LETTER TO THE EDITOR
Active music therapy for persons with dementia and their
family caregivers
Dementia is a dramatic and growing disease with a
high social and psychological impact also on family
caregivers (FC). Usually, behavioral disturbances
(BPSD) of a person with dementia (PWD) and their
management induce stress and burden in FC (Raggi
et al., 2015). Moreover, during the moderate–severe
stage of disease, a difficulty in communication, due
to cognitive decline, is frequent.
Active music therapy (AMT) is proved to reduce
BPSD in dementia (Vink et al., 2004) and seems to
be a valid way to communicate with PWD also in se-
vere stages of the disease (Raglio et al., 2008).
Literature showed the possibility to use AMT tech-
niques to improve the relationship between PWD and
their FC with significant changes also in psychological
and behavioral outcomes (Clair, 2002; Brotons and
Marti, 2003).
In this study, we proposed a structured AMT inter-
vention involving a music therapist as a facilitator of
communication between PWD and FC. The purpose
of the study was to investigate possible effects of this
approach in reducing BPSD in PWD and in improving
psychological and stress conditions in FC.
Data of four couples including four PWD living at
home (sex: male n = 3, female n = 1; age mean:
78.25 years; education mean: 4.5 years; diagnosis: vas-
cular dementia n = 2, frontotemporal dementia n = 1,
Alzheimer’s disease n = 1; duration of disease mean:
6.75 years) and their FC (wife: n = 3; husband: n = 1)
were reported in this paper. The couples underwent
12 AMT sessions (40 min each, twice a week) con-
ducted by a trained music therapist. The aim of the in-
tervention was to promote communication and
relationship in the couples and to reduce BPSD in
PWD and psychological symptoms and stress in FC.
A psychological assessment was made using the Bur-
den Interview, the Hamilton Anxiety Rating Scale,
and the Beck Depression Inventory to evaluate the
stress level, anxiety, and depression in FC, while
mini-mental state examination (MMSE), the Neuro-
psychiatric Inventory, and the Geriatric Depression
Scale have been used for cognitive and behavioral
evaluations in PWD. Clinical evaluations were made
at T0, T1, and T2 (respectively before and after the
treatment and 1 month after the end of AMT sessions).
Copyright # 2016 John Wiley & Sons, Ltd.
Psychotropic medications both in PWD and in FC
have not been modified during the treatment. PWD
and FC signed an informed consent before admission
at treatment.
We found that in PWD, BPSD improved consider-
ing the means of Neuropsychiatric Inventory global
scores (T0 = 30.75; T1 = 28.50; T2 = 27.25) and of
Geriatric Depression Scale (T0 = 14.5; T1 = 11;
T2 = 11.75). Cognitive evaluations have not showed
any improvements during the treatment (MMSE:
T0 = 16; T1 = 14.75; T2 = 16.75).
The burden and psychological symptoms improved
in FC (mean of Burden Interview: T0 = 43.50;
T1 = 32.75; T2 = 39.75; mean of Hamilton Anxiety
Rating Scale: T0 = 29.25; T1 = 20; T2 = 19.75; Beck De-
pression Inventory: T0 = 16; T1 = 15.25; T2 = 16.75).
Figure 1 summarizes the main results of the study.
Behavioral disturbances and in particular depres-
sion showed a global decrease: the most part of
PWD improved in psychological outcomes showing a
positive trend. This trend underlined a possible rela-
tionship between the improvement and AMT treat-
ment. Cognitive profile showed a slight worsening at
T1 in all PWD and a small increase of MMSE scores
can be observed at T2. Considering the shortness of
the intervention and the kind of music therapy ap-
proach, significant changes in cognitive domains were
not looked for. Significant results were obtained on FC
in anxiety and burden reduction in which all subjects
showed a remarkable improvement at T1 and some-
times also at follow-up. Also in depression symptom,
the most part of FC slightly improved.
These preliminary data proved the effects of AMT
approach both on PWD and their FC, in particular
on behavioral and psychological symptoms. The inter-
vention was perceived by FC as an important support
in the management of PWDs’ behavioral and commu-
nicative disturbances. Thus, sonorous-music and non-
verbal communication led by a trained music therapist
can be considered a possible way to promote the rela-
tionship between PWD and FC reducing their feeling
of frustration and the burden caused by management
disease. Future studies focusing on stronger research
methodology (randomized controlled trials) and as-
sessment are needed to confirm these results and to
Int J Geriatr Psychiatry 2015
2 Letter to the Editor

Figure 1 Trends of the outcomes of the study in people with dementia and their family caregivers (means).

implement AMT approach as an effective non- Clair AA. 2002. The effects of music therapy on engagement in family caregiver and
care receiver couples with dementia. Am J Alzheimers Dis Other Demen 17:
pharmacological intervention for PWD/FC couples. 286–290.
Raggi A, Tasca D, Panerai S, Neri W, Ferri R. 2015. The burden of distress and related
coping processes in family caregivers of patients with Alzheimer’s disease living in
the community. J Neurol Sci 358: 77–81.
Conflict of interest Raglio A, Bellelli G, Traficante D, et al. 2008. Efficacy of music therapy in the treat-
ment of behavioral and psychiatric symptoms of dementia. Alzheimer Dis Assoc
Disord 22: 158–162.
None declared. Vink AC, Birks JS, Bruinsma MS, Scholten RJPM. 2004. Music therapy for people
with dementia. Cochrane Database Syst Rev 3: CD003477.

A. RAGLIO1*, C. FONTE2, P. REANI3, V. VARALTA2,

Key points D. BELLANDI4 AND N. SMANIA2,5
1
• Active music therapy can reduce behavioral 2
Salvatore Maugeri Foundation, IRCCS, Pavia, Italy
Neuromotor and Cognitive Rehabilitation Research Center,
disturbances in dementia.
• Music therapy approach can improve commu-
Department of Neurological, Biomedical and Movement
Sciences, University of Verona, Verona, Italy
nication and relationship between persons with 3
Alzheimer Italia Association, Verona, Italy
dementia and their family caregivers. 4
• Active music therapy can reduce burden and can
Geriatrics Department, Sospiro Foundation, Sospiro,
Cremona, Italy
improve psychological aspects in family 5
Neurorehabilitation Unit, Hospital Trust of Verona,
caregivers.
Verona, Italy
*E-mail: alfredo.raglio@fsm.it
References
Published online in Wiley Online Library
Brotons M, Marti P. 2003. Music therapy with Alzheimer’s patients and their family
(wileyonlinelibrary.com)
caregivers: a pilot project. J Music Ther 40: 138–150. DOI: 10.1002/gps.4421

Copyright # 2016 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2015