Aim: The
objective of this research is to highlight the effectiveness of physical
exercise and music therapy in older patients with Alzheimer’s disease (AD). Methods: Patients with a mild level of AD were included in this study, divided into the
therapy group (TG; N = 30, aged 68 ± 3.2 years) and the control group (CG;
N=30, aged 65 ± 2.6 years). The therapy group was enrolled in an
exercise-training program (walking, resistance and balance exercises) combined
with musical therapy for 10 weeks (three sessions of 60 minutes per week). The
Control group was instructed to follow their daily rhythm of life (e.g., rest,
reading) under the same conditions. The intervention program was enrolled under
the supervision of; one psychologist; a neurologist; two music therapists, and two
physiotherapists, all belonging to the same hospital unit. After 10 weeks of
participation in the combined program, cognitive parameters were improved in
the therapy group measured with the Behavior Pathology in Alzheimer Disease
(BEHAVE-AD), (p < 0.05) for activity disturbance, diurnal rhythm
disturbances, anxieties and phobias, affective disturbance. The percentage
range of improvements is 1.07% to 2.96%. Results: Our results
demonstrate that physical exercise combined with music therapy improves
cognitive function in patients with Alzheimer’s disease. Conclusions: Physical exercise and music therapy are beneficial combined treatments for
improving life quality in older patients. This approach may be useful to help
patients with a mild level of Alzheimer’s disease improve their behavioral and
psychological parameters.
References
[1]
Haapasalo, A., Pikkarainen, M. and Soininen, H. (2015) Alzheimer’s Disease: A Report from the 7th Kuopio Alzheimer Symposium. Neurodegenerative Disease Management, 5, 379-382. https://doi.org/10.2217/nmt.15.31
[2]
Alzheimer’s Association (2018) 2018 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dement, 14, 367-429. https://doi.org/10.1016/j.jalz.2018.02.001
[3]
Rapporto Censis (2007) I costi economici e sociali della malattia di Alzheimer: Cosa è cambiato? Roma.
[4]
Hajjem, S. and Achour, N. (2001) Espérance de vie sans incapacité′ de la population tunisienne agée. Institut National de la Sante′ Publique, Tunis, 17-25.
[5]
Gouiaa, R. (2015) Geriatric Medicine in Tunisia: Still Young. European Geriatric Medicine, 6, 96. https://doi.org/10.1016/j.eurger.2014.06.015
[6]
Yount, K.M., Agree, E.M. and Rebellon, C. (2004) Gender and Use of Health Care among Older Adults in Egypt and Tunisia. Social Science & Medicine, 59, 2479-2497. https://doi.org/10.1016/j.socscimed.2004.04.004
[7]
Starr, J.M. and Lonie, J. (2007) Relationship between Behavioural and Psychological Symptoms of Dementia and Cognition in Alzheimer’s Disease. Dementia and Geriatric Cognitive Disorders, 24, 343-347. https://doi.org/10.1159/000108632
[8]
Prince, M. and Jackson, J. (2010) Alzheimer’s Disease International. Relatorio sobre a Doenca de Alzheimer no mundo de 2009. Alzheimer’s Disease International, Resumo Executivo em Portugues, Londres.
[9]
Cohen, L., Binagwaho, A., Galea, S., Grover, A., Jabbour, S. and Nuwayhid, J. (2017) Supporting Families to Care for People with Dementia. Bulletin of the World Health Organization, 95, 734-735. https://doi.org/10.2471/BLT.17.021117
[10]
Lou, M.F. (2001) The Use of Music to Decrease Agitated Behaviour of the Demented Elderly: The State of the Science. Scandinavian Journal of Caring Sciences, 15, 165-173. https://doi.org/10.1046/j.1471-6712.2001.00021.x
[11]
Li, C.H., Liu, C.K., Yang, Y.H., et al. (2015) Adjunct Effect of Music Therapy on Cognition in Alzheimer’s Disease in Taiwan: A Pilot Study. Neuropsychiatric Disease and Treatment, 11, 291-296. https://doi.org/10.2147/NDT.S73928
[12]
Nobari, H., Azimzadeh, E., Hassanlouei, H., Badicu, G., Pérez-Gómez, J. and Ardigò, L.P. (2021) Effect of Physical Guidance on Learning a Tracking Task in Children with Cerebral Palsy. International Journal of Environmental Research and Public Health, 18, Article 7136. https://doi.org/10.3390/ijerph18137136
[13]
Nobari, H., Rezaei, S., Sheikh, M., Fuentes-García, J.P. and Pérez-Gómez, J. ( 2021) Effect of Virtual Reality Exercises on the Cognitive Status and Dual Motor Task Performance of the Aging Population. International Journal of Environmental Research and Public Health, 18, Article 8005. https://doi.org/10.3390/ijerph18158005
[14]
American College of Sports Medicine (2014) ACSM’s Guidelines for Exercise Testing and Prescription. Indianapolis.
[15]
Radak, Z., Hart, N. and Sarga, L. (2010) Exercise Plays a Preventive Role against Alzheimer’s Disease. Journal of Alzheimer’s Disease, 20, 777-783.
https://doi.org/10.3233/JAD-2010-091531
[16]
Valenzuela, P.L., Castillo-García, A., Morales, J.S., de la Villa, P., Hampel, H., Emanuele, E., Lista, S. and Lucia, A. (2020) Exercise Benefits on Alzheimer’s Disease: State-of-the-Science. Ageing Research Reviews, 62, Article ID: 101108.
https://doi.org/10.1016/j.arr.2020.101108
[17]
Shams, A., Nobari, H., Afonso, J., Abbasi, H., Mainer-Pardos, E., Pérez-Gómez, J., Bayati, M., Bahrami, A. and Carneiro, L. (2021) Effect of Aerobic-Based Exercise on Psychological Well-Being and Quality of Life among Older People: A Middle East Study. Frontiers in Public Health, 9, Article 764044.
https://doi.org/10.3389/fpubh.2021.764044
[18]
World Federation of Music Therapy (2013) WFMT/ FAQ Music Therapy.
[19]
Robles, A., Del Ser, T., Alom, J., Peña-Casanova, J. and Asesor, G.X. (2002) Proposal of Criteria for the Clinical Diagnosis of Mild Cognitive Impairment, Dementia and Alzheimer’s Disease. Neurologia, 17, 17-32.
[20]
Oneca, N. (2014) Music Therapy: Fundamentals, Practical Aspects and Application to Hospitalized Children. Ph.D. Thesis, Navarra University, Navrra.
[21]
Samson, S., Clément, S., Narme, P., Schiaratura, L., Ehrlé, N. (2015) Efficacy of Musical Interventions in Dementia: Methodological Requirements of Nonpharmacological Trials. Annals of the New York Academy of Sciences journal, 1337, 249-255.
https://doi.org/10.1111/nyas.12621
[22]
Association AMT (2021) Definition and Quotes about Music Therapy.
http://www.music-therapy.org
[23]
Clair, A.A. (1996) The Effect of Singing on Alert Responses in Persons with Late Stage Dementia. Journal of Music Therapy, 33, 234-247.
https://doi.org/10.1093/jmt/33.4.234
[24]
Kneafsey, R. (1997) The Therapeutic Use of Music in a Care of the Elderly Setting: A Literature Review. Journal of Clinical Nursing, 6, 341-346.
https://doi.org/10.1111/j.1365-2702.1997.tb00326.x
[25]
Kim, M. and Tomaino, C.M. (2008) Protocol Evaluation for Effective Music Therapy for Persons with Nonfluent Aphasia. Topics in Stroke Rehabilitation, 15, 555-569.
https://doi.org/10.1310/tsr1506-555
[26]
Fabre, C., Chamari, K. and Mucci, P. (2002) Improvement of Cognitive Function via Mental and/or Individual Aerobic Training in Healthy Elderly Subject. International Journal of Sports Medicine, 23, 415-421.
https://doi.org/10.1055/s-2002-33735
[27]
Oswald, W.D., Gunzelmann, T., Rupprecht, R. and Hagen, B. (2006) Differential Effects of Single versus Combined Cognitive and Physical Training with Older Adults: The SimA Study in a 5-Year Perspective. European Journal of Ageing, 3, 179-192.
https://doi.org/10.1007/s10433-006-0035-z
[28]
Shatil, E. (2013) Does Combined Cognitive Training and Physical Activity Training Enhance Cognitive Abilities More than Either Alone? A Four-Condition Randomized Controlled Trial among Healthy Older Adults. Frontiers in Aging Neuroscience, 5, Article 8. https://doi.org/10.3389/fnagi.2013.00008
[29]
Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) “Mini-Mental State”: A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198. https://doi.org/10.1016/0022-3956(75)90026-6
[30]
Guyatt, G.H., Pugsley, S.O., Sullivan, M.J., Thompson, P.J., Berman, L., Jones, N.L., Fallen, E.L. and Taylor, D.W. (1984) Effect of Encouragement on Walking Test Performance. Thorax, 93, 812-822. https://doi.org/10.1136/thx.39.11.818
[31]
Morris, J.C. (1993) The Clinical Dementia Rating (CDR): Current Version and Scoring Rules. Neurology, 43, 2412b-4. https://doi.org/10.1212/WNL.43.11.2412-a
[32]
Reisberg, B., Borenstein, J., Salob, S.P., Ferris, S.H., Franssen, E. and Georgotas, A. (1987) Behavioral Symptoms in Alzheimer’s Disease: Phenomenology and Treatment. Journal of Clinical Psychiatry, 48, 9-15. https://doi.org/10.1037/t13385-000
[33]
Sclan, S.G., Saillon, A., Franssen, E. and Hugonot-Diener, L. (1996) The Behavioral Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD): Reliability and Analysis of Symptom Category Scores. International Journal of Geriatric Psychiatry, 11, 819-830.
https://doi.org/10.1002/(SICI)1099-1166(199609)11:9<819::AID-GPS389>3.0.CO;2-S
[34]
Schulkind, M.D., Hennis, L.K. and Rubin, D.C. (1999) Music, Emotion, and Autobiographical Memory: They’re Playing Your Song. Memory and Cognition, 27, 948-955. https://doi.org/10.3758/BF03201225
[35]
Jebali, R. (2010) Approches interculturelles de la musicothérapie en Tunisie: De la Musicothérapie traditionnelle Stambâlî, à la musicothérapie moderne. Revue Francaise de Musicotherapie, 4, 69.
[36]
Salimpoor, V.N., Benovoy, M., Larcher, K., Dagher, A. and Zatorre, R.J. (2011) Anatomically Distinct Dopamine Release during Anticipation and Experience of Peak Emotion to Music. Nature Neuroscience, 14, 257-262.
https://doi.org/10.1038/nn.2726
[37]
Sherratt, K., Thornton, A. and Hatton, C. (2004) Music Interventions for People with Dementia: A Review of the Literature. Aging & Mental Health, 8, 3-12.
https://doi.org/10.1080/13607860310001613275
[38]
Olderog-Millard, K.A. and Smith, J.M. (1989) The Influence of Group Singing Therapy on the Behavior of Alzheimer’s Disease Patients. Journal of Music Therapy, 26, 58-70. https://doi.org/10.1093/jmt/26.2.58
[39]
Hall, G.R. and Buckwalter, K.C. (1987) Progressively Lowered Stress Threshold: A Conceptual Model for Care of Adults with Alzheimer’s Disease. Archives of Psychiatric Nursing, 1, 399-406.
[40]
Gerdner, L.A. (2000) Effects of Individualized versus Classical Relaxation Music on the Frequency of Agitation with Alzheimer’s Disease and Related Disorders. International Psychogeriatrics, 12, 49-65. https://doi.org/10.1017/S1041610200006190
[41]
Sacks, O. (2006) The Power of Music. Brain, 129, 2528-2532.
https://doi.org/10.1093/brain/awl234
[42]
Katona, C. (2007) International Psychogeriatric Association Consensus Statement on Defining and Measuring Treatment Benefits in Dementia. International Psychogeriatrics, 19, 345-354. https://doi.org/10.1017/S1041610207005145
[43]
Cerejeira, J., Lagarto, L. and Mukaetova-Ladinska, E.B. (2012) Behavioral and Psychological Symptoms of Dementia. Frontiers in Neurology, 3, Article 73.
https://doi.org/10.3389/fneur.2012.00073
[44]
Mathews, R.M., Clair, A.A. and Kosloski, K. (2001) Keeping the Beat: Use of Rhythmic Music during Exercise Activities for the Elderly with Dementia. American Journal of Alzheimer’s Disease & Other Dementias, 16, 377-380.
https://doi.org/10.1177/153331750101600608
[45]
Satoh, M., Ogawa, J.I., Tokita, T., Nakaguchi, N. and Nakao, K. (2017) Physical Exercise with Music Maintains Activities of Daily Living in Patients with Dementia: Mihama-Kiho Project Part 21. Journal of Alzheimer’s Disease, 57, 85-96.
https://doi.org/10.3233/JAD-161217
[46]
van der Steen, J.T., van Soest-Poortvliet, M.C., van der Wouden, J.C., Bruinsma, M.S. and Scholten, R.J. (2017) Music-Based Therapeutic Interventions for People with Dementia. Cochrane Database of Systematic Reviews, 5, CD003477.
https://doi.org/10.1002/14651858.CD003477.pub3
[47]
Sergent, J., Zuck, E., Terriah, S. and MacDonald, B. (1992) Distributed Neural Network Underlying Musical Sight-Reading and Keyboard Performance. Science, 257, 106-109. https://doi.org/10.1126/science.1621084
[48]
Satoh, M., Takeda, K., Nagata, K. and Tomimoto, H. (2011) The Lateral Occipital Complex Is Activated by Melody with Accompaniment: Foreground and Background Segregation in Auditory Processing. Journal of Behavioral and Brain Science, 1, 94-101. https://doi.org/10.4236/jbbs.2011.13013
[49]
Mazzoni, M., Moretti, P., Pardossi, L., Vista, M. and Muratorio, A. (1993) A Case of Music Imperceptions. Journal of Neurology, Neurosurgery & Psychiatry, 56, 322-324. https://doi.org/10.1136/jnnp.56.3.322
[50]
Satoh, M., Nakase, T., Nagata, K. and Tomimoto, H. (2011) Musical Anhedonia: Selective Loss of Emotional Experience in Listening to Music. Neurocase, 17, 410-417. https://doi.org/10.1080/13554794.2010.532139