Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Research Article Dement Geriatr Cogn Disord 2009 28:36���46 DOI: 10.1159/000229024 Effect of Music Therapy on Anxiety and Depression in Patients with Alzheimer���s Type Dementia: Randomised, Controlled Study S. Gu��tin a, c, d F. Portet a M.C. Picot b C. Pommi�� a, c M. Messaoudi a L. Djabelkir a A.L. Olsen c M.M. Cano c E. Lecourt d J. Touchon a, c a Service de Neurologie, Centre M��moire de Ressources et de Recherches (CMRR), Inserm U888, CHRU Montpellier, and b D��partement d���Information M��dicale, CHRU Arnaud de Villeneuve, Montpellier , c Association de Musicoth��rapie Applications et Recherches Cliniques (AMARC) and d Laboratoire de Psychologie Clinique et Psychopathologie (LCPL) EA 4056, Universit�� Paris 5 ��� Ren��e Descartes, Paris , France The effect of music therapy was sustained for up to 8 weeks after the discontinuation of sessions between weeks 16 and 24 (p ! 0.01). Conclusion: These results confirm the valuable effect of music therapy on anxiety and depression in pa- tients with mild to moderate Alzheimer���s disease. This new music therapy technique is simple to implement and can easily be integrated in a multidisciplinary programme for the management of Alzheimer���s disease. Copyright �� 2009 S. Karger AG, Basel Introduction According to a recent study, 24.3 million people cur- rently suffer from Alzheimer���s disease or related disor- ders, and 4.6 million new cases are reported worldwide each year. The number of patients is expected to double every 20 years, to reach 43.2 million by 2020 and 81.1 million by 2040 [1] . Alzheimer���s type dementia (AD) is the most common degenerative disease, with only half of the cases being diagnosed and one third treated. With the 2-fold increase in the number of cases anticipated over the next few decades, this progressive disease has become a major public health problem. Alzheimer���s disease is characterised by acquired impairment in cognitive func- tion, with a gradual impact on the patient���s professional Key Words Music therapy Alzheimer���s disease Depression Anxiety Abstract Background/Aims: Numerous studies have indicated the value of music therapy in the management of patients with Alzheimer���s disease. A recent pilot study demonstrated the feasibility and usefulness of a new music therapy technique. The aim of this controlled, randomised study was to assess the effects of this new music therapy technique on anxiety and depression in patients with mild to moderate Alzhei- mer-type dementia. Methods: This was a single-centre, comparative, controlled, randomised study, with blinded as- sessment of its results. The duration of follow-up was 24 weeks. The treated group (n = 15) participated in weekly ses- sions of individual, receptive music therapy. The musical style of the session was chosen by the patient. The validated ���U��� technique was employed. The control group (n = 15) par- ticipated under the same conditions in reading sessions. The principal endpoint, measured at weeks 1, 4, 8, 16 and 24, was the level of anxiety (Hamilton Scale). Changes in the depres- sion score (Geriatric Depression Scale) were also analyzed as a secondary endpoint. Results: Significant improvements in anxiety (p ! 0.01) and depression (p ! 0.01) were observed in the music therapy group as from week 4 and until week 16. Accepted: June 2, 2009 Published online: July 23, 2009 St��phane Guetin 9 rue L��on Cogniet FR���75017 Paris (France) Tel. +33 6 20 47 67 57, E-Mail stephane.guetin@yahoo.fr �� 2009 S. Karger AG, Basel 1420���8008/09/0281���0036$26.00/0 Accessible online at: www.karger.com/dem

Effect of Music Therapy in Alzheimer���s Disease Dement Geriatr Cogn Disord 2009 28:36���46 37 and social/family activities. Changes in emotions and be- havioural disorders are generally already present. Vari- ous types of depressive and anxiety disorder may develop and are said to be among the earliest noncognitive ex- pressions of the disease [2] . Psychological/behavioural disorders become apparent from the start of progression: a tendency towards isolation, apathy, lack of interest and gradual withdrawal from activities. These disorders are often associated with irritability, aggression and unchar- acteristic emotional reactions [3] . Recent clinical studies, namely in functional neuro- imaging, have been able to evidence the favourable role of music therapy in the management of Alzheimer���s dis- ease [4, 5] . Music-based therapy corresponds to 2 funda- mental methods, a ���receptive��� listening-based method, and an ���active��� method, based on playing musical instru- ments. Music therapy was defined by Munro and Mount [6] as: ���the intentional use of the properties and the po- tential of music and its impact on the human being���. Re- ceptive music therapy is perceived by Biley [7] as a ���con- trolled method for listening to music, making use of its physiological, psychological and emotional impact on the individual during treatment for an illness or trauma���. A distinction is generally made between 2 types of receptive method: (1) receptive ���relaxation��� music therapy [8, 9] : this method is similar to other approaches, such as hyp- nosis, sophrology and relaxation in general, and is often used in the treatment of anxiety, depression and cogni- tive disorders (2) receptive ���analytical��� music therapy: in this instance, music is used as a medium for ���analytical��� psychotherapy [10] . The aim is to encourage the expres- sion and development of thought. It may thus allow pa- tients with cognitive disorders to stimulate, use and dis- cover their remaining abilities. This psychotherapeutic approach encourages emotional and self-enhancing sup- port. It may be perceived as a type of psychotherapy prac- tised in line with the major current trends in psychother- apy. The most widely used method in the context of de- mentia is receptive ���relaxation��� music therapy. The use of this method is able to reduce the frequency and extent of affective and psychological/behavioural disorders. Music is a major means of triggering emotions and helping patients express themselves verbally. Music therapy stimulates intellectual function, acts on anxiety and depression and thus significantly improves autono- my in patients suffering from Alzheimer���s disease [11��� 15] . This is because the music is chosen on the basis of personal experience, which will stimulate memory by evoking autobiographical events. Listening to music, to- gether with the resulting relaxation factor, is also effec- tive in numerous areas. Choosing music connected to the individual���s personal experience is thus of paramount importance. These studies confirm that music therapy has a relaxing effect on patients suffering from Alzhei- mer���s disease. A pilot study demonstrated the feasibility and benefit of individual receptive music therapy sessions. Signifi- cant improvements in anxiety and depression (p ! 0.001) were observed from the first session and were maintained significantly during the subsequent sessions. The physi- cal and mental burden felt by the main caregiver was re- duced significantly (p ! 0.01). The sessions helped stimu- late cognitive function by encouraging memory encod- ing and recall [16] . The results obtained made it possible to estimate the number of subjects required to set up a randomised controlled study. The primary objective of this randomised controlled study is to evaluate the impact of short- and medium- term music therapy on anxiety disorders in patients suf- fering from mild to moderate stages of AD. The second- ary objectives concern depression and the persisting ef- fect of music therapy up to 2 months after discontinuation of the sessions. Materials and Methods Consent This study received a favourable opinion from the ethics com- mittee, as required by French legislation on bioethics, even though the study does not entail any additional risks (music therapy ses- sion, no impairment of physical or psychological integrity). Dur- ing the inclusion visit, and before any subjects were included in the study, potentially eligible subjects (or their family or legal rep- resentative) signed the informed consent form (stating that they did not object) to take part in the project. Type of Study The study design corresponded to a randomised, controlled, comparative, single-centre study, with the results evaluated under blind conditions. The study was conducted over a total duration of 18 months, with a follow-up period of 6 months. Study Population The included patients were residents at the Les Violettes nurs- ing home in Montpellier over the period from September 2007 to April 2008. They all suffered from mild to moderate stages of AD. Each patient was required to have a baseline Mini Mental State Evaluation (MMSE) [17, 18] score of between 12 and 25 and a base- line Hamilton Anxiety Scale score of at least 12. The included patients were men or women aged 70���95 years, with adequate ver- bal or written expression, visual and hearing abilities (hearing aids not permitted) in order to carry out the tests. All of the pa- tients had been receiving stable anticholinergic treatment for 6 months. Psychotropic and anxiolytic treatment was authorised at