Music-Based Interventions in Dementia

Vollständiger Abstract

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Abstract Purpose of Review Music-based interventions (MBIs) are increasingly incorporated into dementia care to promote engagement, evoke autobiographical memories, and address behavioral and psychological symptoms of dementia, yet their role in routine clinical practice remains poorly defined. MBIs engage brain regions involved in reward, salience, autobiographical memory, social-affective processing, autonomic regulation, and motor entrainment, providing a biologically plausible basis for symptom-targeted therapeutic applications and future mechanistic clinical trials. Recent Findings Recent systematic reviews and landmark clinical trials have refined understanding of the role of MBIs in dementia care. Contemporary evidence supports therapist-led music therapy, caregiver-delivered music interventions, individualized preferred-music listening, and community-based music programs for selected clinical indications, although optimal patient selection, intervention dose, and comparative effectiveness remain uncertain. Emerging mechanistic studies incorporating neuroimaging, electrophysiology, autonomic physiology, and digital biomarkers are beginning to elucidate the neural substrates underlying music responsiveness and may facilitate more individualized treatment approaches. Summary Consistent with the National Institute for Health and Care Excellence (NICE) dementia guideline, which recommends structured assessment of behavioral symptoms and initial use of psychosocial and environmental interventions before antipsychotic treatment when appropriate, we propose incorporating music within a stepped-care framework prior to escalation to psychotropic medications. This review summarizes the neurobiology underlying music responsiveness in Alzheimer's disease and related dementias, critically appraises the contemporary clinical evidence, and proposes a practical framework for prescribing music according to target symptom, disease stage, patient preferences, care setting, and available resources. Future priorities include dementia subtype-specific interventions, mechanistic clinical trials, biomarker-informed studies, implementation research, and development of evidence-based prescribing strategies to facilitate integration of music into routine dementia care. Opinion Statement Music should be considered a symptom-targeted, nonpharmacologic therapeutic option within contemporary dementia care rather than simply a recreational activity. We recommend an individualized, person-centered approach in which music-based interventions are selected according to the patient’s most prominent symptoms, care setting, personal preferences, and available resources. Preferred music listening may be particularly useful for agitation, anxiety, and distress. Therapist-led interventions may be appropriate for complex behavioral symptoms, while caregiver-delivered approaches can facilitate engagement and strengthen social connection within everyday care routines. Emerging evidence suggests that music engages distributed neural systems involved in musical memory, reward and salience processing, autobiographical memory, social-affective processing, and autonomic regulation, providing a plausible neurobiological basis for its clinical effects. Music is best prescribed within a multidisciplinary framework that includes music therapists engaged by behavioral neurology, geriatrics, psychiatry, primary care, rehabilitation clinicians. Although music is unlikely to modify the underlying neurodegenerative disease process, it may improve quality of life, reduce distress, support personhood, and enhance caregiver-patient relationships. Future work should focus on identifying which patients are most likely to benefit, defining the active ingredients of music-based interventions, and integrating music into broader precision dementia care and brain health strategies. Important barriers to implementation include variable reimbursement, uneven access to trained providers, licensure differences across jurisdictions, and inconsistent institutional prioritization of nonpharmacologic therapies.