260 report dementia music therapy
TRANSCRIPT
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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
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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