Effects of Music Therapy on Heart Rate Variability in Elderly Patients with Cerebral Vascular Disease and Dementia

Abstract

Objective: In Japan, the number of elderly people with cerebral vascular disease (CVD) and dementia is increasing, resulting in increased expenditures to treat such patients. Reports indicate that music therapy can reduce anxiety in patients with myocardial infarction. However, it is unclear whether music therapy can have beneficial effects on very elderly patients with CVD and dementia, as these conditions may influence cardiac autonomic nerve functions. Therefore, we investigated the effects of music therapy on the autonomic nerve system in elderly patients with CVD and dementia, using an ambulatory Holter ECG system. Methods and Results: The subjects were 12 elderly patients aged !75 years, hospitalized for CVD and dementia. We measured their heart rate variability (HRV) indices of power domain and frequency domain analysis. The mean RR significantly increased during music therapy, from 842 AE 174 to 1022 AE 284 (p < 0:05), and decreased to 820 AE 284 ms after music therapy. HF significantly increased during music therapy, from 59 AE 41 to 127 AE 97 ms 2 (p < 0:01), and decreased to 77 AE 60 ms 2 after music therapy. LF/HF decreased from 2:2 AE 1:3 to 1:7 AE 1:3 during music therapy (p < 0:10), and increased to 2:0 AE 1:1 after music therapy. Time domain (HRV) indices increased during music therapy and decreased after music therapy: RMSSD increased from 19:4 AE 11 to 39:8 AE 17 ms, and then decreased to 19:4 AE 8:3 ms; pNN50 increased from 3:6 AE 3:2 to 16:1 AE 13:3% (p < 0:01), and then decreased to 4:3 AE 4:2%.Conclusions: Music therapy enhanced parasympathetic activity and decreased sympathetic activity in elderly patients with CVD and dementia. These findings suggest that music therapy is useful for alleviating anxiety, increasing comfort and facilitating relaxation for elderly patients with CVD and dementia. (J Arrhythmia 2006; 22: 161-166)

Measuring physiological responses to the arts in people with a dementia

“…Apart from these discrepancies, outcomes measured in more than one study (excluding those results not yet published [76] ) tended to change in the same way. Both studies measuring salivary cortisol reported no statistically significant changes [68,69] , and all studies measuring HRV reported changes indicative of increased parasympathetic activity [67,73,74,75] .…”

“…In terms of the outcomes measured, seven of the 13 papers measured a cardiovascular outcome [67,68,72,73,74,75,76] , eight of the papers measured an endocrinological outcome [63,64,65,66,67,68,69,70] , one measured galvanic skin responses but did not publish the data [76] , and one measured rate of respiration [72] . Also, four studies measured more than one kind of outcome [67,68,72,76] .…”

“…The papers detailed in this review differed in terms of the time course over which they measure these outcomes, with six documenting changes over the course of the individual sessions of an arts intervention [66,67,70,72,73,75] and six documenting longer-term changes over the entire course of an arts intervention [63,64,65,68,69,74] . HR and HRV were used most often as short term indicators of the effect of an intervention and statistically significant changes in HR and HRV were observed in all such studies [67,72,73,75] . One study measured HRV before and after the entire course of an intervention but reported no statistically significant changes [74] .…”

“…A study of 12 hospitalised patients with CVD and dementia found that a 30 minute MT session had a significant effect on HRV parameters recorded via ECG, namely an increase in HF, RMSSD and pNN50, and a decrease in LF/HF [73] . However, this study did not include a control and measurements were only taken over one session.…”

“…Additionally, 'interactive' MT sessions, during which the recipients are encouraged to sing and clap, have a greater effect on HR and HRV than 'passive' music interventions, in which recipients simply listen [75] . Considering that nine of the 13 studies were conducted in residential care [63,66,68,69,70,72,74,75,76] and four of them in a hospital [64,65,67,73] , the setting may well have had an effect on outcomes. Moreover, factors such as the musical background of participants [78] , or the severity of their dementia [79] have been shown to have an effect on the way in which they experience MT.…”