260 report dementia music therapy

8/7/2019 260 report dementia music therapy

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I. Dementia (Definition,

Symptoms, Causes, Types,

Prognosis, Treatment)

II. Music Therapy (Treatment

for Dementia Symptoms)

III.Musicians Brain as a

Model of Neuroplasticity


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What is Dementia?de (apart) + mentis (mind)

- a syndrome or a collection of symptoms

caused by disease of the brain, usually of a

chronic or progressive nature, in which

there is disturbance of multiple higher

cortical functions including memory,

thinking, orientation, comprehension,

calculation, learning capacity, language,

and judgment.

There is also loss of emotional control and

experience agitation, delusions, and

hallucinations.

These impaired mental and emotionalfunctioning interferes everyday activities

and social relationships.


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What are the signs?

Memory loss

Moodiness

Communicative difficulties


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Death of nerve cells or loss ofcommunication among the cells

No specific finding about how

dementia develops

Abnormal structures in the brain

called inclusions (Alzheimer's

disease, Lewy body dementia,Parkinson's dementia, and Pick's

disease)

Contain abnormal proteins

Plays a role in the

development of symptoms

May be a side effect of thedisease process

Genetic make-up

Result of complex interaction of

genes, lifestyle factors, and other

environmental influences

What Causes Dementia?


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What are the types of

Dementia caused by

Diseases?

AlzheimersDisease

Vascular (Multi-Infarct) Dementia

Dementia with Lewy Bodies

Fronto-Temporal Dementia

OthersKorsakoffs syndrome

HIV and AIDS Creutzfeldt-Jakob disease

Parkinsons disease

Huntingtons disease

Motor Neurone disease Multiple Sclerosis


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Alzheimers DiseaseFast Facts

Alzheimers is the most common cause of dementia in people 65 years and older

Up to 4 million people in US are living with the disease

At least 360,000 Americans are diagnosed with Alzheimer's disease each year and

about 50,000 are reported to die from it. In most people, symptoms of Alzheimer's disease appear after age 60.

There are some early-onset forms of the disease, usually linked to a specific gene

defect, which may appear as early as age 30.

Alzheimer's disease usually causes a gradual decline in

thinking abilities, usually during a span of 7 to 10 years.

Nearly all brain functions, including memory, movement,language, judgment, behavior, and abstract thinking, are

eventually affected.


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AugusteDeter was the first person reported (in 1901) to have the form of dementia

now known as Alzheimer's disease. The disease is named after Alois Alzheimer, the

German doctor who first described it. After Auguste Deter died in 1906, doctors

examined her brain and found that it appeared shrunken and contained several

unusual features; including strange clumps of protein called plaques and tangled

fibers inside the nerve cells.

A woman in her early 50s was admitted to a hospital because of increasingly odd

behavior. Her family reported that she had been showing memory problems and

strong feelings of jealousy. She also had become disoriented at home and was hiding

objects. During a doctor's examination, the woman was unable to remember her

husband's name, the year, or how long she had been at the hospital. She could read

but did not seem to understand what she read, and she stressed the words in an

unusual way. She sometimes became agitated and seemed to have hallucinations

and irrational fears.


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Alzheimer's disease is characterized by two abnormalities in the brain:

Amyloid Plaques

Found in the tissue between the nerve cells Unusual clumps of protein called beta amyloid along with degenerating bits

of neurons and other cells

Neurofibrillary Tangles

Bundles of twisted filaments found within neurons.

Largely made up of a protein called tau In healthy neurons, the tau protein helps the functioning of microtubules,

which are part of the cell's structural support and deliver substances

throughout the nerve cell.

In Alzheimer's disease, tau is changed in a way that

causes it to twist into pairs of helical filaments that collect

into tangles. When this happens, the microtubules cannotfunction correctly and they disintegrate. This collapse of

the neuron's transport system may impair communication

between nerve cells and cause them to die.


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Vascular (Multi-Infarct) DementiaFast

Facts

Vascular dementia is the second most common cause of dementia.

Caused by brain damage from cerebrovascular or cardiovascular problems -

usually strokes.

It also may result from genetic diseases, endocarditis (infection of a heart

valve), or amyloid angiopathy (a process in which amyloid protein builds up in

the brain's blood vessels, sometimes causing hemorrhagic or "bleeding"

strokes).

In many cases, it may coexist with Alzheimer's disease.

Unlike people with Alzheimer's disease, people with

vascular dementia often maintain their personality and

normal levels of emotional responsiveness until the later

stages of the disease.

People with vascular dementia frequently wander

at night and often have other problems commonly

found in people who have had a stroke, including

depression and incontinence.


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Types of Vascular Dementia:

Multi-infarct dementia (MID) Caused by numerous small strokes in the brain

Typically includes multiple damaged areas, called infarcts, along with

extensive lesions in the white matter, or nerve fibers, of the brain

Single-infarct Dementia

In some cases a single stroke can damage the brain enough to cause

dementia Dementia is more common when the stroke takes place on the left side

(hemisphere) of the brain and/or when it involves the hippocampus, a

brain structure important for memory.

Other types of vascular dementia include Binswanger's

disease and CADASIL (cerebral autosomal dominant

arteriopathy with subcortical infarct andleukoencephalopathy).


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Lewy Body Dementia

FASTFACTS

One of the most common types of progressive dementia

Usually occurs sporadically, in people with no known family history

of the disease

Cells die in the brain's cortex (outer layer), and in a part of the mid-

brain called the substantia nigra Many of the remaining nerve cells in the substantia nigra contain

abnormal structures called Lewy bodies that are the hallmark of the

disease


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Overlap with Alzheimer's disease in many ways

May include memory impairment

Poor judgment

Confusion

Visual hallucinations

Shuffling gait (walk)

Flexed posture

Day-to-day fluctuations in the severity of symptoms.

Patients with Lewy body dementia live an average of 7

years after symptoms begin. There is no cure for Lewy

body dementia, and treatments are aimed at controlling

the Parkinsonian and psychiatric symptoms of the

disorder.

Symptoms of Lewy Body Dementia:


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Fronto-Temporal Dementia

FASTFACTS

Sometimes called frontal lobe dementia

A group of diseases characterized by degeneration of nerve cells - especially

those in the frontal and temporal lobes of the brain

Usually does not include formation of amyloid plaques

In many people with frontotemporal dementia, there is an abnormal form oftau protein in the brain, which accumulates into neurofibrillary tangles. This

disrupts normal cell activities and may cause the cells to die.


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Accounts for 2% to 10% of all cases of dementia

Symptoms usually appear between the ages of 40 and 65 In many cases, people with frontotemporal dementia have a family history of

dementia, suggesting that there is a strong genetic factor in the disease.

The duration of frontotemporal dementia varies, with some patients declining

rapidly over 2 to 3 years and others showing only minimal changes for many years.

People with frontotemporal dementia live with the disease for an average of 5 to

10 years after diagnosis.

People with frontotemporal dementia often have problems maintaining normal

interactions and following social conventions.

They may steal or exhibit impolite and socially inappropriate behavior, and they

may neglect their normal responsibilities.

Other common symptoms include loss of speech and language, compulsive or

repetitive behavior, increased appetite, and motor problems such as stiffness and

balance problems.

Memory loss also may occur, although it typically appears late in the disease.


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HIV-associated Dementia (HAD)

Results from infection with the human immunodeficiency virus (HIV) that causes AIDS

Can cause widespread destruction of the brain's white matter

Leads to a type of dementia that generally includes impaired memory, apathy, socialwithdrawal, and difficulty concentrating

People with HIV-associated dementia often develop movement problems as well.

No specific treatment for HIV-associated dementia, but AIDS drugs can delay onset of the

disease and may help to reduce symptoms.

Huntington's Disease

A hereditary disorder caused by a faulty gene for a protein called

Huntington

Causes degeneration in many regions of the brain and spinal cord

Symptoms of Huntington's disease usually begin when patients are in

their thirties or forties, and the average life expectancy after diagnosis is

about 15 years Cognitive symptoms of Huntington's disease typically begin with mild

personality changes, such as irritability, anxiety, and depression, and

progress to severe dementia

Many patients also show psychotic behavior

Causes chorea - involuntary jerky, arrhythmic movements of the body -

as well as muscle weakness, clumsiness, and gait disturbances


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Dementia Pugilistica

Also called chronic traumatic encephalopathy or Boxer's syndrome

Caused by head trauma, such as that experienced by people who have been punched many

times in the head during boxing

Most common symptoms of the condition are dementia and parkinsonism, which can appear

many years after the trauma ends

Affected individuals may also develop poor coordination and slurred speech

A single traumatic brain injury may also lead to a disorder called posttraumatic dementia (PTD).

Posttraumatic dementia is much like dementia pugilistica but usually also includes long-term

memory problems Other symptoms vary depending on which part of the brain was damaged by the injury.


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Dementias in Children

While it is usually found in adults,

dementia can also occur in

children. Infections and poisoning

can lead to dementia in people of

any age. In addition, some

disorders unique to children can

cause dementia. These include

Niemann-Pick disease, Batten

disease and Lafora body disease.


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What Other Conditions Can Cause Dementia?

Reactions or side effects to medications Metabolic problems and endocrine abnormalities such as thyroid disease, hypoglycemia,

too little (hyponatremia) or too much sodium or calcium (hypercalcemia), or the inabilityto absorb vitamin B12 (pernicious anemia)

Nutritional deficiencies such as thiamine (vitamin B1), B6, or B12 and severe dehydration

Infections such as meningitis, encephalitis, untreated syphilis, and Lyme disease

Subdural hematomas where there is bleeding between the brain's surface and its outer

covering (the dura)

Poisoning such as exposure to lead, other heavy metals, alcohol, recreational drugs or o

other poisonous substances Brain tumors

Anoxia/hypoxia in which there is a diminished supply of oxygen to an organ's

tissues, for example heart attack, severe asthma, heart surgery, smoke or carbon

monoxide inhalation, or an overdose of anesthesia

Heart and chronic lung problems disease that prevents the brain from

receiving adequate oxygen, which can starve brain cells.


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How Is Dementia Diagnosed?

Ruling out of any treatable conditions, such as depression, normal pressure

hydrocephalus, or vitamin B12 deficiency, which can cause similar symptoms.

Asking questions about the patient's history

Physical examination

Neurological evaluations (balance, sensory function, reflexes, etc.)

Cognitive and neuropsychological tests (memory, language skills, math skills, problems

solving, etc.)

Brain scans (computed tomographic (CT) scans and magnetic resonance imaging (MRI),etc.)

Laboratory tests (blood tests, urinalysis, toxicology screen, thyroid tests, etc.)

Psychiatric evaluation

Presymptomatic testing (genetic tests)


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Cognitive Training

Medications for Symptoms

Practice Tasks

Behavior Modification

Aromatherapy

Massage Therapy

Animal-assisted Therapy

How is dementia treated?


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Can Dementia be Prevented?

People who maintain tight control over their glucose levels tend to score better on tests

of cognitive function than those with poorly controlled diabetes. Several studies also have suggested that people who engage in intellectually stimulating

activities, such as social interactions, chess, crossword puzzles, and playing a musical

instrument, significantly lower their risk of developing Alzheimer's disease and other

forms of dementia.

Other preventive actions include lowering homocysteine (amino acids), lowering

cholesterol levels, lowering blood pressure, exercise, education, controlling inflammation,and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen,

naproxen, and similar drugs.


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What is Music Therapy?

Music Therapy is the use of music and/or its musical

elements (sound, rhythm, melody and harmony) by a

qualified music therapist, with a client or group, in a process

designed to facilitate and promote communication,

relationships, learning, mobilization, expression, organization

and other relevant therapeutic objectives in order to meet

physical, emotional, mental, social and cognitive needs.

- World Federation of Music Therapy, 1996


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What conditions can music therapy address?

Children/adolescents/adults with developmental or learning disabilities

Alzheimers disease and other age-related conditions

Substance abuse problems

Brain injuries

Physical disabilities

Acute and chronic pain Mothers in labor


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Who are qualified to practice?

Depending on the state or the country, credited music therapy practitioners havedifferent qualifications.

Credited by the Certification Board for Music Therapists

May have masters degree in music therapy or in other clinical field (social

work, mental health counseling, etc.)

In New York, practitioners should be licensed as creative arts therapists and/orshould pass the examination

Graduated from the music therapy PhD program (Temple Univ & Lesley Univ)

Should be proficient in guitar, piano, voice, music theory,

music history, reading music, improvisation, assessment,

documentation, and other counseling and health care skills.


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What are the techniques used in Music Therapy? Singing

- Assists in developing proper breathing and articulation- Fosters social interaction when done in a group setting

- Encourages reminiscence of the past

- Calms down the anxious patient

Playing instruments

- Improves gross and fine motor coordination

- Increases self-esteem and sense of satisfaction with the self

Music improvisation and Songwriting

- Encourages creativity

- Serves as a means of self-expression

- Facilitates sharing of thoughts

Rhythm-based exercises

- Improves motor skills, balance, coordination, gait, etc.

- Establishes proper rhythm in doing practical things

Listening to and discussing music

- Develops attention and memory

- Gives sense of predictability in the environment

and hence promotes relaxation

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What are its benefits for patients with Dementia?

maintains adequate levels of meaningful stimulation and interaction

improves quality of life

manages behaviral symptoms such as:

agitation

cognitive decline and memory loss

moodiness

communicative difficulties increases reality orientation


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How does music therapy tackle with Dementia symptoms?

Memory Deficits

Past memories, images and personal experiences can all be stimulated by

certain songs. Through interviews with patients and their caregivers, these

specific songs are identified so that they can be applied in Music Therapy

sessions.

Familiar songs are used to stimulate memory.Musical improvisation is used to enhance self-expression when meaningful

words are no longer possible.

Rhythm-based activities are used to increase attention and focus.

Phrases are put to music to aid memory recall.

Improved memoryIncreased attention, motivation and focus

Improved cognitive skills

Increased self-expression

Increased awareness of self and others

Reduced agitation


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Motor Development

The music therapist uses musical instruments that require specific movements in

order to meet these exercise needs. For most individuals, finding the motivation to

exercise is sometimes difficult. Combining exercise with enjoyable, creative and

successful musical experiences can often accelerate the rehabilitation process.

Specialized equipment can be adapted to existing abilities, no matter how limited.

Music making provides experiences that transcend the usual focus of exercise.

Fine motor (dexterity) and/or gross motor (range of motion) activitiesRhythmic strengthening exercises

Motivation, focus and attention

Motion initiated in parts of the body that have limited movement

Movement maintained in affected extremities

Increased range of motionRepertoire of exercises built up so that a resident can

perform independently with confidence

Motivation to participate in daily activities

Increased neuromuscular control


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Speech Difficulty

Many individuals have never sung before and are a bit hesitant to try singing as therapy. In

such cases it is helpful to remember that everyone, even non-musicians, can use singing to

promote vocal support, organize conversational speech and improve communication skills.The focus during the Musically Assisted Speech groups is language and speech

improvement, not professional musical achievements.

Music can organize and facilitate speech because it utilizes other areas of the brain involved

in communication.

Rhythm can aid in vocal production by organizing mechanisms involved in speech.

Breathing exercises

Articulation exercises

Melodic phrasing

Rhythmic vocalization

Conversational phrases are embedded into familiar song phrases

to support speechImproved Communication Skills: improved clarity and fluency,

increased expressive speech and vocal range and volume.

Increased confidence in communication attempts

Enhanced expression


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Emotional Instability

Led by a music therapist with a specialty in psychotherapy, this session allows individuals to

connect to feelings and express thoughts and emotions related to trauma.

The music therapist facilitates specific music according to lyrics, familiar melody or even the

key or tempo in order to facilitate self expression and provide emotional support.

Not all feelings can be described verbally,

By developing trust and a relationship with the therapist, deep feelings and emotions can be

reached through music.

Musical expression through improvised or composed music that focuses

on a specific issue.

Express verbally or non-verbally an emotional response to a piece of

music as part of a treatment.

Cope with feelings related to issues in the past as well as to those in the

present, such as current injury, disease, loss of function or independence.

Reduced pain and increased movements of relazation

by experiencing the power of music.

Intra and inter-personal communication stimulated

through improvisational techniques and guided imagery to music.

Coping skills are learned, practiced and mastered in

relation to disease.


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State of the Science

Music therapy is a relatively new field which started in the United States in 1994.Now, there are several organizations which advocates the use of music as a

therapeutic tool to treat various psychological and psychiatric problems. Among

these are:

American Music TherapyAssociation

Institute forMusic and Neurologic Function

- By Dr. Concetta Tomaino- Working on a project which provides iPods to patients

with customized playlists

Nordoff-Robbins Center forMusic Therapy

-

The Bonny Foundation


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In the Philippines

There are no practitioners of music therapy in the Philippines but there are

Filipino licensed music therapists abroad such as:

Aileen Ravalo-Voyles, MT-BC

-Works with children with and without special needs in grou and indiv. Settings

-Bachelors degree in Piano Performance in UP

-Bachelors degree in Music Therapy in Colorado State Univ

-Co-Eduation Chair for the Colorado Association for Music Therapy

Karen Rae Sanchez, MT-BC-Founder/Director, In Harmony Music Therapy Services

-Magna cum laude, Bachelor of Music in Music Therapy and minor in

Speech and Language Pathology in University of Pacific in Stockton

Rita Rich Antonia Abante, MT-BC

-Summa cum laude, Berklee College of Music

-Voice major in UP


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Case Examples

Hanna

has vascular dementia

almost blind

had difficulty moving

memory capacity reduced

no psychopharmacological treatment

declared that she was fond of music music could reduce her crying

often anxious, restless and complained about back pain

spent much of her time in bed

during the operatta recordings, hummed to the melodies and remained

sitting in her chair

becomes agitated when music is stopped classical music eases her anxiety

music made her sit in her chair without crying for longer time


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Dan

has vascular dementia

independent in walking and movement bladder and bowel incontinence

confusion and agitation

hits or scratches the nurse staff

during the first session, he was emotionally affected and cried because of the

nostalgic songs after, he voluntarily participated in the music activities and spoke

to nurses in a positive manner

asks what they will sing next

no agitated behavior during the sessions

hitting and scratching while nurses change the diaper decreased


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Sensory

Inner Ear (Cochlea) sorts complex sounds into simple frequencies Transmission along separately tuned auditory nerve fibers as trains of

neural discharges

Auditory Cortex in the Temporal Lobe

Frequency Map

Different cells in the auditory system of the brain respond best to certainfrequencies

Neighboring cells have overlapping tuning curves so that there is no gap


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ResponseMcKenna & Weinberger (1980s)

Cell responses varied with how tone is presented within a melody (contour).

Rhythm Left temporal lobe brief stimuli presentation

Right temporal lobe long stimuli presentation

Harmony

Auditory region in right temporal lobe

Timbre

Right temporal lobe activated by timbre discrimination tasks


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Musicians vs. Non-musicians

MUSI

CIA

NS

- Has 25% more left-hemisphere

auditory regions activated while

listening to piano playing

- Volume of auditory cortex is 130%

larger

- Enlarged finger representation in

the cortex

- Anterior corpus callosum of

musicians is larger

- Motor cortex and the cerebellum

are larger

Non- MUSI

CIA

NS

- Has less gray matter

- Smaller auditory cortex

- Less response to musical stimuli

- Anterior corpus callosum of

musicians is smaller

- Motor cortex and the cerebellum

are smaller


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EmotionalResponse to Music

Damage on the temporal lobes including auditory cortical regions impair

only musical comprehension but not musics capacity to evoke emotions

Emotional response could be subcortical and could involve other brain

regions such as the frontal lobe

Blood and McGill (2001), consonant chords or pleasant-sounding music

activates the right hemispheres orbitofrontal area; dissonant chordsor unpleasant music activates the right parahippocampal gyrus

Blood and Zatorre (2001), brain regions that are have greater blood

flow when a musician experiences chills are the amygdala,

orbitofrontal cortex, ventral striatum, midbrain, and ventral medial

prefrontal cortexall of which involved in the reward system


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Case Example

Woody

large amount of plaque in the brain

has memory loss

no idea of what he did for a living, where he is living now, or what he did ten

minutes ago

still remembers the baritone part to almost every song that he sung could still perform in front of an audience


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Music and rhythm find their way into thesecret places of the soul. - Plato

260 report dementia music therapy

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