The results compiled below were analyzed and published in Dementia by Renee Beard.

Please also go to http://jennyknauss.net

Additions to the Music Category

Here are three additions to be added to the Music category contributed by Anne Basting.

Palo-Bengtsson L, Ekman S. (1997). Social dancing in the care of persons with dementia in a nursing home setting: A phenomenological study. Scholarly Inquiry for Nursing Practice: An International Journal, 11, 101-123.

Palo-Bengtsson L, Winblad, B., & Ekman S. (1998). Social dancing: A way to support intellectual, emotional and motor functions in persons with dementia. Journal of Psychiatric and Mental Health Nursing, 5, 545-554.

Verghese, J., Lipton, R. B., Katz, M. J., Hall, C. B., Derby, C. A., Kuslansky, G., Ambrose, A. F., Sliwinski, M., & Buschke, H. (2003). New England Journal of Medicine, 348, 2508-2516.

Palo-Bengston, L., & Ekman, S. L. (2002). Emotional response to social dancing and walks in persons with dementia. American Journal of Alzheimer's Disease And Other Dementias, 17, 149-153.

And, here is another addition just published:

Raglio, Alfredo MT; Bellelli, Giuseppe MD; Traficante, Daniela PsyD, PhD; Gianotti, Marta MT; Ubezio, Maria Chiara MD; Villani, Daniele MD; Trabucchi, Marco MD. Efficacy of Music Therapy in the Treatment of Behavioral and Psychiatric Symptoms of Dementia. Alzheimer Disease & Associated Disorders. 22(2):158-162, April/June 2008.

Contributed by Don Moyer.

Why No Articles on Memory Training?

Articles on memory training were not reviewed here because we see this as not directly life enriching.

True, memory training like medications, diet, physical activity, and mental activity, inasmuch as they do mitigate challenges, do enable life enrichment. These enablements are appropriate for a different study.

It is also true that persons engaging in memory training have testified that this gave them a sense of accomplishment, which they found life enriching. Life enriching sense of accomplishment is real and can be had from no end of activities. We limited ourselves to a small set of activities where each activity can be well defined so that replicable results can be obtained.

Contributed by Don Moyer.

Answering some Questions about this Blog

Mona Johnson asked me several very good questions about this blog and I'll share my answers here.

The persons I hope will use the blog comprise pros in the field and activists like Mona like me like many DASNI members and even persons living with the challenges.

Getting all the best existing research in one place and annotated by Renee from the point of view of a researcher having excellent grasp of reliable research methods shows the state of the art and gives us the opportunity to look at the annotated results for answers to our original three questions:

1 What do we know about means for enriching lives of persons having memory blues?

2 Can these means be helpful to these persons living at home?

3 Can information technologies be used to help implement these means for these persons living at home?

One conclusion is that the state of the art speaks mainly to other questions. I haven't fully digested the results yet; as I do I'll likely form other conclusions.

Conclusions etc. from other users of these results are desired. One reason for posting the results in this form is so that others can ask questions of the state of the art and draw their conclusions and make suggestions.

I hope that pros will see opportunities for research which will speak more to our questions and will produce useful and reliable results. And, I hope that pros will see opportunities to adapt activities – using information technologies for example – to help persons living at home; I've been waving this banner for years since I know that it can be done, but nothing happens. I hope activists will push and aid pros to grasp these opportunities, where "grasp" should be understood in the sense of understand and in the sense of take hold of.

I also hope that the model will catch on, the model being where lay persons take research ideas to researchers, participate in designing research, raise funds to pay for the research, etc. etc. (as many persons did for AIDS research for example).

Renee will write a scholarly paper giving more context, drawing conclusions, and making suggestions.

Contributed by Don Moyer.

Annotated Results: 6 Other

Please add comments. Tell us about work we've missed. Add work published after we closed our review.

In your annotated additions please tell what was studied, what benefits were found, what quality of life benefits were found, and how well benefits were sustained.

Thanks. Don

6. Other

Alessi, C.A.; Yoon, E.J.; Schnelle, J.F.; Al-Samarrai, N.R.; Cruise, P.A. (1999). A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve? Journal of the American Geriatric Society, 47, 784-791.
The study tested whether an intervention combining increased daytime physical activity with improvement in the nighttime environment improves sleep and decreases agitation in nursing home residents using a randomized trial in one community nursing home in the Los Angeles, California area. It included twenty-nine incontinent residents (mean age 88.3 years, 90% female) randomized to receive either (1) an intervention combining increased daytime physical activity (14 weeks in duration) plus a nighttime program (5 nights in duration) to decrease noise and sleep-disruptive nursing care practices (intervention group), or (2) the nighttime program alone (control group). Measurements included daytime physical activity monitors and structured physical function assessments; nighttime wrist activity monitors to estimate nighttime sleep; and timed daytime behavioral observations of sleep versus wakefulness, either in or out of bed, and agitation. Physical function measures did not change significantly. Wrist actigraphy estimation of nighttime percent sleep increased in intervention subjects from 51.7% at baseline to 62.5% at follow-up compared with 67.0% at baseline to 66.3% at follow-up in controls. At follow-up, intervention subjects averaged a 32% decrease in the percent of daytime observations in bed compared with baseline, with essentially no change in controls. Seven of 15 intervention subjects had a decrease in observed agitation at follow-up, compared with baseline, versus only 1 of 14 controls with a decrease in observed agitation. The authors contend that this study provides preliminary evidence that an intervention combining increased physical activity with improvement in the nighttime nursing home environment improves sleep and decreases agitation in nursing home residents.

Bober, S.J.; McLellan, E.; McBee, L.; & Westreich, L. (2002). The Feelings Art Group a vehicle for personal expression in skilled nursing home residents with dementia. Journal-of-Social-Work-in-Long-Term-Care, 1(4), 73-87.
Based on the assumption that dementia sufferers continue to experience emotions even in the severe stages of the disease and despite profound declines in cognitive functioning, the authors argue that many struggle to communicate these emotions verbally. This article looks at the Feelings Art Group, a social work led group on a dementia Special Care Unit within a 514-bed academic nursing home offered an ongoing group therapy program for skilled nursing residents with Alzheimer's type and other dementias. This group therapy program employed art-based activities as a stimulus to facilitate uncommunicated emotions in severely demented nursing home residents. The intervention was designed to tap into resident's feelings on a series of universal topics including family, work, holidays and seasons, using art as a vehicle for the expression of emotions. Employing visual, tactile, olfactory and audio stimulation, dementia sufferers were helped to find "voice" for their feelings. Before and after the group, residents with limited verbal abilities were able to identify feelings using a visual recognition scale and verbal cues. Outcomes included a heightened ability to identify emotions and increased socialization among group members.

Brooker, D.J. & Duce, L. (2000). Well-being and activity in dementia: a comparison of group reminiscence therapy, structured goal-directed activity, and unstructured time. Aging and Mental Health, 4 (4), 354-358.
A comparison of well-being levels of 25 individuals with mild to moderate dementia during three types of activity was made. The first was group reminiscence therapy (RT), the second was group activities (GA), and the third was unstructured time (UT). These activities were all part of the usual program of activities within three day hospitals where the study took place. Dementia Care Mapping results indicated that individuals experienced a greater level of relative wellbeing during RT than GA. The level of wellbeing in both RT and GA was significantly higher than in UT.

Brooker, D.J. (2001). Enriching Lives: evaluation of the ExtraCare activity challenge. Journal of Dementia Care, May/June, 33-37.
This article evaluates the ExtraCare activity, which took 19 PWD out of their normal environment for an “exciting 5-day outdoor activity holiday,” including canoeing, hot air ballooningm pony trap riding, abseiling, the zip wire, swimming in the heated pool and the Jacuzzi. The author argues that the intervention of “going on holiday” has not been systematically evaluated as an experience for PWD. Through the use of dementia care mapping (DCM), the well-being of residents was systematically evaluated before, during and one month after the ExraCare challenge to understand the experiences of participants and benefits for both residents and staff. Blinded staff reports suggest that residents with dementia gain enormous increases in self esteem from their achievements on these holidays, in addition to significant improvements in sleep, continence and mobility. In particular, as a group well-being was significantly higher while participants were on holiday and a month later well-being was similar to what it had been prior to the holiday. The control group, who did not go on the holiday, experienced only slight changes in well-being over the same time period.

Brooker, D.J. & Woolley, R.J. (2007). Enriching opportunities for people living with dementia: the development of a blueprint for a sustainable activity-based model. Aging and Mental Health, 11(4), 371-383.
This study includes a lit review (of medline, CINAHL, Cocharne using key words such as AD, activity/occupation, therapy, long term care/homes) but focuses on an expert working group featuring the special expertise of the locksmith, “whose raison d’etre was to ensure residents and tenants reach their potential for well-being” (373). The locksmith’s title is chosen to reflect responsibility in discovering and developing keys that “would unlock the potential for well-being in individuals with dementia” (373). Their role was described as pivotal as resource and leader, with a firm commitment that PWD are entitled to and able to enjoy life. Focus group data was gathered and analyzed to determine how people felt about the project, what life was like for residents/tenants, what were identified as barriers to an enriched life, and what helped facilitate an enriched life.

Brooker, D.J.; Woolley, R.J. & Lee, D. (2007). Enriching opportunities for people living with dementia in nursing homes: an evaluation of a multi-level activity-based model of care. Aging and Mental Health, 11(4), 361-370.
The main facets of this program and its approach have already been summarized in Brooker & Woolley (2007), based on 127 subjects diagnosed with dementia or enduring mental health problems in 3 specialist nursing homes in the UK. However, an interesting distinction was noted in this report between the success of the program in nursing homes and the challenges it faced in extra care housing schemes: “The nursing homes had an established person-centered pattern of working with PWD and specialized in this area” whereas the extra care housing staff had little training and a population more diverse in their problems. Again, the level of long term in-depth commitment from locksmiths was emphasized as a factor explaining why the program was successful. Core components of the program involved general good quality person-centered care, individualized simple and fun activity that occurred everyday, communal space and equipment, and opportunities to get out of the facility (19).

Camp, C. J. & Skrajner, M.J. (2004). Resident-assisted Montessori programming (RAMP): training persons with dementia to serve as group activity leaders. The Gerontologist, 44(3), 426-431.
Four women with ESD were trained to serve as leaders for a small group activity (memory bingo) played by nine persons with more advanced dementia. They demonstrated the potential to fill the role effectively, were described as exhibiting “assisted leadership,” (430) and needing “external cueing” (426), expressed satisfaction with role, and the players showed higher levels of positive engagement and pleasure (measured by the MPES, which looks at four kinds of engagement: constructive, passive, non, and other (428)). The authors contend “that persons with dementia can be trained to produce effects similar to those produced by activity staff.” They state, “We believe that it will one day be possible for dementia residents to lead Montessori-based activities virtually unassisted,” and that satisfaction and self worth are heightened through this work which creates a meaningful social role for leaders as well as engagement for participants. They also state they would like to see it applied to other settings. Activities are defined as rehabilitative “if they can increase or prevent further decline in adaptation and functional levels” (426).

Cartwright, J.C.; Archbold, P.G.; Stewart, B.J.; & Limandri, B. (1994). Enrichment Processes in Family Caregiving to Frail Elders. Advances in Nursing Science, 17(1), 31-43.
This article looks at the role of enrichment and the associated AT activities for family caregivers of frail seniors. It is one of the few studies that examines “enrichment.”

Cheston, (1998). Psychotherapeutic work with people with dementia: A review of the literature. British Journal of Medical Psychology, 71, 211-231.
This article reviews the literature on the utility and outcomes of psychotherapy with people who have dementia.

Chung, J. (2004). Activity Participation and Well-being of People with dementia in long term care settings. Occupation, Participation, and Health, 24(1), 22-31.
43 subjects in Hong Kong long term residential services were evaluated during a 6 hour period. Those with severe dementia “engaged in significantly more passive activities” than those with mild/moderate dementia, and “had fewer social interactions and displayed more negative behavior” (22). The overall research question of the study was: “What were the states of well-being of long term care residents with dementia when participating in their usual activity patterns?” (23). The results described were that participants spent 1/3 time in a passive state, 21% time in passive watching, and 12% of time asleep (29). The greatest amount of time observed was spent engaging in passive activities (43%), double that of those engaged in daily living activities (21%). 15% of respondents spent time in mobility and action activities and the least amount of time was spent engaged in therapeutic/leisure activities. A significant association was found between activity participation and well being. Eating and drinking was listed as the second most important activity. This study did not examine the physical and social environments of the two participating nursing homes, which the authors state “may have had an impact on performance” (30).

Cohen-Mansfield, J. (2005). Nonpharmacological Interventions for Persons with Dementia. Alzheimer, 6(2), 129-145.
Nonpharmacological approaches to the care of persons with dementia differ from pharmacological treatment in that they consider the interaction between the person, caregiver, environment, and system of care in the treatment design. Such interventions generally provide more personalized care for these individuals, addressing their needs, and considering their preferences. Nonpharmacological interventions have been used to enhance cognition, affect, and performance of activities of daily living; to reinforce a positive sense of self; and to reduce agitation/behavior problems and psychotic symptoms. This article presents a framework for implementing such interventions, provides examples from the literature of existing interventions, and argues for increased advocacy to support their research and use.

Devlin, B. (2006). The art of healing and knowing in cancer and palliative care. International Journal of Palliative Nursing, 12(1), 16-19.
This article looks at the role of AT in healing and living with cancer and end-of-life care. It discusses the meaning and therapeutic processes of AT for participants.

Dowd S.B, & Davidhizar, R. (2004). Chess and gardening: the Rx for Alzheimer's?
Caring : National Association for Home Care Magazine, 23(6), 34-38
This article looks at the benefits of activities such as playing chess and gardening as an intervention in the behavioral symptoms associated with dementia.

Dowd S.B, & Davidhizar, R. (2003). Can mental and physical activities such as chess and gardening help in the prevention and treatment of Alzheimer's? Healthy aging through stimulation of the mind. Journal of Practical Nursing, 53(3), 11-13.
This article looks at the role of physical and mental activities (AT), including chess and gardening, in preventing and reducing the behavioral symptoms of AD. It touts a “use it or lose it” approach to brain health and aging generally.

Ehrenfeld, M. (2003). Using therapeutic dolls with psychogeriatric patients. In Schaefer C.E. (Ed.), Play therapy with adults. New York: John Wiley & Sons.
This article reports on the potential usefulness of doll therapy approaches to reduce challenging behaviors, including “acting out” and “non-active” presentations, in seniors with PWD who are agitated, distressed, have communication difficulties, or are withdrawn.

Gigliotti, C.M.; Jarrott S.E.; & Yorgason, J. (2004). Harvesting Health: effects of three types of horticultural therapy activities for persons with dementia. Dementia 3(2), 161-180.
HT uses plant materials to achieve measurable treatment goals with special populations. All 3 types of HT, cooking, crafts, and planting, were used 3 times a week at an adult day service program (averaging 5-19 participants) over nine weeks. DCM and observation were used to map response. Individual codes used were Social, HT (horticulture behavior), productive, nothing. High levels of positive affect, pride, and constructive engagement were observed during all activities. No measurable difference was noted between each of the three. HT utilized Montessori-based activity modifications known as “extensions” to minimize risk of failure, maximize success, and accommodate all individuals within a group setting.

Heath, Y. (2004). Evaluating the effect of therapeutic gardens. American Journal of Alzheimer’s Disease and Other Dementias, 19, 239-242.
This article explores how the visitors to therapeutic gardens do not necessarily always experience the garden the way the designers intended. A postoccupancy evaluation (POE) can reveal discrepancies between the designer’s intentions and use of the environment by the actual visitors. A POE is a user-oriented assessment that elicits the opinions of the visitors to a building, facility, or environment. This paper describes a POE of therapeutic gardens at a multilevel care facility for the aged. The population included patients at various stages of Alzheimer’s disease progression.

Hellestrom, I.; Nolan, M.; & Lundh, U. (2007). Sustaining ‘Couplehood’: Spouses strategies for living positively with dementia. Dementia, 6(3), 383-409.
This study involved 152 interviews with twenty couples over five years. Using constructivist grounded theory methodology, three main phases were identified as “sustaining couplehood,” “maintaining involvement,” and “moving on.” Interviews were structured around the themes of the home, memory disturbance, quality of relationship, everyday life, and dignity and autonomy. In all cases there was an awareness of the diagnosis of dementia but in the majority of cases, a conscious decision was reached not to dwell upon the implications of this, but to focus on the present, and make life as meaningful and enjoyable as possible (enriching). While affirming that the caring role required “work” by the spouse, this work was not seen as burdensome, and carers expressed that they gained as much from their relationships as did PWD. Both parties, especially in the early stages of illness, were found to strive to maintain quality and closeness in their relationship by creating a “nurturative relational context.” The authors describe the gradual way a PWD “hands over” or “let’s go” of responsibilities to their partner.

Kolanowski, A. & Richards, K. (2002). Introverts and extroverts: leisure activity behavior in persons with dementia. Activities, Adaptation, and Aging, 26(4),1-16.
This article looks at the role of AT in reducing the behavioral symptoms of persons with dementia, namely encouraging social interaction and discouraging social withdrawal.

Kovach, C. & Henschel, H. (1996). Planning activities for patients with dementia. Journal of Gerontological Nursing, 22(9), 33-38.
This article examines the effect of various MT interventions on the attention span of persons with dementia. It suggests that MT can increase the attention span of participants.

Larner, A.J. (2005). Gardening and dementia. International Journal of Geriatric Psychiatry, 20(8), 796.
This letter to the editor discusses the positive role that gardening can have in the lives of stimulating persons with dementia. The author suggests that if gardening is contemplated as a component of occupational therapy for dementia patients, an individual approach tailored to cognitive abilities and deficits may be required.

Lee, Y. & Kim, S. (2008). Effects of indoor gardening on sleep, agitation, and cognition in dementia patients-a pilot study. International Journal of Geriatric Psychiatry, 23(5), 485-489.
This pilot study examined the efficacy of indoor gardening on sleep, agitation and cognition of dementia patients. Twenty-three institutionalized dementia patients who had sleep disturbance and/or agitation participated in a 5-week study protocol of 1 week of baseline and 4 weeks of treatment. The study design was a one group repeated measures study. For the first and fifth week of the study period, sleep patterns, agitation, and cognition were evaluated using a sleep diary, Modified Cohen-Mansfield Agitation Inventory and revised Hasegawa Dementia Scale respectively. Significant improvement in wake after sleep onset, nap, nocturnal sleep time, and nocturnal sleep efficiency was identified. On the contrary sleep onset time, wake-up time, total sleep time did not change after indoor gardening. Agitation and cognition score was significantly improved. The authors conclude that indoor gardening was found to be effective for sleep, agitation, and cognition of dementia patients but note that randomized controlled studies of larger sample size are needed to confirm treatment effect.

Libin, A. & Cohen-Mansfield, J. (2004). Therapeutic robocat for nursing home residents with dementia: preliminary inquiry. American Journal of Alzheimer’s Disease and Other Dementias, 19, 111-116.
This article looks at the use of a therapeutic robocat doll for play with PWD living in nursing homes. It reports positive effects of dolls on the lives of seniors with dementia.

Marshall, M. & Hutchingson, S. (2001). A critique of research on the use of activities with persons with Alzheimer’s Disease: a systematic literature review. Journal of Advanced Nursing, 35(4), 488-496.
This critique of research on the use of therapeutic activities found many articles did emphasize QOL and enrichment as goals and stated the benefits of such activities, but concluded the knowledge is still “minimal and fragmented” (489). Theoretical and methodological weaknesses were outlined, research was described as mostly anecdotal, and gaps in research were identified such as a “lack of emphasis on gender, ethnic, racial, or cultural differences” (488). It was also noted that music was used in 16 studies making it by far the intervention activity of choice. The authors found that the nursing literature in particular emphasized pleasure, dignity, friendship, meaning-making, and self-esteem, supporting the use of therapeutic activities, over insufficient long-term results.

Orsulic-Jeras, S.; Judge, K.; & Camp, C. (2000).Use of Montessori-based activities for clients with dementia in adult day care: effects on engagement. American Journal of Alzheimer’s Disease and Other Dementias, 15(1), 42-46.
The results of this study are not clear as to why both greater pleasure and lower anxiety/fear were found in Montessori-based activities for 16 residents in a dementia unit of a Jewish facility. A key issue discussed is whether long-term care staff and volunteers can conduct Montessori-based activities within existing schedules and organizational constraints. The authors state it is their hope that their programs can be implemented across settings.

Phinney, A.; Chaudhury, H.; & O’Connor, D. (2007). Doing as much as I can do: The meaning of activity for people with dementia. Aging and Mental Health, 11(4), 384-393.
Eight subjects with mild to moderate dementia were interviewed 2-6 months, with the goal of ascertaining what type of activities people with mild/moderate dementia identify as important in their everyday lives, and what their involvement in these types of activities means to them. The results emphasize the benefits of meaningful activity to retain autonomy and identity through leisure and recreation, chores, work, and social relationships. These activities were described as meaningful by virtue of their bringing pleasure and enjoyment, a sense of connection and belonging. The authors suggest that changes that accompany dementia may be less traumatic when the person is in a familiar place, surrounded by familiar objects, and engaging in activities that have long been part of their life, so as to establish continuity. The article emphasizes that pleasure can be derived from activities that rely on an “embodied geography” or a “physical insideness.”

Robinson, L.; Hutchings D.; & Corner, L. et al. (2006). A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use. Health Technology Assessment, 10, 26.
This article reviews the literature on the efficacy of non-pharmacological interventions to reduce behavioral symptoms thought to be associated with dementia, namely wandering. It also evaluates the ethics of various techniques.

Scholzel-Dorenbox, C.J.M.; Ettema, T.P.; Bos, J.;Boelens-van der Knoop, E.; Gerritsen, D.L.; Hoogeveen, F.; de Lange, J.; Meihuizen, L. & Droes, R-M. (2007). Evaluating the outcome of interventions on quality of life in dementia: selection of the appropriate scale. International Journal of Geriatric Psychiatry, 22, 511-519.
This study shows how the severity of dementia, care type, setting and the specific QOL domains an intervention focuses on can determine which QOL instrument is appropriate. It cites evidence for difference in views on QOL between patients, caregivers, and theoretical models. The authors argue that while caregivers focus on most of the domains that patients consider important, domains that PWD consider important such as financial situation, self-determination/freedom, and being useful/giving meaning to life are focused on least (Rabins 2000) (512). They determine that “…patients can rate their own QOL until late stages of dementia and that caregiver ratings do not substitute for patient ratings…” (517), and that patient’s subjective ratings should be the gold standard, while acknowledging that independent observational ratings are of benefit for patients with (very) severe dementia.

Thelander, V.B.; Wahlin, T-B.R.; Olofsson, L.; Heikkilä, K.; & Sonde, L. (2008). Gardening activities for nursing home residents with dementia. Advances in Physiotherapy,10(1), 53-56.
This article looks at the benefits of gardening, as a type of activity therapy, for persons with dementia in nursing homes. The focus is on the reduction of behavioral problems believed to be association with the condition.

Threadgold, M. (1995). Touching the soul through the senses. Journal of Dementia Care, 3(4), 18-19.
This article reports on an approach called Sonas aPc, which utilizes a series of preplanned and ordered activities including listening to music, singing, touch, exercise, relaxation and reminiscence with groups of up to 8 people with significant communication difficulties. The authors report that participants become more physically responsive and socially aware. Allegedly, they relax and demonstrate evidence of enjoyment, and show signs of heightened cognitive functioning (e.g., talking more spontaneously and recalling memories). In terms of promoting communication, Sonas aPc can be seen as a tool rather than simply an activity.

Truscott, M. (2004). Adapting leisure and creative activities for people with early stage dementia (ESD). Alzheimer’s Care Quarterly, 5, 92-102.
The author, who has ESD, describes her adaptations, and family support, in finding creative outlets despite her loss of cognitive abilities. She focuses on process and pleasure rather than content and suggests hobbies and activities for other PWD.

Vernooij-dassen, M. (2007). Meaningful Activities for People with Dementia. Aging Mental Health,11(4), 359-360.
This editorial reviews the Brooker & Woolley (2007) Enriching Opportunities model of activities with dementia care. It praises the role/style of the locksmith and the programs’ practical approach. Accordingly, “the activities of PWD become meaningful through feelings of pleasure and involvement, a sense of connection and belonging, and a sense of autonomy and self-identity….activities show a striking resemblance to those meaningful for other adults…the question is how can these activities be stimulated…” (359)

Volicer L.; Simard, J.; Pupa J.H. et al. (2006). Effects of continuous activity programming on behavioral symptoms of dementia. Journal of the American Medical Directors Association, 7(7), 426-731.
This article looks at the impact of AT on reducing the behavioral symptoms of dementia. The focus is on behavior modification/management from the perspective of staff in residential settings.

Zeisel, J. & Raia, P. (2000). Nonpharmacological treatment for Alzheimer's disease: A mind-brain approach. American Journal of Alzheimer’s Disease and Other Dementias, 15(6), 331-340.
This article looks at the use of non-pharmacological treatments of AD, such as various art therapies, that can produce behavioral improvements. The authors argue that a new paradigm is needed that focuses on minimizing the symptoms of AD rather than focusing only on a search for a cure. To include AD in the same class of diseases as cancer, multiple sclerosis, diabetes, congestive heart failure, and degenerative arthritis places AD in the realm of the medically and psychosocially understandable and manageable. A critical first step toward making this shift is to examine carefully the way in which we define the disease. An approach to care for people with AD results in treatment when it systematically compensates for functional losses of dementia by linking caregiving actions and environments to specific brain dysfunctions; namely, the neuropathology of the disease. The ultimate measures of success of such a treatment approach are improved quality of life, delayed institutionalization, slowed rate of progression of the disease, people who achieve their potential, and reduced need for medication.

Annotated Results: 5 Mixed

coming soon

Please add comments. Tell us about work we've missed. Add work published after we closed our review.

In your annotated additions please tell what was studied, what benefits were found, what quality of life benefits were found, and how well benefits were sustained.

Thanks. Don

Annotated Results: 4 Dance

Please add comments. Tell us about work we've missed. Add work published after we closed our review.

In your annotated additions please tell what was studied, what benefits were found, what quality of life benefits were found, and how well benefits were sustained.

Thanks. Don

4. Dance

Arakawa-Davies, K. (1997). Dance/movement therapy and reminiscence: a new approach to senile dementia in Japan. The Arts in Psychotherapy, 24(3), 291-299.
This study explored the role of DMT in stimulating reminiscence and the life review in 10-12 male and female temporarily hospitalized patients with senile dementia. While the use of DMT is still new in Japan, the authors cite its potential as a natural bridge between the reminiscing of the elderly and the traditional role elders hold in Japan of narrating traditional culture. Goals met included: revitalizing movement, releasing psycho-social tensions, stimulating constructive recall, reality contact, social interaction, and expressing feelings. The authors suggest that DMT can improve QoL and welfare of seniors with dementia.

Berrol, C.F. (2000). The spectrum of research options for dance/movement therapy. American Journal of Dance Therapy, 22(1), 29-46.
This article looks at the range of research interventions available within DMT and the state-of-the-science. It discusses techniques such as dance and movement programs as well as storytelling/making and reminiscence.

Coaten, R. (2001). Exploring reminiscence through dance and movement. Journal of Dementia Care, 9, 19-22.
This article explores the use of DMT on reminiscence through the program Living Arts Scotland (LAS), which focuses on staff training in residential homes and day centers. The authors suggest that the greater the richness and variety of opportunities residents have to express themselves, the more likely it will be that both they and their care workers will be enriched. Although based on anecdotal evidence only, findings suggest that DMT fosters connection and that participants can benefit physically, emotionally, cognitively, spiritually, and socially. There is no emphasis on learning dance techniques to participate. In fact, the authors point out that “When we work with people with dementia we are working with fragments. Our task is in some way to listen for and recognize the harmony that exists within the dissonance. We need to learn how to be more alert to these moments so that we can recognize, honour and celebrate them (p 21).” They highlight the importance of role reversal where the resident becomes the facilitator or teacher, for however short a time (p 22). Ultimately, the process is more important than the product (p 22).

Crighton, S. (1997). Moving is the language I use, Communication is my goal. Journal of Dementia Care, 5, 16-17.
This article uses drama/movement therapy to facilitate communication between persons with dementia.

Donald, J. & Hall, S. (1999). Dance: The Getting There Group. Journal of Dementia Care, 7(3), 25-27.
This article reports on a 10-week, structured approach to Dance/Movement Therapy for 4 individuals in the early stages of AD. The brief case studies suggest that there are psychotherapeutic benefits to D/MT.

Gibson, F. (1994). What can reminiscence contribute to people with dementia? In Bornat J. (Ed.), Reminiscence Reviewed: Perspectives, Evaluations, Achievements (pp 53). Buckingham: Open University Press.
This paper discusses the contribution reminiscence can have on the experience of PWD. Short-term positive experiences are reported for those participating in reminiscence. The fact that pleasure may be fleeting or transitory does not negate its value either to the person or carer who often can be encouraged by such responses to persevere in their caring role (p 53).

Hill, H. (1999). Dance Therapy and Communication in Dementia. Signpost, 4(1), 13-14.
This dance therapist explores the principle of dance with PWD. Her holistic approach gives primacy to communication and efforts to empower people with the condition.

Jerrome, D. (1999). Circles of the Mind. Journal of Dementia Care, 7(3), 20-24.
This article reports on the use of circle dancing, which encourages slowness and a sense of community, with PWD.

Johnson, C.M.; Lahey, P.; & Shore, A. (1992). An Exploration of Creative Arts therapeutic group work on an Alzheimer’s unit. The Arts in Psychotherapy, 19(4), 269-277.
This article examines the use of creative arts therapies in groups of PWAD.

Killick, J. & Allan, K. (1999a). The arts in dementia care: tapping a rich resource. Journal of Dementia Care, 7, 4, 35-38.
This article provided a review of the art therapy research used in dementia care as activity, not therapy. The emphasis in this first paper is on the art form where the most work has been done with people with dementia – music. Benefits included being more physically responsive, socially aware, demonstrating evidence of enjoyment, some heightened cognitive functioning such as talking more spontaneously and recalling memories, and promoting “sonas” or community. The authors participation in “coma work sessions” is also described. Overall, the authors challenge a strict bio-medical view and see meaning in the disinhibitions and creativity in communication that PWD exhibit.

Nystrom, K. & Lauritzen, S.O. (2005). Expressive Bodies: demented persons' communication in a dance therapy context. Health, 9(3), 297-317.
This study involved six women and one man, over 70, diagnosed with dementia and living in nursing homes. Group dance and therapy sessions were videotaped and analyzed with a focus on how verbal and nonverbal modes of communication were used by participants, allowing for those with a limited memory capacity to express themselves. This study challenged the “default model” and shifted focus from limitations caused by illness to a more profound understanding of the world of the ill person. The purpose was defined as promoting well being by “increasing the range of his/her movement repertoire.” Various existential themes that were expressed included: ageing, loneliness, loss of dear ones as well as bodily capacity, length and quality of life, feeling young at heart, and acceptance. The dance therapist (Nystrom) played the dual role of therapist and researcher so sessions were taped and analyzed by a research team.

Wilkinson, N.; Srikumar, S.; Shaw, K.; & Orrell, M. (1998). Drama and Movement Therapy in Dementia: a pilot study. The Arts in Psychotherapy, 25(3), 195-201.
This study focused on patients with dementia attending a psychiatric day hospital and used the Sesame method, a symbolic approach based in Jungian psychology and humanistic philosophy to access patient’s subjective experience (self-esteem) rather than improving their cognition or reducing psychiatric symptoms as measured by quantitative scales. The study criticizes the quantitative approach with its emphasis on statistical significance and deductive reasoning as unable to capture the validity derived from more descriptive and qualitative methods. Authors found "deterioration in dementia is expected but stimulating and maintaining social skills, independence, self-esteem, and self-belief through drama therapy may improve quality of life." The study notes that future groups need to match groups more carefully for age, sex, cognitive impairment, and functional dependency.

Annotated Results: 3 Drama

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In your annotated additions please tell what was studied, what benefits were found, what quality of life benefits were found, and how well benefits were sustained.

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3. Drama

Banks-Wallace, J. (2002). Talk that talk: storytelling and analysis rooted in African-American oral tradition. Qualitative Health Research, 12, 410-426.
This article explores the importance of storytelling in African-American oral tradition.

Basting, A.D. (2001). ‘God is a talking horse’: dementia and the performance of self. The Drama Review, 45(3), 78-94.
The article looks at the role of DT in helping persons with dementia express themselves nonverbally.

Batson, P. (1998). Drama as therapy: bringing memories to life. Journal of Dementia Care, 6, 19-21.
This article looks at drama as therapy, including mime, story making, role play, movement and music, as empowering PWD so that they can live as fully as possible. Accordingly, drama can help individuals and groups to express themselves and interact with one another creatively (p 20). Outcome measured is “quality moments,” defined as the characteristics associated with well-being in dementia care mapping (e.g., humour, alertness, responsiveness, creative self-expression, showing pleasure or enjoyment, being active and/or purposeful, initiating social contact, etc.; p 20). For example, mime is an especially effective way of enabling pts to express themselves when find it difficult to use words; stories can create a sense of accomplishment; and props can be effective in stimulating interests and holding attention. Use of drama can provide another means of stimulation that enables them to relate with others and experience increased moments of well-being.

Brooker, D.J. & Duce, L. (2000). Well-being and activity in dementia: a comparison of group reminiscence therapy, structured goal-directed activity, and unstructured time. Aging and Mental Health, 4 (4), 354-358.
A comparison of well-being levels of 25 individuals with mild to moderate dementia during three types of activity was made. The first was group reminiscence therapy (RT), the second was group activities (GA), and the third was unstructured time (UT). These activities were all part of the usual program of activities within three day hospitals where the study took place. Dementia Care Mapping results indicated that individuals experienced a greater level of relative wellbeing during RT than GA. The level of wellbeing in both RT and GA was significantly higher than in UT.

Byres, A. (1995). Beyond marks: working with people with severe memory loss. Inscape, 1, 13-18.
This article explores the use of reminiscence with people who have memory loss. Overall outcomes included increased communication/interaction and improved understanding of nonverbal forms of storytelling

Casson, J. (1994). Flying towards Neverland. Dramatherapy, 36(2/3), 2-7.
This article is a highly personal account of one psychodramatist’s excursion into the world of PWD. He examines the ways that spontaneity can be used to enhance personhood. He reflects on sensory stimulation, symbolic language, music and storytelling, through vivid case studies. The emphasis on the arts and communication in dementia care make this a seminal piece.

Dent-Brown, K. & Wang, M. (2006). The mechanism of storymaking: a grounded theory study of the 6-part story method. The Arts in Psychotherapy, 33, 316-330.
49 subjects (24 mental health clinicians and 25 users with borderline personality disorder (BPD) were asked to create and tell a fictional story, following structured guidelines, and then relate how far the story communicated something about their own lives. Using direct participant accounts, the aim of the technique was to “assist the individual to reach self-awareness and improve external and internal communication.” Results suggested those with BPD may be less likely to identify closely with their story and that storymaking may distance rather than bridge the gap, though the method could be used as a tool to pursue those “easily overwhelmed by powerful feelings.”

Gersie, A. (1991). Storymaking in bereavement: dragons fight in the meadow. London: Jessica Kingsley Publishers.
The article looks at the role of storymaking/telling for helping people deal with bereavement. It suggests that telling and making stories, as “symbolic expressive activities,” can assist people in managing their losses and sadness.

Jenny, S. & Oropeza, M. (1993). Memories in the Making: A Program of Creative Arts Expression for Alzheimer’s Patients. Alzheimer’s Association of Orange County, California: California.
This article outlines the “Memories” method of AT. Using various approaches, this program aims to support people in expressing themselves through art. The emphasis is on the process of creation, rather than the finished product, and is based on the conviction that PWD have important things to tell us, and that there is meaning in what they say and do even if it is not immediately obvious to others. It includes a step-by-step guide to using the program.

Johnson, C.M.; Lahey, P.; & Shore, A. (1992). An Exploration of Creative Arts therapeutic group work on an Alzheimer’s unit. The Arts in Psychotherapy, 19(4), 269-277.
This article includes a description of the authors’ long-term care facility, a summary of AD, exploration of the “loss of self” phenomenon, rationale for including creative arts therapies in special care unit, and a discussion of issues relative to group process and technique with AD patients. The role of arts activities in groups is discussed within a therapy-orientation model.

Killick, J. (2003). Funny and sad and friendly: A drama project in Scotland. Journal of Dementia Care, 11, 1, 24-26.
This article discusses a project utilizing drama therapy as a tool to help persons with dementia meaningfully interact and express their emotions.

Killick, J. (2000). Storytelling and Dementia. Elderly Care, 12, 2, 8-10.
This article looks at the use of storytelling, or reminiscence, in dementia care. It suggests that such activities are meaningful in the moment, regardless of “outcomes.”

Martin, R. & Stepath, S. (1993). Psychodrama and reminiscence for the geriatric psychiatric patient. Journal of Group Psychotherapy, Psychodrama & Sociometry, 45- 139-148.
This article looks at the role of psychodrama and reminiscence for seniors with psychiatric disturbances. It finds that nonverbal techniques are more effective than traditional verbal modalities in reminiscence group sessions with elderly PWD (p 145).

Mayers, K.S. (2003). Play for individuals with dementia. In Schaefer C.E. (Ed.), Play therapy with adults. New York: John Wiley & Sons.
This article looks at the use of dolls for play with PWD. It reports positive effects of dolls on the lives of seniors with dementia.

McKee, K.J.; Wilson, F.; Chung, M.C.; Hinchliff, S.; Goudie, F.; Elford, H. et al. (2005). Reminiscence, regrets and activity in older people in residential care: Associations with psychological health. British Journal of Clinical Psychology, 44, 543-562.
This cross-sectional interview-based questionnaire survey with 142 (N=142) seniors living in residential and nursing homes was used to determine current levels of reminiscence, activity participation, and psychological health, while care staff recorded the participants’ observed affect over the previous 2-week period. Multivariate analyses showed significant associations between reminiscence frequency, reminiscence enjoyment, and regrets, and psychological health outcomes, while controlling for age, dependency, self-reported health, and social well-being. While reminiscence enjoyment was associated with positive psychological health, high frequency of reminiscence and the presence of regrets were associated with negative psychological health.

Noice, H. & Noice, T. (2006). What Studies of Actors and Acting Can Tell Us About Memory and Cognitive Functioning. Current Directions in Psychological Science, 15, 14-18.
This study compared dramatic and musical forms of theater performance to investigate the neural mechanisms underlying acting with the goal to promote healthy cognitive aging. Older adults in state supported housing without higher education at risk of cognitive decline were encouraged to “actively experience” performance. While the study is not yet completed, the authors hypothesize that the findings could “add physiological support to existing behavioral evidence that bodily action and emotion response, along with semantic evidence, can enhance human memory and also help us to understand the aesthetic experience.”

Pendzik, S. (2006). On dramatic reality and its therapeutic function in drama therapy. The Arts in Psychotherapy, 33, 271-289.
This article describes the therapeutic implications of “dramatic reality” as a theory, allowing for the inner world to be expressed, validating such experience and providing a bridge to the outer world (as with narrative therapy). The author stresses how the dramatic encounter is co-created and relational, and that by “doing reality,” one may transform everyday life.

Rentz, C.A. (2002). Memories in the Making©: Outcome-based evaluation of an art program for individuals with dementing illnesses. American Journal of Alzheimer’s Disease and Other Dementias, 17(3), 175-181.
This study observed 41 seniors attending Adult Day Care and living in skilled nursing facilities participating in a weekly art program. Based on Lawton’s psychological well-being model and measuring QoL in respondents, findings report that 66% greeted and socialized; 83% had sustained attention; 80% expressed pleasure; and 78% had enhanced self-esteem. Limitations include: there wasn’t a control group, it was not longitudinal and no inter-rater reliability measures were used.

Snow, S.; Damico, M.; & Tanguay, D. (2003). Therapeutic theatre and wellbeing. The Arts in Psychotherapy, 30(2), 73-82.
This present study examined therapeutic theatre in the field of drama therapy. This paper reviews the concept as it has been articulated by several important practitioners and, subsequently, attempts to postulate a common definition. It, then, focuses on the model of therapeutic theatre implemented at the Centre for the Arts in Human Development at Concordia University in Montreal. This model incorporates qualitative methodology for the evaluation of its effectiveness. Preliminary results from this research indicate that the Centre’s approach has considerable therapeutic value for the participants, all of whom are individuals with developmental disabilities who have previously shown deficits in communication, cognition and social skills. This article documents these results, along with describing the two qualitative evaluation methods: pre- and post-performance interviews and observations made from running records taken at different intervals in the three-month long process of producing the Centre’s most recent therapeutic theatre production, based on the story of Pinocchio.

Thorgrimsen, L.; Schweitzer, P.; & Orrell, M. (2002). Evaluating Reminiscence for people with dementia: a pilot study. The Arts in Psychotherapy, 29, 93-97.
This study looked at reminiscence (R) with 11 PWD and their informal carers. The intervention was based on standardized the manual: Reminiscing with people with dementia- a Handbook for Carers (Bruce et al, 1999). While the study finds positive trends supporting anecdotal evidence that reminiscence is a valuable therapeutic intervention, the authors conclude that no firm conclusions can be reached about its effectiveness for dementia due to lack of scientifically rigorous research and poorly defined evaluative processes. The authors did note that carer perceptions are weighed twice as heavily as the PWD themselves.

Wilkinson, N.; Srikumar, S.; Shaw, K.; & Orrell, M. (1998). Drama and Movement Therapy in Dementia: a pilot study. The Arts in Psychotherapy, 25(3), 195-201.
This study focused on patients with dementia attending a psychiatric day hospital and used the Sesame method, a symbolic approach based in Jungian psychology and humanistic philosophy to access patient’s subjective experience (self-esteem) rather than improving their cognition or reducing psychiatric symptoms as measured by quantitative scales. The study criticizes the quantitative approach with its emphasis on statistical significance and deductive reasoning as unable to capture the validity derived from more descriptive and qualitative methods. Authors found "deterioration in dementia is expected but stimulating and maintaining social skills, independence, self-esteem, and self-belief through drama therapy may improve quality of life." The study notes that future groups need to match groups more carefully for age, sex, cognitive impairment, and functional dependency.

Annotated Results: 2 Visual Arts

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In your annotated additions please tell what was studied, what benefits were found, what quality of life benefits were found, and how well benefits were sustained.

Thanks. Don

2. Visual Arts

Beaujon-Couch, J. (1997). Behind the veil: mandala drawings by dementia patients. Art Therapy: Journal of the American Art Therapy Association, 14(3),187-193.
The 13 stages of the MARI Card Test (a psychological instrument developed by Joan Kellogg based on Carl Jung’s theories of archetypal imagery) were used to categorize drawings created by PWD. Six stages were drawn most frequently and certain colors were described as indicating thoughts and emotions PWD experience but cannot express verbally due to the disease process. Among 471 mandalas, drawn by 71 PWD, many were found to be similar in design. The authors state, “The MARI card test can…facilitate understanding of each patient’s symbolic expression and provide the art therapist with valuable clinical information” (192).

Chaudhury, H. (2003). Remembering Home through Art. Alzheimer’s Care Quarterly, 4(2), 119-124.
This article explores the use of art to encourage reminiscence of familiar, comforting memories such as home.

Doric-Henrdy, L. (1997). Pottery as Art Therapy with Elderly Nursing Home Residents. Journal of the American Art Therapy Association, 14, 162-171.
This study looked at the utilization of pottery as art therapy with seniors in nursing homes as an important tool for psychotherapists working with PWD.

Espinel, C.H. (1996). de Kooning’s Late Colours and Forms: Dementia, Creativity, and the Healing Power of Art. The Lancet, 347 (9008), 1096-1099.
This article uses the art career of Willem de Kooning, particularly his “recovery” period in which he was quite prolific, to explore art “as an aid for understanding dementia, and art as a discipline for the study of the mind,” (1098). The author raises the question: “how does creativity, a preeminently human function, depend upon and adapt to biological and environmental influences, to age, to disease?”(1098).

Johnson, C.M. & Sullivan-Marx, E.M. (2006). Art Therapy: Using the Creative Process for Healing and Hope Among African American Older Adults. Geriatric Nursing, 27, 5, 309-316.
Two case studies are discussed and examples of artwork provided. The article explores how art making addresses the specific developmental tasks of the elderly in a culturally competent manner (specifically, using storytelling and life review with African-Americans who value such skills). The authors suggest that the field of AT combines the potent resource of art with the creative process to bring healing and hope, thereby helping clients make meaning of their lives. Accordingly, AT offers healing by providing social connection, the experience of control and the opportunity to both express and manage emotions and offers hope by facilitating nonverbal communication and providing opportunity to create meaning through life review (309). Most importantly, the artwork is a visual reminder for participants that they can still accomplish and learn new things despite limited mobility or cognition (312). The authors argue that AT makes it possible for others to see beyond the limitations of PWD to their strengths and beauty (316).

Johnson, C.M.; Lahey, P.; & Shore, A. (1992). An Exploration of Creative Arts therapeutic group work on an Alzheimer’s unit. The Arts in Psychotherapy, 19(4), 269-277.
This article discusses the role of arts activities in groups and includes a description of the authors’ long-term care facility, a summary of AD, exploration of the “loss of self” phenomenon, rationale for including creative arts therapies in special care unit, and a discussion of issues relative to group process and technique with AD patients within a therapy-orientation model.

Kahn-Denis, K. (1997). Art therapy with geriatric dementia clients. Art Therapy: Journal of the American Art Therapy Association,14(3), 194-199.
This article explains how the evocative nature of art allows PWD to become expressive and bypass some of their cognitive deficits. The authors argue that art’s versatility supports cognitive status and gives the therapist a flexible method of releasing obscured thinking and feeling processes. They outline the benefits of art therapy as assisting with diagnosis and evaluation of cognitive status, providing a vehicle for nonverbal communication, offering a vehicle for reminiscing, enabling sensory stimulation, and providing a self-reflective activity that has art work itself as the intended end product.

Kamar, O. (1997). Light and Death: art therapy with a patient with Alzheimer’s disease. American Journal of Art Therapy, 35, 120-121.
In this article the therapist worked with a group of between 7-12 participants with AD for 2 years in a day care center for the elderly in Hampstead, North London. The focus is on a case-study of one man who rejected initial attempts at cooperative work but then created remarkable “creatures” similar to those found in prehistoric cave paintings, which his therapist read as metaphors for his anxiety and fears. The authors suggest that art therapy can be used as alternative to verbal communication, self-expression, and an outlet for tension and frustration. They note that the intervention can only momentarily heighten QOL, but is still powerful in allowing for communication and reducing tension, isolation, and frustration.

Killick, J. & Allan, K. (1999b). The arts in dementia care: touching the human spirit. Journal of Dementia Care, 7, 5, 33-37.
This article looks at the use of Montessori-based art therapies in dementia care as a means for “reaching” people with dementia. The visual arts are discussed in terms of its application in “diagnosis and assessment, promoting non-verbal communication, enhancing opportunities for reminiscence, its application to sensory stimulation and enjoyment, and finally in strengthening the individual’s sense of self” (pp 33).

Kinney, J. & Rentz, C. (2005). Observed well-being among individuals with dementia: Memories in the Making, an art program, versus other structured activity. American Journal of Alzheimer’s Disease and other Dementias, 20(4), 220-227.
In this article seven domains of well-being with 12 PWD spanning a diversity atypical in most studies reviewed (5 men, 7 women, with a range of diagnoses, 65-85, 5 African Americans, 7 white persons, an equal number of blue collar and professional persons, with a range of art experience) were observed during traditional adult daycare activities and “Memories in the Making,” an art program that “encourages self-expression through the visual arts” (220). PWD displayed significantly more interest, sustained attention, pleasure, self-esteem, and normalcy (problematically defined) during participation in the program and sustained attention for periods of 30-45 minutes.

Lev-Wiesel, R. & Hirshenzon-Segev, E. (2003). Alzheimer’s disease as reflected in self-figure drawings of diagnosed patients. The Arts in Psychotherapy, 30, 83-89.
This study used self-figure drawings to observe AD in persons with and without Alzheimer’s. The 32 subjects included 4 persons with early, 8 with moderate, and 4 with late-stage AD as well as 16 control subjects. Findings suggest that the greater the severity of cognitive decline, the earlier the artistic developmental stage. That is, they argue that the severity of AD is reflected in artistic developmental stages. Importantly, even those who suffered from severe moderate dementia managed to comply to the request “draw yourself.” Therefore, the use of AT in general and drawing in specific seems to be a useful channel of communication with AD patients, regardless of disease stage (88).

Malley, S.M., Datillo, J. & Gast, D. (2002), Effects of visual arts instruction on the mental health of adults with mental retardation and mental illness. Mental Retardation, 40(4), 278-296.
This article examines the effects of visual arts instruction, namely painting, on the mental health of adults with intellectual disabilities and/or mental illnesses.

Newell-Walker, U. (2002). Getting a picture of the client’s world view: art-making and subjectivity as evidence. Journal of Social Work Practice,16(1), 43-54.
This article outlined an approach for social workers to make sense of nonverbal communications through a project exploring 9 self-selected subjects undergoing midlife and its transitions. It found that art-making that accentuates sensory exploration, curiosity, and experimentation, contributed to a changed relationship with self and the external world. The author states that “when adult clients seem to be very ‘stuck’, life-stage may be a factor and creative work useful. Jung (1933) contended that the onset of the second half of life is often experienced as difficult because the familiar “rules” from earlier adulthood falter, and thoughts of mortality increasingly intrude…creative activity is useful for the development of increased tolerance of uncertainty and chaos…Art making can enable reconnection, and drawings can be a map of the process” (53-4).

Radley, A. & Taylor, D. (2003). Remembering One’s stay in hospital: a study in photography, recovery, and forgetting. health: an interdisciplinary journal for the social study of health, illness, and medicine, 7(2), 129-159.
Using one woman’s lens, the authors describe how photo-based interviews made legible the images of hospital experience and the part these images played in the respondent’s account of her recovery. The study shows how remembering involves an ongoing transfer between different kinds of representation and how photos can serve as “retrospective evidence.” Data is drawn from 9 patients hospitalized at least one week who were asked to photograph up to 12 things they found significant about their stay. One female subject was featured because of the range of photos she took and the richness of her interview demonstrating key issues of recovery and recall, and re-presenting displaced experiences through photos as communicative acts.

Reynolds, F. & Lim, K.H. (2007). Contribution of visual art making to subjective well-being of women living with cancer: a qualitative study. The Arts in Psychotherapy, 34(1), 1-10.
In this study the views about the contribution of art-making to the subjective well-being of 12 women living with cancer were explored, based on the principles of interpretive phenomenological analysis (IPA). Psychosocial benefits to well-being listed in response to the challenges posed by illness were: enhancing the present moment, an outward expression of positive life experience, enhanced self worth and identity through opportunities to demonstrate continuity, challenge, and achievement, resistance to a social identity subsumed under the master status symbol of cancer, and for a minority, it enabled symbolic expression of feelings. Researchers did caution the possibility of obtaining “heroic narratives” to enhance self-presentation but strategies were believed to manage illness-related anxieties rather than distort or deny difficult realities.

Seifert L.S. & Baker M.K. (2002). Art and Alzheimer-Type Dementia A Longitudinal Study. Clinical Gerontologist, 26(1/2), 3-15.
Based on the promise of art activities for individuals with probable AD to provide enjoyable, supportive environments for those with mild to moderate dementia, this study examined several tasks over a three-month period tested in a group setting at a long-term care facility. This study included not only those with mild memory difficulties, but also individuals with moderate to severe dementia, something largely missing from the literature. Five individuals without dementia and five individuals with probable AD participated on a regular basis. The most successful art activities utilized stickers. All participants seemed able to acquire basic skills associated with making pictures with stickers. In fact, individuals with probable AD retained the “sticker placing” skill after a three-month retention interval and transferred it to a slightly different task, as well.

Shore, A. (1997). Promoting Wisdom: the role of art therapy in geriatric settings. Art Therapy: Journal of the American Art Therapy Association,14(3), 172-177.
This article looks at the role of storytelling through art in allowing participants to share wisdom, leave a legacy, and find meaning in their lives. The struggle inherent in the creative art process is examined as a means to facilitate developmental struggle, through symbol formation, conflict resolution, using mature defenses (like suppression, sublimation, altruism), culminating in wisdom, even in PWD. The author states, “The failure to struggle with pain can result in a disconnected and dormant state” (172).

Annotated Results: 1 Music

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In your annotated additions please tell what was studied, what benefits were found, what quality of life benefits were found, and how well benefits were sustained.

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1. Music

Aldridge, D. (2003). Music therapy references relating to cancer and palliative care. British Journal of Music Therapy, 17(1), 17-25.
This article looks at the impact of MT on the experiences of cancer and end-of-life care. Findings suggest various benefits of creative expression, including dealing with loss, relief of suffering, restoration of identity, empowerment and helping to find meaning in challenging situations.

Aldridge, D (Ed.) (2000). Music Therapy in Dementia Care. London: Jessica Kingsley Publishers.
This edited volume includes pieces from many of the pioneers in music therapy, including the editor and contributors throughout the world. It covers a wide range of the clinical benefits of MT for PWD. This is a great resource for those interests in a comprehensive overview of the empirical work and clinical experiences of music therapists until 2000.

Aldridge, D. (1998). Music Therapy and the treatment of Alzheimer’s Disease. Journal of Clinical Geropsychology, 4(1), 17-30.
This article traces how anecdotal evidence supports how music therapy can improve QOL (sense of belonging, acceptance), and improvised musical therapy in particular can supplement mental state exams and assess small memory changes. The article highlighted the case study of a 55 female depressed patient with AD who was given 10 40-minute sessions and after playing the piano was able to cook and write her name, and was less depressed. While the study’s emphasis is still “management strategy,” fun is also considered, marginally. “…music therapy appears to play an important role in enhancing the ability to actively take part in daily life…” (27).

Aldridge, D. & Aldridge, G. (1992). Two epistemologies: music therapy and medicine in the treatment of dementia. The Arts in Psychotherapy, 19, 243-255.
This study suggests that the musical assessment of AD patient behavior, which would recognize nonverbal therapeutic changes, may provide a complementary assessment tool in diagnosing dementia and assessing current abilities, when used with medical diagnosis. The authors point out that the “normal process of cognitive loss in aging” is still unknown, and we are even more “in the dark as to the normal improvisational musical abilities of the elderly.” The authors note that although clinical benefits remain speculative, their study has helped create a common language to discuss and compare therapeutic changes, a first step in research dialogue.

Ashida, S. (2000). The effect of reminiscence music therapy sessions on changes in depressive symptoms in elderly persons with dementia. Journal of Music Therapy, 37, 170-182.
This article looks at the impact of music therapies that use reminiscence on depressive symptoms of seniors with various dementias. The author reports that MT can be effectively used to treat depressed mood in seniors with dementia.

Bright, R. (1992). Music Therapy in the Management of Dementia. In B. Miesen & G. Jones (Eds.), Caregiving in Dementia: Research and Applications. London: Routledge.
This article looks at the impact of music therapies in managing the symptoms of various dementias in seniors. The approach is a medical one, with no attention paid to the qualitative experiences of participants.

Brotons, M. & Koger, S.M. (2000). The Impact of Music Therapy on Language Functioning in Dementia. Journal of Music Therapy, XXXVII, 183-195.
This article looks at the effect of AT in improving specific areas of cognitive functioning, namely language. A case study approach was used to elicit the positive impact of AT on the verbal skills of PWD.

Brotons, M. & Marti, P. (2003). Music therapy with Alzheimer’s patients and their family caregivers: a pilot project. Journal of Music Therapy, 40, 138-150.
This article looks at the effect of AT in improving language functioning in persons with dementia and depression for diagnosed individuals and their support persons. The authors found that PWD had significant decreases in agitated behaviors at the 10th session of group MT.

Bugos, J.A.; Perlstein, W.M.; McCrae, C.S.; Brophy, T.S.; & Bedenbaugh, P.H. (2007). Individualized Piano Instruction (IPI) enhances executive functioning and working memory in older adults. Aging and Mental Health, 11(4), 464-471.
IPI is cited as a ‘potential cognitive intervention’ to mitigate normal age-related decline in older adults. 16/31 musically naïve subjects were in the experimental group. The goal of the study was to evaluate the role of musical instruction in intervention to prevent mild age-related memory loss or maintain cognitive skills in normal aging. The results found that IPI may increase cognitive abilities related to attention and concentration, contributing to overall working memory but there was no mention of enrichment.

Butterfield-Whitcomb, J. (1994). “I would weave a song for you”: Therapeutic music and milieu for dementia residents. Activities, Adaptation and Aging, 18(2), 57-74.
The author, a music therapist for over 15 years, describe strategies she has successfully used with PWD to assist professionals, caregivers, and health care professionals to help improve QOL. The author argues that symptoms like agitation, depression, fear, confusion, loneliness can be ameliorated by playing music from the early lives of PWD that is meaningful and appealing to them. Her aim is to focus on “therapy strategies that foster behavior management in ways that enable patients to find meaning, self-expression, and peace of mind, while remaining restraint free whenever possible” (60). “I think the creation and maintenance of therapeutic environment should be thought of as a way of life, a primary goal of the facility, not an activity” (69).

Butterfield-Whitcomb, J. (1993). The way to go home: Creating comfort through therapeutic music and milieu. American Journal of Alzheimer's Care and Related Disorders and Research, 8(6), 1-10.
This article examines how to use MT to enhance QoL, namely comfort, for PWAD. Therapeutic music was found to improve QoL for participants. The author, a music therapist for over 15 years, describe strategies she has successfully used with PWD to assist professionals, caregivers, and health care professionals to help improve QOL.

Carruth, E. (1997). The effects of singing and the spaced retrieval technique on improving face-name recognition in nursing home residents with memory loss. Journal of Music Therapy, 34(3), 165-186.
This article looks at the effects of singing and spaced retrieval on improving face-name recognition in participants with memory loss living in nursing homes. The study tested residents’ ability to name familiar staff members when shown photos after a singing activity and found that MT is a good way to improve the recognition and naming abilities of some nursing home residents who suffer from memory loss, due to increased cognition during the MT treatment.

Christie, M.E. (1992). Music therapy applications in a skilled and intermediate care nursing home facility: A clinical study. Activities, Adaptation and Aging, 16(4), 69-87.
This article looks at the use of MT with seniors living in various levels of nursing facilities. The author argues that group MT can be used to increase the QoL of residents.

Clair, A.A. (1996). The effect of singing on alert responses in persons with late stage dementia. Journal of Music Therapy, 33(4), 234-247.
This article examines the effect of singing on the alertness of persons with severe dementia. It suggests that MT can increase the attention span of participants. The author reports that PWAD are in most instances able to participate in MT and increases in well-being are observed as a result.

Clark, M.E.; Lipe, A.W. & Bilbrey, M. (1998). Use of music to decrease aggressive behaviors in people with dementia. Journal of Gerontological Nursing, 24(7), 10-17.
This article looks at the impact of an individualized music intervention in promoting relaxation and relieving anxiety (i.e., reducing agitated and aggressive behaviors) in persons with dementia.

Cuddy, L.L. & Duffin, J. (2005). Music, memory, and Alzheimer’s disease: is music recognition spared in dementia, and how can it be assessed? Medical Hypotheses, 64, 229-235.
This article looks at the effect of music on motor activity and memory recall. Findings suggest that music recognition may be spared and motor functioning may be improved in persons with dementia through the use of music therapy. In particular, memory for familiar music was spared in PWD and MT may prompt motor activity and memory recall for participants.

Daykin, N.; McClean, S. & Bunt, L. (2007). Creativity, identity and healing: participants’ accounts of music therapy in cancer care. health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 11(3), 349-370.
This qualitative study conducts semi-structured interviews with 23 respondents following a single-session group music intervention as part of a complementary and alternative medicine (CAM) program to understand first-person accounts of the experience of cancer. The authors discuss the importance of identity and the role of creativity in processes of individuation and healing when dealing with cancer. Accordingly, in research on MT, or CAM therapies, issues of identity can be key to an understanding of questions of therapeutic impact.

Daykin, N. (2005). Disruption, dissonance and embodiment: Creativity, health and risk in music narratives. health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 9(1), 67-87.
This article looks at the role of creativity in the music narratives of musicians following illness or injury. She suggests that creativity is used to help make sense of biographical disruptions caused by illness/injury.

Garwin, L. (2007). Harmony of the Hemispheres. Nature, 449, 977.
(Review of Musicophilia by Oliver Sacks, and This is our brain on music: understanding a human obsession, by Daniel Levitin.)
This review provides evidence as to why music therapy is possibly conducive to PWD. Sacks cites the example of a man who cannot dress himself or remember his job but “still knows the baritone parts of hundreds of songs, performs successfully in public, and seems to recover his essential ‘self’ while he is singing.”

Gerdner, L.A. (2005). Use of individualized music by trained staff and family: Translating research into practice. Journal of Gerontological Nursing, 31(6), 22-30.
This article described a pilot study using mixed methodology to evaluate the effectiveness of individualized music (customized to the personal preferences of eight female residents with ADRD) for the management of agitation when implemented by trained staff and family. The music was played on a CD player 30 minutes daily at a time selected to precede residents’ peak level of agitation. The results were that all CNAs reported a reduction in resident agitation during presentation of individualized music. They also commented on the pleasure participants attained in simply listening to the music. Some became actively involved, dancing and singing. A key factor contributing to the music’s effectiveness was the ability of family members to provide information that allowed a selection of music that was meaningful and elicited positive memories. Other benefits were that the music allowed for collaboration between staff and families, and promoted humanistic, individualized care and enhanced QOL.

Gerdner, L.A. (2000). Effects of individualized versus classical relaxation music on the frequency of agitation in elderly persons with Alzheimer’s disease and related disorders. International Psychogeriatrics, 12, 49-65.
This article compares the impact of individual versus classical relaxation music therapies on occurrence of agitated behaviors in persons with AD. This crossover design on 39 individuals with agitation and severe cognitive impairment showed a significant reduction in agitation during and following an individualized compared to a classical music session.

Gerdner, L.A. (1999). Individualized music intervention protocol. Journal of Gerontological Nursing, 25(10), 10-16.
This article looks at the impact of an individualized music intervention in promoting relaxation and relieving anxiety (i.e., reducing agitated behavior).

Glynn, N.J. (1992). The music therapy assessment tool in Alzheimer’s patients. Journal of Gerontological Nursing, 18(1), 3-9.
This article looks at the impact of music therapies to assess the cognitive functioning and affect of seniors with AD. The authors devised the Music Therapy Assessment Tool to “assess the effects of music therapy on behavioural patterns of Alzheimer’s disease patients.” The instrument does not appear to have been utilized or reported on since. The medical approach does not discuss subjective experiences of MT.

Groene, R.W. (1993). Effectiveness of music therapy—1:1 intervention with individuals having senile dementia of the Alzheimer's type. Journal of Music Therapy, 30(3), 138-157.
This article explores the effectiveness of 1:1 MT on the cognitive performance of persons with SDAT. It suggests that MT is a form of cognitive stimulation that can enhance cognitive functioning.

Hanser, S.B. (2005). Challenges of music therapy in a world of need. The Arts in Psychotherapy, 32(3), 217-224.
This article discusses the challenges of implementing and measuring the effects of MT in various different health and social care settings using a diverse range of practices.

Holmes, C.; Knights, A.; Dean. C.; Hodkinson, S. & Hopkins, V. (2006). Keep music live: music and the alleviation of apathy in dementia subjects. International Psychogeriatrics, 18(4), 623-630.
32 subjects in the south of England meeting ICD-10 diagnostic criteria for moderate to severe dementia and fulfilling criteria for apathy were exposed to live, interactive music, passive pre-recorded music, or silence, for 30 minutes. Each subject was video-recorded and the recording was analyzed every 3 minutes using DCM to assess the quality of engagement. The results of this study indicated that, compared to the silent placebo period, the majority (69%) of subjects, regardless of their diagnosed dementia severity, showed a significant and positive engagement to live music. Pre-recorded music was non-significant (25%). No subjects showed a state of ill-being during either form of music exposure. “This placebo-controlled trial shows evidence that music is of benefit in the short term treatment of apathy in subjects with moderate to severe dementia” (628). Stated limitations of this study included that the study only examined immediate effects and not long-term consequences.

Jennings, B. & Vance, D. (2002). The short-term effects of music therapy on different types of agitation in adults with Alzheimer’s. Activities, Adaptation and Aging, 26, 27-33.
This article examines the effects of music therapy on various types of agitated behaviors related to AD. Findings report that residents’ agitated behaviors were reduced significantly over time after four sessions of group MT.

Killick, J. (2001). The Power of Song. Elderly Care, 12,10, 12-13.
This article looks at the power of song for brining meaning into the lives of seniors in general. It is based on anecdotal evidence of participant satisfaction.

Korlin, D. & Wrangsjo, B. (2002). Treatment effects of guided imagery and music (GIM) therapy. Nordic Journal of Music Therapy, 11(1), 3-15.
This article looks at the effects of guided imagery and music (GIM) therapy as relaxation technique to help treat dementia symptoms. It finds minimal “treatment effects” (without specifying which exactly) for GIM participants.

Kovach, C. & Henschel, H. (1996). Planning activities for patients with dementia. Journal of Gerontological Nursing, 22(9), 33-38.
This article examines the effect of various MT interventions on the attention span of persons with dementia. It suggests that MT can increase the attention span of participants. The authors founds that PWD were able to verbalize coherent thoughts related to a topic more often during exercise and MT programs than in AT and cognitive activities. Study subjects also spent more time actively participating in these activities, and song lyric recall was much better than recollection of other cognitive information.

Krout, R. (2007). Music listening to facilitate relaxation and promote wellness: integrated aspects of our neurophysiological responses to music. The Arts in Psychotherapy, 34(2), 134-141.
In this study, the role listening to music plays in enhancing neurophysiological and emotional responses related to relaxation is discussed. Suggestions are provided for general consumers to create their own wellness/relaxation regime.

Kumar, A.; Tims, F.; Cruess, D. et al. (1999). Music therapy increases serum melatonin levels in patients with Alzheimer's disease. Alternative Therapies, 5(6), 49-57.
This article looks at the impact of MT on promoting relaxation and relieving anxiety (i.e., reducing agitated behavior) in PWAD. It finds significant increases in the melatonin levels of PWAD after attending daily MT sessions, and further increases after a 6 week follow-up. Sessions included active singing, drumming, and instrumental improvisation. Melatonin levels decrease with age, and the related aging effects are much higher for those with AD. The authors conclude that the increased melatonin related to MT may have contributed to participants’ relaxed and calm mood.

Kydd, P. (2001). Using music therapy to help a client with Alzheimer’s disease adapt to long-term care. American Journal of Alzheimer’s Disease and Other Dementias, 16, 2, 103-108.
This case study explored the influence of music therapy on improving QoL and enhancing relationships with others for persons with AD. Music therapy is defined as including singing, movement or exercise, playing, listening, improvising, composing, and engaging in discussion /trivia. Findings suggest that MT can be used to help people transition from independent living to nursing home life. In particular, for the depressed and reclusive resident studied, MT helped to encourage active participation in the numerous social and recreational opportunities available. Although it states that MT is “evaluated regularly and changes are made as needed” there is no discussion regarding whom and when these evaluations/changes are implemented. It was also found that MT helped make staff members’ jobs more enjoyable while working with this resident.

Lipe, A.W. (1991). Using music therapy to enhance the quality of life in a client with Alzheimer's dementia: A case study. Music Therapy Perspectives, 9, 102-105.
This article examines how to use MT to enhance QoL of PWAD. This case study approach suggests that MT increases QoL for the one individual studied.

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.
This article looks at the existing literature exploring the role of music in reducing agitation in seniors with dementia. The main recommendation is that further development of more stringent methodology in terms of validity and reliability of measures and experimental design with larger sample size is needed to overcome the significant methodological limitations present in the vast majority of empirical studies to date.

Mavely, R. & Mitchell, G.J. (1994). Consider Karaoke. Canadian Nurse, 22-24.
This article looks at the use of music therapies as activities. It describes the use of a Karaoke machine to stimulate responses from PWD. The authors report remarkable successes, but there is no concrete measurement or documentation of such outcomes.

McCloskey, L.J. (1990). The silent heart sings. Generations, winter, 63-65.
This article looks at the impact of music therapies, namely music, reminiscence and life review, on seniors. The program, named Reprise, reports the effect of unlocking a person’s memories.

Millard, K. & Smith, J. (1989). The influence of group singing therapy on the behaviour of Alzheimer's disease patients. Journal of Music Therapy, 26(2), 58-70.
This article looks at the impact of group singing on the reality orientation of seniors with AD. Findings suggest that MT can reorient participants, at least temporarily, during the group singing exercises. This reorientation was achieved by including information about day, time, and season in the selected music, and encouraging interaction with other group members during the music program.

Miller, B.L.; Boone, K.; Cummings, J.L.; Read, S.L.; & Mishkin, F. (2000). Functional correlates of musical and visual ability in frontotemporal dementia. British Journal of Psychiatry, 176, 458-463.
This article uses a case study approach to explore how loss of function in one brain area can release new functions elsewhere. The patients acquired, or sustained, new musical/visual abilities despite progression of dementia. Authors argue that certain regions of loss may lead to facilitation of artistic or musical skills (p 458).

Norberg, A.; Melin, E. & Asplund, K. (2003). Reactions to music, touch and object presentation in the final stage of dementia: an exploratory study. International Journal of Nursing Studies, 40, 473-479.
This exploratory study looked at the reactions of 2 individuals in the final stage of AD who were stimulated with music, touch and object presentation. Based on direct observations, video and pulse/respiration rates for 12 consecutive days, both subjects reacted differently. Conclusions include that persons in the final stage of dementia can be made contact with at least by means of music and can exhibit reactions, which can be evaluated without any technically complicated apparatus.

O’Callaghan, C. & McDermott, F. (2004). Music therapy’s relevance in a cancer hospital researched through a constructivist lens. Journal of Music Therapy, 41(2), 151-185.
This article looks at the use of MT with cancer patients. The authors find that “aliveness” is a key factor of the subjective experiences of patients emerging from the data.

Olderog-Millard, K.A. & 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.
This article discusses the effect of group singing therapy on agitation and depression in 10 persons with AD. The authors report a significant change in behavior after treatment sessions. There was not a control group and how change was measured or which behaviors were of interest to the study are not given.

Perrin, T. (1998). Lifted into a world of rhythm and melody. Journal of Dementia Care, 6, 20-24.
This article looks at the impact of music therapies on the mood and experiences of seniors with various dementias using dementia care mapping (DCM) to measure the effects of various Jabadao sessions. The author highlights that the element of personal interaction is essential.

Pollack, N. & Namazi, K. (1992). The effect of music participation on the social behaviour of Alzheimer's disease patients. Journal of Music Therapy, 29(1), 54-67.
This article explores the effect of MT participation on the social behavior of PWAD. It suggests that MT can enhance socialization and improve social skills. Findings report increased social behaviors, namely interaction, of PWAD after MT sessions as well as a decrease in nonsocial behaviors, which could lead to social isolation. Some subjects even assumed leadership roles in the MT sessions.

Prickett, C.A. & Moore, R.S. (1991). The use of music to aid memory of Alzheimer's patients. Journal of Music Therapy, 28(2), 101-110.
This article looks at the use of music to assist the memory recall of PWAD. When comparing recall of familiar and new song material, findings report “dramatically better” recall of once familiar material. Therefore, MT can help participants access their memory (of the words to specific songs, for example).

Sambandham, M. & Schirm, V. (1995). Music as a nursing intervention for residents with Alzheimer's disease in long-term care. Journal of Gerontological Nursing, 16(2), 79-83.
This article looks at the impact of music therapy in promoting relaxation and relieving anxiety (i.e., reducing agitated behavior) in nursing home residents with AD. Findings suggest that when music is played, residents showed a decrease in verbalization and unrelated interactions, indicating that they were focused, but an increase in interactions with each others when the music stopped. Residents with the most severe cognitive impairment exhibited the most improvement in memory and reminiscence abilities. Socially acceptable behavior and signs of mental stimulation were also observed after MT sessions. The focus is on making PWAD more “manageable” for nursing home staff.

Sherratt, K; Thornton, A.; & Hatton, C. (2004a). Music Interventions for people with dementia: A Review of the Literature. Aging and Mental Health, 8(1), 3-12.
21 articles were reviewed and analyzed in terms of their findings, method, and use of theory. The authors argue for Kitwood’s personhood theory to guide future research. This review includes articles not just relating to problem behaviors like agitation (although 16/21 seem to focus on this, see table on page 5), but also those of engagement and participation (5/21).

Sherratt, K; Thornton, A.; & Hatton, C. (2004b). Emotional and behavioral responses to music in people with dementia: an observational study. Aging and Mental Health, 8(3), 233-241.
Using Kitwood’s theory of personhood as a framework, this study hypothesized that levels of well-being (WB) and engagement would be greatest during a live music condition compared with recorded and no music conditions, and that “challenging behaviors” would decrease. The findings suggest live music is more effective in increasing WB and engagement regardless of level of cognitive impairment.

Smith-Marchese, M. (1994). The effects of participatory music on the reality orientation and sociability of Alzheimer's residents in a long-term care setting. Activities, Adaptation & Aging, 18(2), 41-55.
This article looks at the impact of group singing on the reality orientation of seniors with AD. Findings suggest that MT can reorient participants, at least temporarily, during the group singing exercises. This reorientation was achieved by including information about day, time, and season in the selected music, and encouraging interaction with other group members during the music program. MT was also found to encourage and increase socialization of PWD, including increased eye contact, facial expression, and body language.

Smith, G.H. (1986). A comparison of the effects of three treatment interventions on cognitive functioning of Alzheimer patients. Music Therapy, 6A(1), 41-56.
This article compares the impact of three music interventions on the cognitive performance of PWAD. It suggests that MT is a form of cognitive stimulation that can enhance cognitive functioning.

Spendlove, C. (1997). In tune with clients. Nursing Times, 93(50), 58-59.
This article looks at the impact of music therapies on the mood and affect of participants. The author, a musician and mental health nurse, improvises using his voice for and with people with special needs, including dementia.

Sung, H-c.; Chang, S-m.; Lee, W-l. & Lee, M-s. (2006). The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan. Complementary Therapies in Medicine, 14, 113-119.
This study notes that agitated behaviors are identified by caregivers as the most challenging in dementia care. These behaviors were significantly reduced in an experimental group following 4 weeks of group music with movement intervention, compared to the control group. Group music (featuring Taiwanese folk songs with pleasant rhythm and tempo) with movement intervention (designed to move the body and extremities) was administered for 30 minutes in the afternoons 2 times a week over a 4 week period (8 sessions total) to 18 subjects in a long-term care facility (18 in the control group) by a nursing researcher and two research assistants trained in music intervention. CMAI was used to measure the occurrence of agitated behaviors. The authors concluded that intervention should be a part of the daily care routine to improve QOL with PWD.

Sung, H-c. & Chang, A. (2005). Use of preferred music to decrease agitated behaviors in older people with dementia: a review of the literature. Journal of Clinical Nursing,14(1), 1133-1140.
8 articles 1993-2005 were reviewed on the topic of decreasing/managing agitated behaviors in older PWD; four from nursing professionals, one by a mental health professional, one by a music therapist, one by a recreational professional, and one by an occupational therapist. The main findings were: 7 reported significant improvement in agitation, only 2 found significant changes in agitated behaviors both during and following music sessions, and one found no decrease, but significantly improved relaxation.

Svandottir, H.B. & Snaedal, J. (2006). Music therapy in moderate and severe dementia of Alzheimer’s type: a case-control study. International Psychogeriatrics, 18, 4, 613-621.
38 subjects with moderate to severe AD were assigned randomly to a music therapy and control group carried out by qualified music therapists in 2 nursing homes and 2 psychogeriatric wards. Stated results indicated a significant reduction in activity disturbances, or symptoms, in the music therapy group over 3 sessions a week for 6 weeks. These symptoms were measured with a BEHAVE-AD instrument that rates paranoid and delusional ideation, hallucination, activity disturbance, aggressiveness, diurnal rhythm disturbance, affective disturbance, anxieties and phobias. The study also recorded a sign reduction in activity disturbances (anxiety, aggressiveness). But four weeks later the effects had mostly disappeared.

Tabloski, P.; McKinnin-Howe L. & Remington, R. (1995). Effects of calming music on the level of agitation in cognitively impaired nursing home residents. American Journal of Alzheimer's Care and Related Disorders & Research, 10(1), 10-15.
This article looks at the impact of calming music on promoting relaxation and relieving anxiety (i.e., reducing agitated and aggressive behaviors) in nursing home residents with AD. Findings report reduced agitation and more socially acceptable behaviors in residents with cognitive impairment, both during and after the MT intervention. The focus is on making PWAD more “manageable” for nursing home staff.

Van de Winckel, A.; Feys, H. & De Weerdt, W. (2004). Cognitive and behavioral effects of music-based exercises in patients with dementia. Clinical Rehabilitation, 18, 253-260.
This article explores the cognitive and behavioral effects of exercises set to music on persons with dementia. It finds increased MMSE scores but no effect on behavior. The effects of 6-week music-based group exercises were not significant on behavioral changes of persons with moderate to severe dementia although there was a significant improvement on their cognitive function.

Walker, O. (1996). Music vibrates in the memory. Journal of Dementia Care, 4(1), 16-17.
This article explores the use of MT in stimulating the memory of persons with dementia. It argues that music sparks memories and is enjoyable for participants.

York, E. (1994). The development of a quantitative music skills test for patients with Alzheimer’s Disease. Journal of Music Therapy, 31(4), 280-296.
This article discusses the development of a quantitative test, The Residual Music Skills Test, to measure the “music behaviours” of PWAD. The instrument does not appear to have been utilized or reported on since.

Zeisel, J. & Raia, P. (2000). Nonpharmacological treatment for Alzheimer's disease: A mind-brain approach. American Journal of Alzheimer’s Disease and Other Dementias, 15(6), 331-340.
This article looks at the use of non-pharmacological treatments of AD, such as various art therapies, that can produce behavioral improvements.