituto Ospedaliero di Sospiro Onlus UNIVERSITÁ DI PAVIA Dipartimento di Sanità Pubblica, Medicina Sperimentale e Forense -‐ 
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Musicoterapia e Ascolto Individualizzato e nel trattamento dei disturbi comportamentali nelle demenze di livello moderato-‐severo: uno studio multicentrico randomizzato controllato. P.I. Alfredo Raglio Co-‐P.I. Daniele Bellandi Strutture coinvolte: Fondazione Sospiro (CR)
-‐ Istituto Auxologico Italiano I.R.C.C.S. (MI) Fondazione Maugeri I.R.C.C.S. (PV) -‐ Centro Alzheimer Fondazione Roma (RM) Residenza S. Pietro (MB) -‐ I.R.A.S. (Rovigo) Fondazione Stefania Randazzo (CA) – RSA De Benedictis (TE) Rifugio Re Carlo Alberto (TO) Fondazione Onlus “Longini-‐Morelli” (BS) Dr. Alfredo Raglio, ASP Città di Bologna 2014
Progetto di Ricerca: L’EFFICACIA DELLA MUSICOTERAPIA SULLO STRESS DEL CAREGIVER CHE ASSISTE LA PERSONA CON DEMENZA: UNO STUDIO RANDOMIZZATO CONTROLLATO Fondazione Sospiro Dipartimento di Scienze Neurologiche e del Movimento (Università di Verona) Associazioni Familiari (Cremona e Verona) Dr. Alfredo Raglio, ASP Città di Bologna 2014
Grazie per l’attenzione!
alfredo.raglio@unipv.it
Dr. Alfredo Raglio, ASP Città di Bologna 2014

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