| Abstract [eng] |
Background: Dementia affects approximately 55 million people worldwide, with depression (20–30%) and anxiety (20–40%) among its most prevalent neuropsychiatric manifestations. Pharmacological treatment of these symptoms carries significant risks, including sedation, falls, and accelerated cognitive decline, prompting growing interest in non-pharmacological alternatives. Music therapy — a professional, music-therapist-led intervention — engages preserved neurobiological systems including dopaminergic reward circuits and musical memory networks, providing a theoretical basis for its therapeutic effects. However, existing reviews have not simultaneously examined both depression and anxiety as co-primary outcomes using the most recent evidence, including the landmark MIDDEL multinational trial. Aim: To evaluate the effectiveness of music therapy in reducing depression and anxiety in adults with dementia, based on evidence from randomised controlled trials. Objectives: (1) To describe the theoretical background of dementia, its neuropsychiatric manifestations, and the proposed mechanisms of music therapy; (2) to conduct a systematic search and selection of primary studies using PICO criteria; (3) to appraise included studies using the Cochrane Risk of Bias 2 tool; (4) to synthesise and critically evaluate the evidence on depression and anxiety outcomes. Methods: A systematic search of five databases (PubMed, PsycINFO, Cochrane CENTRAL, Web of Science, CINAHL Ultimate) was conducted in March 2026 following PRISMA 2020 guidelines. Inclusion criteria specified adults with diagnosed dementia, music-therapist-led music therapy, a non-music comparator, and validated depression or anxiety measures. Study quality was assessed using Cochrane RoB 2. A narrative synthesis approach was adopted due to clinical and methodological heterogeneity. Results: From 940 identified records, 15 studies (published 2006–2025; over 2,000 participants across 10 countries) met inclusion criteria. For depression (11 studies), three reported statistically significant improvements, seven found no significant effect, and one produced mixed results; the largest trial (MIDDEL; N = 1,021) found no statistically significant effect. For anxiety (8 studies), six reported statistically significant reductions; critically, all three studies using validated clinical anxiety instruments (HAM-A or RAID) as primary outcomes found statistically significant effects, with up to 60 % symptom reduction (Guetin et al., 2009). 5 Conclusions: Music therapy is a promising non-pharmacological intervention for reducing anxiety in people with dementia, with consistent positive effects observed across all included studies in which anxiety was assessed using validated clinical instruments. The evidence for depression is insufficient to support routine population-level implementation, though individualised approaches may benefit specific patients. Keywords: music therapy, dementia, anxiety, depression, systematic literature review. |
