Cognitive, Psychological and Behavioral Effects: A Systematic Review
Music can reach where words cannot, activating memories and emotions even in the most advanced stages of Alzheimer's.
Alzheimer's disease, the most common form of dementia, affects millions of people worldwide. It is characterized by progressive cognitive decline that impacts memory, thinking, and the ability to perform daily activities. While current pharmacological treatments help manage some symptoms, they cannot stop disease progression.
In this context, music therapy emerges as a non-pharmacological intervention that leverages a remarkable capacity of the human brain: although episodic memories fade in Alzheimer's, musical memory remains notably preserved even in advanced stages 6 . This neuroscientific phenomenon opens a unique therapeutic door to connect with patients and improve their quality of life.
Music therapy goes beyond simply listening to music. According to the American Music Therapy Association, it is an evidence-based therapeutic intervention that uses music to address specific goals in physical, psychological, cognitive, and social areas 4 . It is implemented by certified music therapists who adapt interventions to the individual needs of each patient.
Music simultaneously activates multiple brain regions, including the medial prefrontal cortex, basal ganglia, nucleus accumbens, and cerebellum .
Music stimulates the release of dopamine, a neurotransmitter associated with pleasure and reward, generating feelings of well-being 4 .
Musical stimuli can promote the formation of new neural connections, helping to maintain cognitive functions 4 .
The most surprising benefit of music therapy in Alzheimer's is its impact on cognitive functions, especially considering it is a neurodegenerative disease.
Alzheimer's patients who participate in music therapy sessions show significant improvements in autobiographical memory and verbal fluency 6 4 . One study found that music facilitates the encoding of new verbal information .
Structured musical activities require and train sustained attention capacity and executive functions. Patients must follow rhythms, anticipate musical changes, and coordinate responses, constituting a complete cognitive exercise 2 .
Psychological and behavioral symptoms of dementia—anxiety, agitation, aggression, and depression—are often the most distressing for patients and their caregivers. Music therapy demonstrates particularly robust effects in these areas.
Music, especially selected according to the patient's personal preferences, has a well-documented calming effect. A systematic study concluded that music therapy is beneficial for improving anxiety and agitation in dementia patients 3 .
Music therapy sessions promote positive emotions with minimal activation of negative emotions such as guilt, shame, or anger 7 . This is particularly valuable in a disease where communication difficulties often generate frustration and isolation.
| Symptom | Music Therapy Effect | Proposed Mechanism |
|---|---|---|
| Agitation | Significant reduction 3 4 | Distraction from stressful stimuli |
| Anxiety | Notable decrease 7 | Activation of brain reward system |
| Depression | Mood improvement 6 | Dopamine release and evocation of positive memories |
| Aggression | Observed reduction | Emotional channeling through musical expression |
A fundamental investigation in this field was a randomized controlled trial conducted in six nursing homes with 90 Alzheimer's patients 2 . This study systematically compared the effects of active music therapy versus passive therapy.
90 residents with Alzheimer's diagnosis were randomly assigned to three groups: active therapy, passive therapy, and control group.
Participants engaged in group singing activities, rhythms with simple instruments, and body movement to the beat of music.
Participants simply listened to the same music as the active group, without direct physical participation.
Interventions were conducted for 10 weeks, with regular sessions supervised by certified music therapists.
Validated scales such as MMSE (Mini-Mental State Examination) for cognition and NPI (Neuropsychiatric Inventory) for behavioral symptoms were used.
| Evaluated Parameter | Active Therapy | Passive Therapy | Control Group |
|---|---|---|---|
| Temporal Orientation | Significant Improvement | Moderate Improvement | No Change |
| Verbal Fluency | Notable Increase | Slight Increase | Mild Deterioration |
| Depressive Symptoms | Marked Reduction | Moderate Reduction | No Change |
| Social Interaction | Substantial Improvement | Slight Improvement | No Change |
This experiment demonstrates that active bodily and vocal engagement with music enhances its therapeutic benefits, likely by more extensively involving motor and cognitive neural networks.
Research in music therapy uses various tools and methodologies to quantify its effects. Here are some of the most relevant:
Playlists based on patient's personal preferences and music from their youth (between 18-25 years) 7 .
MMSE, CASI, NPI - validated instruments to measure cognitive and behavioral changes .
Heart rate monitors, salivary cortisol and fMRI to objectively measure physiological responses to music.
Simple percussion, sensitive keyboards and vocal tools to allow active participation regardless of motor abilities.
Growing evidence supports the incorporation of music therapy into comprehensive treatment plans for Alzheimer's disease. Its benefits extend beyond patients to their caregivers, by reducing the burden associated with managing behavioral symptoms 1 4 .
While science continues to search for disease-modifying treatments for Alzheimer's, music therapy offers tangible and accessible comfort here and now. As a recent review summarizes, "music therapy is a promising intervention for individuals living with Alzheimer's" 2 — a reminder that, even when so many connections are lost, the human brain retains a remarkable ability to respond to the universal power of music.