Efeitos da intervenção musicoterapêutica na reabilitação da memória em pessoas idosas

Abstract

Despite clinical research for the development of new drugs for the treatment of Alzheimer's disease (AD), the methods described as “non-pharmacological” are useful for the rehabilitation of elderly people with dementia. Music therapy has been shown to be effective in the treatment of general behavioral and cognitive symptoms in healthy elderly people and also in people with dementia. The first study consisted of a systematic review carried out in the databases of PubMed, Cochrane Library, PsycINFO and Lilacs until June 2017. This review included all randomized controlled trials that assessed memory using musical interventions in patients with AD. Fortytwo studies were identified, and 24 studies were selected. After applying the exclusion criteria, four studies involving 179 patients were included. These studies showed benefits of using music to treat memory deficits in patients with AD, especially in autobiographical memory, in long-term verbal memory and, to some extent, in short-term memory. Despite the positive outcome of this systematic review, the available evidence remains inconsistent due to the small number of randomized controlled trials. The second study of this thesis consisted of a randomized double-blind clinical trial, which aimed to evaluate the effects of music therapy on the rate of memory decline in elderly people with memory impairment (Mild Cognitive Impairment with memory deficits, Alzheimer's Dementia, and Alzheimer's Dementia + Vascular Dementia) and healthy elderly people. It also assessed other cognitive domains of the elderly and their mood, and the burden on the caregivers of the elderly with memory impairment. The study had a total sample of 68 participants (including 18 healthy elderly people, 25 elderly people with dementia and 25 caregivers). The experimental group had 12 sessions of music therapy (40 min / session) twice a week and standard medical treatment. The control group received only the standard medical treatment. Neuropsychological interviews, scales and tests were applied, including: Mini-Mental State Examination (MMSE), Bayer Scale (BS), Katz Scale (KS), Geriatric Depression Scale (GDS), WAIS III – Digits test, Corsi Block-Tapping Test, Brief Cognitive Screening Battery (BCSB) - Picture Memory Test; Sung and Spoken Word Memory Test (SSWMT), Autobiographical Memory Test (AMT), Autobiographical Memory Test for Music (AMT-M), Five-Digit Test (FDT), Shulman's Clock Test, Informal Caregiver Burden Assessment Questionnaire (ICBAQ) and Music Therapy Assessment Protocol. All tests were applied before and after the Music Therapy intervention. Data analysisshowed that the intervention had a positive effect for both experimental groups (healthy and cognitive impaired) on BCSB Picture Memory Test (after a 5- minute interval between study and test). In addition, the memory impaired experimental group presented a reduced forgetfulness index on the SSWMT after the music therapy than the memory impaired control group. Overall, the memory impaired elderly forgot less in the sung than in the spoken version of the SSWMT. Finally, even though it did not reach statistical significance, the intervention had a reasonable effect on the performance of the healthy elderly experimental group on the AMT-M. The results of the 2 studies pointed out that music therapy can be promising in the remediation of memory deficits in elderly people. They are also in line with evidence that brain areas related to “memory for music” are less impaired in elderly people with dementia. However, further studies are still needed to develop a detailed theoretical model on the relationship between memory and music, as well as to evaluate which elements of the music therapeutic intervention are crucial to the success of treatment and which are not.