Effects of music and music therapy on mood in neurological patients

Table 1 Characteristics of the included studies concerning effects on dementia

Ref	Design/(Jadad)	Subjects	Diagnosis	Intervention	Professionals	Frequency	Outcome measures	Results
Ashida[60]	CCT (0)	20	Dementia	Playing percussion instruments and listening to live songs performed by the therapist	Music therapist	Five daily session of about 40 min each in a single week	CSDD	Significant reduction of depressive symptoms (P < 0.05)
Choi et al[61]	CCT (1)	20	Dementia	Singing songs, analysis of libretto, making musical instruments, playing instruments, song drawing, and song writing	Music therapist	50 min, 3 times 1 wk for 5 wk (15 sessions)	MMSE, GDS, GQoL, NPI-Q	Positive trends for GDS and GQoL in music group. Improvements in BPDS (P = 0.004) and caregiver distress (P = 0.003)
Guètin et al[62]	RCT (3)	30	Dementia (Alzheimer’s type)	Weekly sessions of individual, self selected music listening. Control group underwent reading sessions	Not specified therapist	Once 1 wk for 18 mo for 20 min	HRSD, GDS	Significant improvements in anxiety and depression (P < 0.01) in the music therapy group
Raglio et al[63]	RCT (3)	20	Dementia	Active-intersubjective approach, based on sonorous-musical improvisation. Control group took part in educational and occupational activities without music	Music therapist	2 times a week for 15 wk for 30 min	ECG Holter, MMSE, ADAS-Cog test, NPI, ADL, IADL	Significant improvement of depression symptoms (P = 0.02) and increase of HRV (P = 0.013)
Cooke et al[64]	RCT (3)	47	Dementia	Musician-led familiar song singing and music listening. Control group participated in reading sessions	Musicians	3 mornings 1 wk for 8 wk for 40 min	DQOL, GDS, MMSE	Not significant effects on GDS and QOL. Positive trends in music group at sub-analysis
Fischer-Terworth et al[65]	CCT (0)	49	Dementia	Singing in group with the therapist, playing elementary musical instruments and listening to biographically relevant music. Control group participated in a nonspecific occupational therapy	Not specified	Once 1 wk for 6 mo for 45 min	NPI, ICEA-D, MMST, GDS	Depression decreased in both groups (P < 0.05). Improvements of NPI and ICEA-D (P < 0.01) in favor of music group No effects on mood. Improvements (P < 0.05) for MPI, MPD, attentional matrices
Ceccato et al[66]	RCT (3)	50	Dementia	Cognitive and sensorial exercises associated with musical stimuli	Music therapist	2 times 1 wk for 12 wk for 45 min	NPI, MPD, ADL, SVAM, GMP, MMSE, CMAI, GDS	No effects on mood. Improvements (P < 0.05) for MPI, MPD, attentional matrices, ADL, SVAM, and GMP
Janata[67]	RCT (3)	38	Dementia	Preferred music listening. Control group was incidentally exposed to the music programming in the course of daily life	Music therapist	Every day for 12 wk from 21 to 65 min	NPI, CMAI, CSDD, MMSE	Reduction of CSDD, NPI, and CMAI score in both groups (P < 0.0001)
Clemént et al[68]	RCT (2)	14	Dementia (Alzheimer’s type)	Listening to music and playing hand-drums over recorded music. Control group underwent cooking activities. Both groups alternated receptive and productive phases	Psychologist with no musical experience	2 times 1 wk for 4 wk for 1 h	BEHAVE-AD, PSMS, SIB. EFE, Discourse contents and STAI-A	Short time effects of emotional indices (P < 0.05) and longer term effects of mood (P < 0.05) up to 4 wk after the end of the treatment
Narme et al[69]	RCT (2)	48	Dementia	Listening to music, singing and playing percussion instruments. Control group took part in cooking activities. Both groups alternated receptive and productive phases	Psychologist with no musical experience	2 times 1 wk for 4 wk for 1 h	SIB, NPI, CMAI, MMST, EFE, Discourse contents and STAI-A	Both group improved in emotional state, NPI score, and professional caregiver distress at different evaluation periods (P < 0.05)
Chu et al[70]	RCT (3)	104	Dementia	Song choice, music-prompted reminiscence, singing, music listening, and instrument playing	Music therapist	Two sessions per week for 6 wk for 30 min	C-CSDD, salivary cortisol, MMSE	Short time effects on depression (P < 0.001) and long time effects on cognition at 1 mo follow-up (P = 0.039)

ADAS-Cog: Alzheimer's Disease Assessment Scale-Cognitive Subscale; ADL: Activities of daily living; BEHAVE-AD: Behavioral Pathology in Alzheimer’s Disease Scale; CCT: Controlled Clinical Trial; CMAI: Cohen-Mansfield Agitation Inventory; CSDD: Cornell Scale for Depression in Dementia; C-CSDD: Chinese Cornell Scale for Depression in Dementia; DQOL: Dementia Quality of Life; ECG Holter: Electrocardiography Holter; GDS: Geriatric Depression Scale; GMP: Good Manufacturing Practice; GQoL: Geriatric Quality of Life; HRSD: Hamilton Rating Scale for Depression; IADL: Instrumental Activities of Dailiy Living; ICEA-D: Inventory to Asses Communication, Emotional Expression and Activity in Dementia; MMSE: Mini-Mental State Examination; NPI: Neuropsychiatric Inventory; NPI-Q: Neuropsychiatric Inventory Questionnaire; RCT: Randomized Controlled Trial; SVAM: Metacognition Assessment Scale.

Table 2 Characteristics of the included studies concerning effects on stroke

Ref.	Design/(Jadad)	Subjects(n)	Diagnosis	Intervention	Professionals	Frequency	Outcomes measures	Results
Purdie et al[71]	RCT1 (0)	40	Stroke	Playing familiar or improvised music with the therapist by means of percussion instruments, synthesizers, or voice	Music therapist	Once a week for 12 sessions lasting 30-40 min each	FAST, HADS, MBRS, NRS	Positive trends in communication skills, behavior and psychological state in treatment group (not significant result)
Nayak et al[72]	RCT2 (0)	18	Stroke or TBI	Singing, playing instruments, composing, improvising, listening	Music therapist	2 or 3 sessions a week during the hospitalization up to a maximum of 10 sessions	Face Scale, VAS, SIP, questionnaire	Positive trends in mood and significant improvements in social interaction (P < 0.02) and involvement in therapy (P < 0.01) in experimental group
Jeong et al[73]	RCT (2)	33	Stroke	Rhythmic motor activity with music based on Rhythmic Auditory Stimulation (RAS) theory (Neurologic Music Therapy)	Instructors	One weekly session of 2 h for 8 wk	ROM, POMS, SS-QOL, exit interview	Improvement in mood states and interpersonal relationship, flexibility, and range of joint motion (P < 0.05)
Särkämö et al[74]	RCT (3)	60	Stroke	Treatment group underwent preferred-music listening.A second group received self-selected audio book listening while a third control group had no listening material	Music therapists	Every day for 2 mo for 1 h (at minimum)	RBMT, WMS-R, BDAE, CERAD, Token test, BVRT, MBEA, FAB, POMS, SAQUOL-39	Improvements in depression (P = 0.024) and positive trends in confused mood with cognitive recovery (verbal memory and focused attention) in music listening group
Forsblom et al[75]	RCT(3)	39	Stroke	Preferred music listening. Control group underwent audio-book listening	Music therapist	Every day for 2 mo for 1 h (at minimum)	Analysis of patient’s interviews	Improved mood, better relaxation, increased motor activity in music listening group (P < 0.0001)
Kim et al[76]	CCT (0)	18	Stroke	Hello song and sharing of events in their lives (5 m), planned musical activities (30 m) and sharing feelings and goodbye song (5 m)	Not specified therapist	Twice a week for 4 wk for 40 min	BAI, BDI, questionnaire of satisfaction	Improvement in depression (P = 0.048) and positive trends for anxiety
Jun et al[77]	RCT (2)	40	Stroke	Stretching exercises while listening to music, singing and/or playing songs on percussion instruments, and final verbalization	Researchers and music therapist	Three times per week for 8 wk for 60 min	ROM, K-MBI, K-POMS-B, CES-D	Improvements in mood states (P = 0.04) and increase in the degree of shoulder (P = 0.03) and elbow (P = 0.04) joint flexion
Chen et al[78]	CCT (0)	19	Stroke	Self-selected individual listening in two different conditions: pleasant music and unpleasant music. A white noise condition acted as control	Not specified	1 session for each condition, separated by no more than 1 wk3	VAS, HR, GSR, SCT, LBT, PST, visual task	Improvement of mood (P = 0.03) and arousal (P < 0.001) under pleasant music condition
Van Vugt et al[79]	RCT4 (1)	28	Stroke	Play fingers exercises and children’s song on the piano	Music therapist	10 therapy sessions for 3/4 times a week for 30 min	9HPT, Finger tapping measurements, POMS	Reduction of depression (P = 0.002) and fatigue (P = 0.02) and improvement in the synchronization tapping (P < 0.05)

¹Subjects expressing a clear preference for treatment (25% of total) were allocated to music therapy while all others were randomly assigned to either treatment or control group;

²The goal of random assignment was not fully achieved because of the need to have 2-3 subject available at the same time to held group session in the treatment condition;

³Subjects heard 1 min of music or noise and after were given all assessments while they were continuously exposed to the sound up to the end of the evaluation;

⁴Patients were quasi-randomly assigned to groups making sure that the two groups were as close as possible in terms of numerosity and clinical characteristics of participants. 9HPT: Nine-Hole Pegboard Test; FAST: Frenchay Aphasia Screening Test; HADS: Hospital Anxiety and Depression Scale; MBRS: Musical Behaviour Rating Scale; NRS: Neurobehavioural Rating Scale; VAS: Visual Analogue Scale; SIP: Sickness Impact Profile; ROM: Range of Motion; POMS: Profile of Mood State; SS-QOL: Stroke Specific Quality of Life Scale; RBMT: Rivermead Behavioural Memory Test; WMS-R: Wechsler Memory Scale-Revised; BDAE: Boston diagnostic aphasia examination; CERAD: Consortium to Establish a Registry for Alzheimer Disease; BVRT: Benton Visual Retention Test; MBEA: Montreal Battery of Evaluation of Amusia; FAB: Frontal Assessment Battery; POMS: Profile of Mood State; SAQUOL-39: Stroke and Aphasia Quality of Life Scale-39; BAI: Beck anxiety inventory; BDI: Beck Depression Inventory; ROM: Range of Motion; K-MBI: Korean-Modified Barthel Index; K-POMS-B: Korea-Modified Profile of Mood States-Brief; CES-D: Center for Epidemiologic Studies Depression Scale; HR: Heart Rate; GSR: Galvanic Skin Response; SCT: Star Cancellation Test; LBT: Line Bisection Test; PST: Picture Scanning Test; POMS: Profile of Mood State.

Table 3 Characteristics of the included studies concerning effects on other neurological disorders

Ref.	Design/(Jadad)	Subjects(n)	Diagnosis	Intervention	Professionals	Frequency	Outcomes measures	Results
Pacchetti et al[80]	RCT (2)	32	Parkinson’s Disease	Relaxing music, choral singing, breathing/voice exercises, rhythmic movements, collective improvisation, body expression to music. Control group underwent specific motor exercises	Music therapist	Once a week for 3 mo for 2 h,	HM, MS, PDQL, UPDRS	Improvement in emotional (P < 0.0001) and motor (P < 0.034) functions, activities of daily living, and quality of life (P < 0.0001)
Schmid et al[81]	RCT (0)	20	Multiple Sclerosis	Active role of both patient and music therapist on playing instruments or singing (Nordoff-Robbins approach)	Music therapist	3 blocks of individual sessions (8 to 10 sessions per block) over the course of 1 yr	BDI, HADS, SESA, HAQUAMS, MSFC	Not significant differences between groups but medium effect size on depression (d = 0.63), self esteem (d = 0.54), and anxiety (d = 0.63)
Thaut et al[82]	CCT (0)	54	Acquired brain dysfunctions	Group improvisation, singing, synchronization, attention, and memory exercises with music (Neurologic Music Therapy). Control group spent an equal amount of time resting	Music therapist	4 group sessions on different days for 30 min each	WAIS-III, AVLT, TMT-B, BSI-18, MAACL, SEQ	Improvements on depression (P = 0.02), anxiety (P = 0.04), sensation seeking (P < 0.01), and executive functions (mental flexibility) (P < 0.01)
Horne-Thompson et al[83]	CCT	21	ALS/Motor neuron disease	Music relaxation, playing/singing familiar songs, and music and imagery. A second group received a listening intervention of self-selected music while a third control group underwent activities such as reading or watching TV	Music therapist	3 d per week for 30 min each condition	HADS, ESAS, HR, oxygen saturation levels	No effect was found on depression, anxiety, heart rate, and oxygenation levels between groups
Tamplin et al[84]	RCT (3)	24	Chronic Quadriplegia	Oral motor and respiratory exercises and therapeutic singing (Neurologic Music Therapy). Control group received group music appreciation and relaxation	Not specified	3 times weekly for 12 wk for 1 h	Standard respiratory function testing, EMG, PVP, POMS, AQoL	Both groups improved in mood (P = 0.002). The singing group showed positive effects on arousal (P = 0.006), speech intensity (P = 0.028), and maximum phonation length (P = 0.007)

HM: Happiness Measure; MS; Motor Subscale; PDQL: Parkinson's Disease Quality of Life Questionnaire; UPDRS: Unified Parkinson’s Disease Rating Scale; BDI: Beck Depression Inventory; HADS: Hospital Anxiety and Depression Scale; SESA: Self-Acceptance Scale; HAQUAMS: Hamburg Quality of Life Questionnaire in Multiple Sclerosis; MSFC: Multiple Sclerosis Functional Composite; WAIS-III: Wechsler Adult Intelligence Scale-III; AVLT: Auditory Verbal Learning Test; TMT-B: Trial Making Test Part B; BSI-18: Brief Symptoms Inventory-18; MAACL: Multiple Affect Adjective Check List; SEQ: Self Efficacy Questionnaire; HADS: Hospital Anxiety and Depression Scale; ESAS: Edmonton Symptom Assessment System; HR: Heart Rate; EMG: Electromyogram; PVP: Perceptual Voice Profile; POMS: Profile of Mood State; AQoL: Assessment of Quality of Life.