Music and dementia–an unpopular viewpoint?

I am not very popular for my views on claims for music and dementia in respect of “therapy”.  But everyone is entitled to an opinion.  For my own opinions to do with dementia I have three levels of conviction. 

“A Cochrane review is the highest quality of research in the UK, and the one published on music therapy and dementia just before COVID struck said there was no evidence of therapeutic effect. No evidence even when people got their paper published. ”

The top level is stuff where the research is strong.  When talking about things in that category which might help dementia I say, “Research says….” Even if I need to go and look it up when challenged because I don’t carry the reference in my head.  This would be research done by a reputable organisation or person, with a significant number of participants, using rigorous methods including (for example) recognised definitions of the intervention, and robust measurement tools for the result, maybe a bit of peer review and other tests that support the evidence.  I’d recommend those interventions even if they carried a level of risk.

The middle level

Where the evidence hasn’t been tested like that, or the tests give a variety of outcomes with no strong evidence one way or another.  With that I’d say, “people are looking into whether….”   I’d be critical of anyone who said about this stuff “research says that” or “everybody knows that”.  You get a lot of that in newspaper headlines. They say “helps Alzheimer’s” when they mean “helps dementia” and they don’t have clear evidence for either or say anything about the difference in meaning between those two words. They might say “dementia”, but they don’t specify if the intervention slows language difficulties, increases recognition of faces, improves memory loss, reduces agitation, and anxiety, reduces getting lost, improves ability to count money… or what?  You need to ask which of the dementia symptoms it affects and for how long.  And ask if it really slows “dementia” if it only slows one of the signs or symptoms or only those that are the least troublesome to people affected.  Whatever the claims, if that intervention is potentially harmful, like drinking coconut oil, I speak out against it, and advise people not to follow the advice.  If that stuff is not harmful, I just say that that it can’t hurt, and I mention it in something softer than a recommendation, for example, “Some people are encouraged by..." 

The bottom level

One where I tend not to intervene or comment any more in public.  This stuff includes anything that is a platitude.  It is often presented is a way so emotionally wrenching that questioning it makes you seem like a misanthropic person, who likes to burst everyone’s balloon. Honestly, I’d love it to be true.  This applies to many interventions involving music.  Music is great, but people should be careful about calling it “therapy”, especially when the person administering the process isn’t a registered and trained music therapist.  To be one of them you need to do an approved master’s degree in music therapy and register with the Health and Care Professionals Council.  And when you do music therapy it’s based on a treatment or care plan, not a random concert.

So what’s the research?

A Cochrane review is the highest quality of research in the UK, and the one published on music therapy and dementia just before COVID struck said there was no evidence of therapeutic effect. No evidence even when people got their paper published. The research which suggests that it is a therapy for dementia was poor partly because all the researchers did something different.  How can you compare trials when people use music live or recorded, with participants playing or in the audience? Does the person with dementia choose it or is it chosen for them, are they alone or in a crowd, are they in their own environment or at a concert? If all these things are different, it is hard to get the sort of outcomes that can add up to significant results. The person with dementia – what sort of dementia do they have?   Are they at an early or late stage, and which of the many symptoms are you measuring?  Even more importantly, how does the music experience compare with other activities such as talking, exercise, playing a game?  Is going to the zoo as good for measurable changes in symptoms of dementia as going to a concert? Will we have zoo therapy?

Framing music events or activities as therapy

Unlike other distractions, music events or activities for people with dementia are often framed in a way that presents music as a “therapy”. What do they mean when they claim this?  My sister and I often say that shopping is a therapy.  Calling shopping a therapy is a metaphor or even a joke. Because there’s nothing clinically wrong with her and me there’s clearly no claim that it is helping with an illness.  It would be different if my sister said, “June has a brain condition and I use shopping with her as it is a therapy for that condition.”   No. It just cheers us up.  But if you say music is a therapy for dementia, you are suggesting more than that it cheers people up. The claims are many and varied. People frequently claim that it improves memory, but there’s no scientific evidence for that.

There is a problem that has to be solved, though, in relation to music and dementia. People with dementia have difficulty in accessing the music they love sometimes because they don’t get to control their environment.  Carers of people with dementia sometimes don’t remember that their loved one enjoys music as one of the many things that might make them less stressed and happier.  So, telling them how to create use a personalised play list is very nice. Having access to the right music is a human right.  But calling it a dementia therapy sticks.

People with dementia enjoy the social aspects of music activities and benefit from being happy and diverted. It is also clear that the family members who take part feel better when their loved one is entertained. Making them happy is every bit as important.

Questioning claims

Gently questioning claims about music and dementia in public hasn’t done me any good. But I have a serious objection. People over-egging the value of music when money is given divert funds from things for which there is evidence.  Funders say they’ve done something for “dementia" and they haven’t really.  Because arts funding is so restricted, arts organisations have to demonstrate societal benefit from their work, so calling music a therapy for dementia is a great way of getting funds from two sources — health and arts.  

Don’t quote me but think about it.  Because if you quote me we’ll just both get into trouble.