Review of music-based interventions for people with dementia

van der Steen,  J.T, Smaling,  H.J.A., van der Wouden,  J.C., Bruinsma,  M.S., Scholten,  R.J.P.M., Vink,  A.C.| 2018| Music‐based therapeutic interventions for people with dementia.| Cochrane Database of Systematic Reviews| Issue 7| Art. No.: | CD003477. DOI: 10.1002/14651858.CD003477.pub4.

The Cochrane Library has produced a new systematic review which looks at the evidence for music‐based therapeutic interventions for people with dementia.bookcase-bookshelves-bookstore-351265.jpg

Plain language summary

Music‐based therapeutic interventions for people with dementia

Background

People with dementia gradually develop difficulties with memory, thinking, language and daily activities. Dementia is often associated with emotional and behavioural problems and may decrease a person’s quality of life. In the later stages of dementia it may be difficult for people to communicate with words, but even when they can no longer speak they may still be able to hum or play along with music. Therapy involving music may therefore be especially suitable for people with dementia. Music therapists are specially qualified to work with individuals or groups of people, using music to try to help meet their physical, psychological and social needs. Other professionals may also be trained to provide similar treatments.

Purpose of this review

We wanted to see if we could find evidence that treatments based on music improve the emotional well‐being and quality of life of people with dementia. We were also interested in evidence about effects on emotional, behavioural, social or cognitive (e.g. thinking and remembering) problems in people with dementia.

What we did

We searched for clinical trials that measured these effects and in which people with dementia were randomly allocated to a music‐based treatment or to a comparison group. The comparison groups might have had no special treatment, or might have been offered a different activity. We required at least five sessions of treatment because we thought fewer sessions than five were unlikely to have much effect. We combined results of trials to estimate the effect of the treatment as accurately as possible. The evidence is current to 19 June 2017.

What we found

We found 22 trials to include in the review and we were able to combine results for at least some outcomes from 890 people. All of the people in the trials stayed in nursing homes or hospitals. Some trials compared music‐based treatments with usual care, and some compared them with other activities, such as cooking or painting. The quality of the trials and how well they were reported varied, and this affected our confidence in the results. First, we looked at outcomes immediately after a course of therapy ended. From our results, we could be moderately confident that music‐based treatments improve symptoms of depression and overall behavioural problems, but not specifically agitated or aggressive behaviour. They may also improve anxiety and emotional well‐being including quality of life, although we were less confident about these results. They may have little or no effect on cognition. We had very little confidence in our results on social interaction. Some studies also looked to see whether there were any lasting effects four weeks or more after treatment ended. However, there were few data and we were uncertain or very uncertain about the results. Further trials are likely to have a significant impact on what we know about the effects of music‐based treatments for people with dementia, so continuing research is important.

 

Authors’ conclusions

Implications for practice
Music‐based therapeutic interventions may be used for people with dementia residing in institutional settings, to improve depressive symptoms. Depression is very common in people with dementia irrespective of the stage of dementia (Verkaik 2007); and it is related to low quality of life (Banerjee 2009Beerens 2014). It is not clear whether effects will persist beyond the intervention period and music‐based interventions may need to be continued for prolonged periods for a sustained effect. The interventions probably also improve overall behaviour but effects differ for different behaviour problems, with probably larger effects on mood (depression) than on agitated or aggressive behaviour. Effects on mood may include effects on anxiety in addition to effects on depression, but effects on anxiety are less certain than effects on depression. Similarly, the interventions may improve emotional well‐being including quality of life, but effects are less certain than effects on depression.

 

The full review is available from The Cochrane Library

NICE guidelines recommend telling people about dementia research opportunities

NIHR | June 2018 | New NICE guidelines recommend telling people about dementia research opportunities

NICE recently advised that every patient diagnosed with dementia should be provided with information of research opportunities they could potentially participate in.

 

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NIHR  New NICE guidelines recommend telling people about dementia research opportunities

 

 

10,000 research participants recruited through Join Dementia Research

NIHR & Join Dementia Research | July 2018 |10,000 research participants recruited through Join Dementia Research

Over 10000 participants have become involved in dementia research as a result of campaigns by NIHR and Join Dementia Research. These latest figures are an important milestone for Join Dementia Research, which was launched 3 years’ ago in response to the then Prime Minister’s Challenge on Dementia, the success since its launch can be seen by participants and researchers alike at Join Dementia Research.

Full details are available from  Join Dementia Research 

Of interest:

NIHR Join Dementia Research Champions 

Related: New NICE guidelines recommend telling people about dementia research opportunities

 

 

 

New dementia briefing suggests that behaviour that challenges can be a result of unmet needs

British Psychological Society |June 2018 | New dementia briefing suggests that behaviour that challenges can be a result of unmet needs 21 June 2018

The British Psychological Society  have recently published an evidence briefing which outlines the importance of having a psychological understanding of the complex causes of behaviour that challenges in dementia.

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The key messages of the briefing, prepared by the Society’s Dementia Advisory Group, include:

  • Behaviour that challenges can be a consequence of a person’s unmet needs
  • Non-pharmacological approaches are the first-line treatments
  • Service pathways for people living at home require different workforce skills and resources compared with those living in 24 hour care settingsThe evidence briefing can be read in full here 

Dementia profile: August 2018 data update

Public Health England | August 2018 | Dementia profile: August 2018 data update

Public Health England (PHE) has published the latest statistics on the estimated diagnosis rate for dementia broken down by geographical area. 

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The Dementia Profile is designed to improve the availability and accessibility of information on dementia. The data is presented in an interactive tool that allows users to view and analyse it in a user-friendly format. The profile provides a snapshot of dementia care, broken down by geographical area, to help local government and health services improve dementia care.

The profile includes the estimated dementia diagnosis rate, which shows the number of people with a formal diagnosis of dementia as a percentage of those estimated to have the disease. A timely diagnosis helps those living with dementia, their carers and healthcare staff to improve health and care outcomes as outlined within the Prime Minister’s challenge (Source: PHE)

Further details are available from PHE 
The profile can be accessed here 

Sprint for Discovery: New Dementia and Cardiovascular Findings

Alzheimer’s Association | July 2018 | Sprint for Discovery: New Dementia and Cardiovascular Findings

New research presented at the recent Alzheimer’s Association 2018 conference in Chicago, indicates that aggressive treatment of  high blood may reduce new cases of  slight but noticeable and measurable decline in cognitive abilities that is not severe enough to interfere with daily life and dementia.

The findings from the randomized controlled trial (RCT) show that there are things we can do, especially regarding cardiovascular disease risk factors, to reduce our risk of mild cognitive impairment and dementia.
The participants  (n= 9361) (all hypertensive adults), though none had a diagnosis of diabetes, dementia or had experienced a stroke, were divided in two groups. The trial investigated the effects of one group’s blood pressure was aggressively treated to reduce it, in the other the target blood pressure was treated less intensively. The researcher’s findings show that the group that had their blood pressure treated aggressively 120 mm Hg), 19 percent less people developed mild cognitive impairment.

When the researchers looked at reduction in risk of mild cognitive impairment and dementia, they found that 15 percent less people developed mild cognitive impairment or dementia (regardless of the underlying cause). The researchers looked at reduction in risk of mild cognitive impairment and dementia, they found that 15 percent less people developed mild cognitive impairment or dementia. According to the research team this is the first time an RCT has demonstrated a significant reduction in the risk for developing cognitive decline and dementia.

Full details about the research are available from the Alzheimer’s Association blog 

The global prevalence of dementia: A systematic review and metaanalysis

The Alzheimer’s Association has published a systematic review which looks at the global prevalence of dementia. The SR and meta-analysis look at international literature between 1980 to 2009, the meta analysis estimates prevalence of dementia and the number of people aged over 60 years affected globally.

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Abstract

Background

The evidence base on the prevalence of dementia is expanding rapidly, particularly in countries with low and middle incomes. A reappraisal of global prevalence and numbers is due, given the significant implications for social and public policy and planning.

Methods

In this study we provide a systematic review of the global literature on the prevalence of dementia (1980–2009) and metaanalysis to estimate the prevalence and numbers of those affected, aged ≥60 years in 21 Global Burden of Disease regions.

Results

Age-standardized prevalence for those aged ≥60 years varied in a narrow band, 5%–7% in most world regions, with a higher prevalence in Latin America (8.5%), and a distinctively lower prevalence in the four sub-Saharan African regions (2%–4%). It was estimated that 35.6 million people lived with dementia worldwide in 2010, with numbers expected to almost double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050. In 2010, 58% of all people with dementia lived in countries with low or middle incomes, with this proportion anticipated to rise to 63% in 2030 and 71% in 2050.

Conclusion

The detailed estimates in this study constitute the best current basis for policymaking, planning, and allocation of health and welfare resources in dementia care. The age-specific prevalence of dementia varies little between world regions, and may converge further. Future projections of numbers of people with dementia may be modified substantially by preventive interventions (lowering incidence), improvements in treatment and care (prolonging survival), and disease-modifying interventions (preventing or slowing progression). All countries need to commission nationally representative surveys that are repeated regularly to monitor trends.

Full reference:

Prince, Martin et al. | 2018| The global prevalence of dementia: A systematic review and metaanalysis |Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association |Vol. 9 |1| p. 63 – 75| e2

The full article is available to read from Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association

Alternatively, it may be downloaded here 

Dementia Training Standards Framework

Health Education England, Skills for Health & Skills for Care, | July 2018 |Dementia Training Standards Framework

Health Education England (HEE) have released the Dementia Training Standards Framework, the resource was previously known as Dementia Core Skills Education and Training Framework, its recent update and review included a number of additions regarding food, drink and oral health.

 

The framework is  an extraordinarily useful resource which details the essential skills and knowledge necessary across the health and social care spectrum. Three tiers are described:

  • Awareness, which everyone should have;
  • Basic skills which are relevant to all staff in settings where people with dementia are likely to appear and;
  • Leadership.

This framework will help ensure quality and consistency in dementia education and training if you are an organisation or an individual working in health, social care or housing.

The framework will allow the differentiation of high quality services, ensure personalised care and support for people living with dementia, and support organisations and individuals to meet requirements of regulators  (source: HEE).

You can access the framework here

Alternatively, the framework can be downloaded from the Skills for Health website

What features of stigma do the public most commonly attribute to Alzheimer’s disease dementia? Results of a survey of the U.S. general public

Stites, S. D., Rubright, J. D., & Karlawish, J. |2018| What features of stigma do the public most commonly attribute to Alzheimer’s disease dementia? Results of a survey of the US general public| Alzheimer’s & Dementia | Vol. 14 | 7 | P. 925- 932 | DOI: https://doi.org/10.1016/j.jalz.2018.01.006

A new abstract presented at last month’s Alzheimer’s Association Conference in Chicago has been published as a journal article in Alzheimer & Dementia, the journal of the Alzheimer’s Association. 

Abstract

Introduction

Understanding the prevalence of beliefs, attitudes, and expectations about Alzheimer’s disease dementia in the public could inform strategies to mitigate stigma.

Methods

Random sample of 317 adults from the U.S. public was analyzed to understand reactions toward a man with mild-stage Alzheimer’s disease dementia.

Results

In adjusted analyses, over half of respondents expected the person to be discriminated against by employers and be excluded from medical decision-making. Almost half expected his health insurance would be limited based on data in the medical record, a brain imaging result, or genetic test result.

Discussion

Public education and policies are needed to address concerns about employment and insurance discrimination. Studies are needed to discover how advances in diagnosis and treatment may change Alzheimer’s disease stigma.

The article is available for NHS staff to request here