The Cochrane database of systematic reviewsMar 6, 2025

Music therapy for people with dementia

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Jan 7, 2026

Abstract

A total of 30 studies with 1720 participants were analyzed to evaluate the effects of music-based therapeutic interventions for people with dementia.

At the end of treatment, music-based therapeutic interventions probably led to a slight improvement in depressive symptoms compared to usual care.
There is low-certainty evidence suggesting that these interventions may improve overall behavioral problems.
Music-based therapeutic interventions likely did not reduce agitation or aggression among participants.
No significant improvements were observed in emotional well-being, anxiety, social behavior, or cognition at the end of treatment.
When compared to other activities, music-based interventions may enhance social behavior at the end of treatment.
No long-term benefits from music-based therapeutic interventions were identified for any outcomes.

Simplified

BACKGROUND: Dementia is a clinical syndrome with a number of different causes. It is characterised by deterioration in cognitive, behavioural, social and emotional functioning. Pharmacological interventions are available but have limited effect on many of the syndrome's features. However, receptivity to music may remain until the late phases of dementia, and music-based therapeutic interventions (which include, but are not limited to, music therapy) are suitable for people with advanced dementia. As there is uncertainty about the effectiveness of music-based therapeutic interventions, trials are being conducted to evaluate this. This review updates one last published in 2018 and examines the current evidence for the effects of music-based interventions for people with dementia.

OBJECTIVES: To assess the effects of music-based therapeutic interventions for people with dementia on emotional well-being (including quality of life), mood disturbance or negative affect (i.e. depressive symptoms and anxiety), behavioural problems (i.e. overall behavioural problems or neuropsychiatric symptoms, and more specifically agitation or aggression), social behaviour and cognition, at the end of therapy and four or more weeks after the end of treatment, and to assess any adverse effects.

SEARCH METHODS: We searched the Cochrane Dementia and Cognitive Improvement Group's Specialised Register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (ISI Web of Science), LILACS (BIREME), ClinicalTrials.gov and the World Health Organisation's meta-register-the International Clinical Trials Registry Platform on 30 November 2023.

SELECTION CRITERIA: We included randomised controlled trials of music-based therapeutic interventions (of at least five sessions) for people with dementia that measured any of our outcomes of interest. Control groups either received usual care or other activities with or without music.

DATA COLLECTION AND ANALYSIS: Two review authors worked independently to screen the retrieved studies against the inclusion criteria and then to extract data from included studies and assess their risk of bias. If necessary, we contacted trial authors to ask for additional data, such as relevant subscales. We pooled data using the random-effects model. We assessed the certainty of the evidence for our two comparisons and our main outcomes of interest using GRADE.

MAIN RESULTS: We included 30 studies with 1720 randomised participants that were conducted in 15 countries. Twenty-eight studies with 1366 participants contributed data to meta-analyses. Ten studies contributed data to long-term outcomes. Participants had dementia of varying degrees of severity and resided in institutions in most of the studies. Seven studies delivered an individual intervention; the other studies delivered the intervention to groups. Most interventions involved both active and receptive elements of musical experience. The studies were at high risk of performance bias and some were at high risk of detection or other bias. For music-based therapeutic interventions compared to usual care, we found moderate-certainty evidence that, at the end of treatment, music-based therapeutic interventions probably improved depressive symptoms slightly (standardised mean difference (SMD) -0.23, 95% confidence interval (CI) -0.42 to -0.04; 9 studies, 441 participants), and we found low-certainty evidence that it may have improved overall behavioural problems (SMD -0.31, 95% CI -0.60 to -0.02; 10 studies, 385 participants). We found moderate-certainty evidence that music-based therapeutic interventions likely did not improve agitation or aggression (SMD -0.05, 95% CI -0.27 to 0.17; 11 studies, 503 participants). Low to very low certainty evidence showed that they did not improve emotional well-being (SMD 0.14, 95% CI -0.29 to 0.56; 4 studies, 154 participants), anxiety (SMD -0.15, 95% CI -0.39 to 0.09; 7 studies, 282 participants), social behaviour (SMD 0.22, 95% CI -0.14 to 0.57; 2 studies; 121 participants) or cognition (SMD 0.19, 95% CI -0.02 to 0.41; 7 studies, 353 participants). Low or very-low -certainty evidence showed that music-based therapeutic interventions may not have been more effective than usual care in the long term (four weeks or more after the end of treatment) for any of the outcomes. For music-based therapeutic interventions compared to other interventions, we found low-certainty evidence that, at the end of treatment, music-based therapeutic interventions may have been more effective than the other activities for social behaviour (SMD 0.52, 95% CI 0.08 to 0.96; 4 studies, 84 participants). We found very low-certainty evidence of a positive effect on anxiety (SMD -0.75, 95% CI -1.27 to -0.24; 10 studies, 291 participants). For all other outcomes, low-certainty evidence showed no evidence of an effect: emotional well-being (SMD 0.20, 95% CI -0.09 to 0.49; 9 studies, 298 participants); depressive symptoms (SMD -0.14, 95% CI -0.36 to 0.08; 10 studies, 359 participants); agitation or aggression (SMD 0.01, 95% CI -0.31 to 0.32; 6 studies, 168 participants); overall behavioural problems (SMD -0.08, 95% CI -0.33 to 0.17; 8 studies, 292 participants) and cognition (SMD 0.12, 95% CI -0.21 to 0.45; 5 studies; 147 participants). We found low or very-low certainty evidence that music-based therapeutic interventions may not have been more effective than other interventions in the long term (four weeks or more after the end of treatment) for any of the outcomes. Adverse effects were inconsistently measured or recorded, but no serious adverse events were reported.

AUTHORS' CONCLUSIONS: When compared to usual care, providing people with dementia with at least five sessions of a music-based therapeutic intervention probably improves depressive symptoms and may improve overall behavioural problems at the end of treatment. When compared to other activities, music-based therapeutic interventions may improve social behaviour at the end of treatment. No conclusions can be reached about the outcome of anxiety as the certainty of the evidence is very low. There may be no effects on other outcomes at the end of treatment. There was no evidence of long-term effects from music-based therapeutic interventions. Adverse effects may be rare, but the studies were inconsistent in their reporting of adverse effects. Future studies should examine the duration of effects in relation to the overall duration of treatment and the number of sessions.

Funding

Competing interests

JS declares that she is involved in a trial on a music‐based therapeutic intervention for people with dementia. She is serving as a methodologist and is supervising the PhD student who is conducting the trial, which could qualify for inclusion in a future update of this review. This study started in 2019 and has concluded recently (results not fully available yet); it was funded by university funds and Alzheimer Nederland. JW declares that he has no conflicts of interest. AM is a Senior Clinical Psychologist and sole proprietor of the business Innovative Clinical Psychology Solutions Ltd (from 9 March 2021 to present), a private clinical psychology practice; she can see patients with dementia and neurological conditions due to her training, but this is not her primary client group. Until 29 December 2022, AM was employed by the NHS and saw people with suspected and confirmed cases of dementia clinically within this role. AM declares consultancy fees from Cochrane to Innovative Clinical Psychology Solutions Ltd for payment for contributing to this review (i.e. to assist with the process of the updated systematic search, including abstract screening and data extraction); this was a personal payment. HS declares that she has no conflicts of interest. AV is affiliated with the ArtEZ Music Therapy Department, and she has published opinion pieces on the website artez.nl. AV declares that she was involved in a study supported by the national funder ZonMw, an independent organisation that supports research and innovation in health, healthcare and well‐being, as part of her dissertation at UMCG The Netherlands, which was eligible for inclusion in the review**. AV is involved in music therapy research and teaching. MB is involved in teaching and practice of music therapy in persons with dementia. She declares that she has no conflicts of interest. **We included two studies on which AV was an author. AV was not involved in assessing the eligibility of these studies, extracting data from them, assessing their risk of bias or grading the certainty of evidence involving these studies. These tasks were performed by JS and HS, and for other articles also by JW and AM. The lead review author, JS, and a co‐author who is a Cochrane expert (JW; and also RS in previous versions), made the final decisions about analysis, presentation and interpretation of the data. None of the authors has a conflict of interest related to the effectiveness of music therapy.

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Music therapy for people with dementia

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