Music Therapy as Non-Pharmacological Treatment in Alzheimer’s Disease—Effects on Memory—Systematic Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The authors have delivered a well-written and organized paper that contributes nicely to the growing literature on music and music therapy with AD.  There are a few places where the term "Music Medicine" differentiated from "Music Therapy" could be added since you are focusing on Music Therapy. This clarification would strengthen the paper.  Perhaps between Lines 76-105, and/or in the Discussion around Lines 375-382. 

Consider the following grammatical and word choice points for tightening up the paper:

Line 55: Avoid contractions in scholarly writing (there's should be spelled out to there is)

Line 91: add "concept" or "point" after the word this 

Lines 147 and 151: These lines are conflicting. Settle on one intention regarding memory systems.

Line 149: "Specifically" and "specific" in the same sentence is awkward. Consider another word choice for one of these places.

 

Author Response

 

REVIEW 1:Comments and Suggestions for Authors 

The authors have delivered a well-written and organized paper that contributes nicely to the growing literature  on music and music therapy with AD. There are a few places where the term "Music Medicine" differentiated  from "Music Therapy" could be added since you are focusing on Music Therapy. This clarification would strengthen the paper. Perhaps between Lines 76-105, and/or in the Discussion around Lines 375-382. Consider the following grammatical and word choice points for tightening up the paper: Line 55: Avoid contractions in scholarly writing (there's should be spelled out to there is) Line 91: add "concept" or "point" after the word this  Lines 147 and 151: These lines are conflicting. Settle on one intention regarding memory systems. Line 149: "Specifically" and "specific" in the same sentence is awkward. Consider another word choice for one  of these places. 

The authors appreciate the suggestions of the reviewer. All suggestions have been incorporated into the text.

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

 

This is an interesting paper, well written with fluent language use and a high degree of readability. The academic standards are OK and it seems that the paper should therefore be eligible for publication. The findings, however, are not quite substantial and do not add much to already existing knowledge. The reference list is also rather limited and the critical discussions could be stronger. Perhaps the major findings and perspectives for future research should be stressed more explicitly. It seems also that there has been an error with the title of the paper, which has no correspondence to the contents of the paper.

 

 I list below some general remarks and detailed comments.

General remarks

 

·      The language use is quite fluent and idiomatic.

·      The readability of the paper is very high.

·      There is a good and concise overview of the existing literature on the subject.

·      The research question is clearly stated.

·      The findings are not very substantial. More in-depth elaboration on the subject of brain plasticitiy and neuroaesthetics should be welcome.

·      The list of references is rather limited.

·      What is the actual take-home message from the paper?

 

Detailed comments

 

·      Lines 1-3: there seems to an error with the title of the paper. I suppose that lines 26-27 have the correct title.

·      Line 74: the reference to creating new synapses and neuronal regeneration is a very important point. Some more in-depth elaboration should be welcome here, especially with references to brain plasticity and music, brain connectivity networks and the aesthetic experience of music. Also, the whole field of the neuroaesthetics of music could be mentioned here somewhat more explicitly as a lot of research has been done recently in this field.

·      Line 103: please provide the full wording of MEAM at first appearance of the term.  

·      Line 129: same remark. More references and a somewhat more in-depth elaboration of the dopaminergic systems should be welcomed here.

·      Line 162: even if the PICOS abbreviation becomes clearly after conitinued reading of table 1, it is recommended to explain the abbreviation at first appearance of the term.

·      Line 162: the guiding question: which one? Please be more explicit.

·      Table 3: what does the abbreviation TEMPau mean?

·      Line 233; there is some confusion here. Is this sentence a new subtitle? In that case, the layout must be adapted.
Line 273: same remark

 

 

 

 

 

 

 

 

Author Response

REVIEW 2: Comments and Suggestions for Authors 

This is an interesting paper, well written with fluent language use and a high degree of readability. The  academic standards are OK and it seems that the paper should therefore be eligible for publication. The  findings, however, are not quite substantial and do not add much to already existing knowledge. The reference  list is also rather limited and the critical discussions could be stronger. Perhaps the major findings and  perspectives for future research should be stressed more explicitly. It seems also that there has been an error  with the title of the paper, which has no correspondence to the contents of the paper. I list below some general remarks and detailed comments. 

General remarks 

• The language use is quite fluent and idiomatic.
• The readability of the paper is very high. 
• There is a good and concise overview of the existing literature on the subject. 
• The research question is clearly stated. 
• The findings are not very substantial. More in-depth elaboration on the subject of brain plasticitiy  and neuroaesthetics should be welcome. 
• The list of references is rather limited. 
• What is the actual take-home message from the paper? 

The authors appreciate the suggestions of the reviewer. All suggestions have been incorporated into the text.

Detailed comments 

• Lines 1-3: there seems to an error with the title of the paper. I suppose that lines 26-27 have the  correct title. The authors have modified the manuscript's title. Music Therapy as a Non-Pharmacological Treatment in Alzheimer's Disease. Effects on Memory. Systematic Review
• Line 74: the reference to creating new synapses and neuronal regeneration is a very important  point. Some more in-depth elaboration should be welcome here, especially with references to brain  plasticity and music, brain connectivity networks and the aesthetic experience of music. Also, the whole field of the neuroaesthetics of music could be mentioned here somewhat more explicitly as a lot of  research has been done recently in this field. The authors have made this modification.

Line 103: please provide the full wording of MEAM at first appearance of the term. The authors have made this modification.

Line 129: same remark. More references and a somewhat more in-depth elaboration of the  dopaminergic systems should be welcomed here. The authors have made this modification.

Line 162: even if the PICOS abbreviation becomes clearly after continued reading of table 1, it is  recommended to explain the abbreviation at first appearance of the term. The authors have made this modification.

Line 162: the guiding question: which one? Please be more explicit. The authors have made this modification.

Table 3: what does the abbreviation TEMPau mean? The authors have made this modification.

Line 233; there is some confusion here. Is this sentence a new subtitle? In that case, the layout  must be adapted. The authors have made this modification.

Line 273: same remark The authors have made this modification.

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

Review of Music Therapy as a Non-Pharmacological Treatment in Alzheimer's Disease. Effects

on Memory. Systematic Review

 

The manuscript reports on a systematic review of the use of music therapy as a memory aid for people with mild to moderate Alzheimer’s disease. The topic should be of interest to the readers of the Journal of Aging and Longevity. As with other therapeutic rather than medical or pharmaceutical interventions, there are a range treatment protocols and the sample sizes in the studies tend to be small. Thus, the systematic review is not the appropriate method for reviewing this body of literature. Rather a scoping review would be a better choice.

 

Abstract

line 9, gradual may be a better word choice than insidious.

 

Introduction

The organization of the Introduction needs to focus on the research topic better. The concepts appear to in the Introduction; however, there is little flow of information from paragraph to paragraph that leads inevitably to the purpose of the research. In the reorganizing, the authors should avoid one sentence paragraphs. The research questions are clear and appropriate for a systematic review.

 

Line 52 – the sentence is not clear and needs to be rewritten.

Lines 76-81 – this sentence needs to be rewritten by separating the different ideas into separate sentences.

Line 83 – The quote is overlong. The authors do not make clear the reason for defining music therapy. The description of music therapy in the following paragraph is all that the authors needed to include.

Line 112 – the defining of the acronym is redundant with the previous paragraph.

 

Methods

The methods for selecting the articles included in the review are clearly presented and include standard means for systematic reviews. The method for analyzing the articles in order to address the study’ research questions is missing from the narrative. In the Results section, Table 3 presents a form of analysis. The sample sizes of two of the studies would be appropriate for case studies.

 

Line 160 – The authors’ opinion of their study is not relevant – remove the first clause.

Line 177 – The figure needs to be wider

 

Results

The findings addressing the first two research questions indicate that the studies may not have been adequately robust for a systematic review and that a scoping review may have been a better tool for the studies included in the review. The authors indicate clusters of information on memory from the studies but do not describe their findings systematically.

In addition, the statistical significance and effect sizes of the findings in the studies are not addressed. Thus, the authors failed to evaluate the quality of the evidence, an essential aspect of a systematic review.

The findings addressing the third research question appear to repeat information on active and/or receptive music therapy techniques. The research question did not address whether a musical therapist was involved, but the results did.

 

Discussion

The authors state in the first paragraph of the Discussion that the data evaluated were insufficient for the authors to synthesize the information from the set of studies in order to tell a single, cohesive story. This synthesis is a major purpose for systematic reviews. In the second paragraph of the Discussion, the authors explain unfavorably results by assuming cognitive changes in the participants without providing evidence from the studies that such changes had occurred.

In the paragraph beginning on line 332 the authors report the heterogeneity of the methods used in the studies as a limiting factor for the review. This issue indicates that a scoping review would have been a better structure for the review than a systematic one.

Comments on the Quality of English Language

no comments

Author Response

REVIEW 3: Comments and Suggestions for Authors 

Review of Music Therapy as a Non-Pharmacological Treatment in Alzheimer's Disease. Effects on Memory. Systematic Review 

The manuscript reports on a systematic review of the use of music therapy as a memory aid for people with  mild to moderate Alzheimer’s disease. The topic should be of interest to the readers of the Journal of Aging and Longevity. As with other therapeutic rather than medical or pharmaceutical interventions, there are a range  treatment protocols and the sample sizes in the studies tend to be small. Thus, the systematic review is not the  appropriate method for reviewing this body of literature. Rather a scoping review would be a better choice. 

Abstract 

• line 9, gradual may be a better word choice than insidious.  Done. The authors have made this modification.

Introduction 

The organization of the Introduction needs to focus on the research topic better. The concepts appear to in the  Introduction; however, there is little flow of information from paragraph to paragraph that leads inevitably to the  purpose of the research. In the reorganizing, the authors should avoid one sentence paragraphs. The research  questions are clear and appropriate for a systematic review.  Thanks. The authors have revised the introduction. 

• Line 52 – the sentence is not clear and needs to be rewritten. The authors have made this modification.“Even though the progression varies among patients, leading to differing symptoms and stages of onset, severe episodic memory deficits are consistently present.”

• Lines 76-81 – this sentence needs to be rewritten by separating the different ideas into separate  sentences. Line 83 – The quote is overlong. The authors do not make clear the reason for defining music therapy. The  description of music therapy in the following paragraph is all that the authors needed to include.  Done. The authors have made this modification. Non-pharmacological therapies refer to "any non-chemical intervention, theoretically based, focused, and replicable, carried out on the patient or caregiver and potentially capable of obtaining relevant benefits" (MSCBS, 2019, p. 43). Their effectiveness in treating AD symptoms is supported by various findings, such as the retention of neuroplasticity in older brains, the learning ability of individuals with mild to moderate AD, and the capacity for creating new synapses and neuronal regeneration (De los Reyes et al., 2012; Escarabajal, 2010).Music therapy as a non-pharmacological treatment has seen significant development in recent years due to brain and biomedical research related to music, transitioning from being considered a supportive therapy with effects on patients' social, psychological, and emotional functions to a key therapeutic modality in cognitive domains related to attention, executive function, language, and memory, proving effective in neurological rehabilitation (Koshimori & Thaut, 2019; Miranda et al., 2017; Thaut et al., 2021). Music therapy as a non-pharmacological treatment has seen significant development in recent years. This development is attributed to brain and biomedical research related to music. It has transitioned from being considered a supportive therapy with effects on patients' social, psychological, and emotional functions. Now, it is recognized as a key therapeutic modality in cognitive domains. These domains include attention, executive function, language, and memory. Music therapy has proven effective in neurological rehabilitation, as evidenced by studies (Koshimori & Thaut, 2019; Miranda et al., 2017; Thaut et al., 2021).
• Line 112 – the defining of the acronym is redundant with the previous paragraph. Done. The authors have made this modification. 

Methods 

The methods for selecting the articles included in the review are clearly presented and include standard means  for systematic reviews. The method for analyzing the articles in order to address the study’ research questions  is missing from the narrative. In the Results section, Table 3 presents a form of analysis. The sample sizes of  two of the studies would be appropriate for case studies. 

• Line 160 – The authors’ opinion of their study is not relevant – remove the first clause. Done. The authors have removed this part of the manuscript.
•  Line 177 – The figure needs to be wider . The authors have adjusted the figure.

Results 

The findings addressing the first two research questions indicate that the studies may not have been  adequately robust for a systematic review and that a scoping review may have been a better tool for the studies included in the review. The authors indicate clusters of information on memory from the studies but do not  describe their findings systematically. In addition, the statistical significance and effect sizes of the findings in the studies are not addressed. Thus, the authors failed to evaluate the quality of the evidence, an essential aspect of a systematic review.  Thanks to the reviewer for this information. This information has been considered in the hypotheses.

The findings addressing the third research question appear to repeat information on active and/or receptive  music therapy techniques. The research question did not address whether a musical therapist was involved, but the results did.  Thanks to the reviewer for this information. The aim of this article is to conduct a systematic review. Effect sizes are considered when performing a meta-analysis; therefore, the authors have not deemed it appropriate to include such measures in this review. This can be included in the section on future lines of research.

Discussion 

The authors state in the first paragraph of the Discussion that the data evaluated were insufficient for the  authors to synthesize the information from the set of studies in order to tell a single, cohesive story. This  synthesis is a major purpose for systematic reviews. In the second paragraph of the Discussion, the authors explain unfavorably results by assuming cognitive changes in the participants without providing evidence from  the studies that such changes had occurred. Thanks to the reviewer for these comments. These paragraphs have been modified.

Alzheimer's disease (AD) progressively impairs episodic, autobiographical, semantic memory, and other memory systems as it advances. This review suggests that music therapy or musical interventions could serve as valuable complementary treatments for memory-related symptoms in AD patients. These interventions potentially stabilize the decline in various memory systems and enhance the ability to evoke autobiographical memories. However, the review highlights a limited number of studies meeting inclusion criteria, including two (Li et al., 2015; Satoh et al., 2015) that did not report positive or significant effects on memory. Therefore, while the hypothesis of music therapy's positive effects on memory in AD patients cannot be definitively proven or disproven, these findings underscore the need for further research rather than providing conclusive evidence of efficacy.

Notably, the studies with unexpected results extended their intervention periods beyond six months, unlike others limited to three months. This disparity suggests that cognitive decline progression among AD participants during longer interventions might influence outcomes or that effects may not endure over time. As highlighted by Satoh et al. (2015, pp. 306), "we cannot determine if a longer intervention will produce a greater effect, or if disease progression will restrict further improvement." Moreover, both Giovagnoli et al. (2017) and Lyu et al. (2018) observed that intervention effects did not persist in long-term assessments (up to three months post-intervention). Therefore, time duration emerges as a critical variable influencing the efficacy of music therapy or musical interventions on memory in AD patients, both during the intervention period and in subsequent long-term evaluations.

In the paragraph beginning on line 332 the authors report the heterogeneity of the methods used in the studies  as a limiting factor for the review. This issue indicates that a scoping review would have been a better structure  for the review than a systematic one. Thanks to the reviewer for this suggestion. The authors will include this suggestion in the limitations section, as well as in the future lines of research.

As future directions, it is necessary to accumulate more evidence using rigorous methodologies focused on the effects of music therapy on memory in AD patients, employing valid and sensitive measurement tools for affected memory systems. Conducting a scoping review and meta-analysis would be essential to consolidate findings and provide a comprehensive overview of the field. Investigating the underlying mechanisms of music's effect on memory in AD patients to optimize interventions would be particularly insightful. Additionally, studying the effects of longer and more extended interventions with robust long-term follow-ups is crucial to determine their efficacy, as current results do not support prolonged interventions or maintenance of long-term effects.

Author Response File: Author Response.docx