Understanding the therapeutic capacities of music for people with dementia

Music is unique in its therapeutic value for people with neurological disorders, such as dementia. This thesis proposes and evaluates the Therapeutic Music Capacities Model (TMCM) which posits that seven specific capacities of music make it a uniquely effective therapeutic tool; namely that music is persuasive, engaging, emotional, personal, physical, social and encourages synchronisation. The thesis explores how these seven attributes of music lead to cognitive, psychosocial, behavioural and motor benefits in a specific neurological population, namely people with dementia. Following an overview of the thesis, two detailed review manuscripts are provided. The first review introduces the TMCM and reviews the existing evidence that demonstrates each capacity's role in a wide range of neurological impairments. The second review focuses on the TMCM in people with dementia specifically, such as facilitating memory recall, fluent speech and the restoration of other cognitive and non-cognitive abilities. These reviews are followed by two empirical manuscripts. The first describes the Music Mind and Movement (MMM) program which is derived from the TMCM. The MMM program involved seven weekly group sessions in which two groups of ten individuals with mild to moderate dementia participated. Group 1 completed the MMM program first and Group 2 acted as a wait list control receiving standard care for the first 7 weeks, completing the program second. Results indicated that there was an overall decline in cognition as measured by Addenbrooke's Cognition Examination, in the control group who received standard care. In the MMM condition, there was a trend for an increase in cognition and these differences were present in domains of attention and verbal fluency. The second empirical manuscript focusses on the personal and emotional capacity of the TMCM. Positive facial expressions (smiles) were examined to measure objectively the emotional characteristics of music evoked autobiographical memories (MEAMs) in people with Alzheimer's Dementia. The frequency of smiles and memories elicited by 16 famous songs was measured in nine participants with Alzheimer's Dementia and ten healthy elderly. There were no differences in the presence of smiles between healthy elderly and participants with Alzheimer's Dementia during MEAMs. In people with Alzheimer's dementia, there were significantly more smiles during the presence of MEAMs triggered by songs from personally pertinent lifetime periods. Taken together, the findings of this thesis shed new light on the way in which targeted therapeutic uses of music can provide value for cognition and autobiographical memory. Specifically, the seven capacities of music and subsequent TMCM provide a framework for the development and optimisation of future music-based treatments in dementia.