Clinical Validation of a Cognitive Stimulation Platform for Individuals With Dementia - Musiquence
Phase: NA
Conditions: Dementia
Sponsor: Universidade da Madeira

  
  
  
  
  
Official Title of the Study: Clinical Validation of a Cognitive Stimulation Platform 
for Individuals With Dementia – Musiquence  
  
  
Unique Protocol ID: 9/CEUMA/2021   
Document Date: 27/05/2021  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
 
 

 

 

 
 
 
Study Protocol 
Dementia is a clinical syndrome characterized by a progressive and irreversible deterioration 
of cognitive functioning that impairs behavioral and functional domains. Within non-
pharmacological approaches, Cognitive Stimulation Therapy (CST) is the most studied and 
well-established intervention for individuals with mild to moderate dementia. The underlying 
assumptions behind cognitive-based interventions of CST are:  
1. IwD can benefit from cognitive stimulation if mobilized relatively preserved cognitive 
functions (e.g., crystallized abilities such as semantic memory and verbal skills);  
2.Even in advanced age, exposure to enriched environments (i.e., socially, and cognitively 
challenging) can enhance cognitive reserve and neuroplasticity.  
Concerning the first assumption of cognitive-based interventions (a1), it is known that even in 
moderate to advanced stages of dementia, musical memory is one of the abilities that remain 
intact. It is hypothesized that music processing abilities precede the development of lexical 
language functions. This hypothesis is corroborated by findings that demonstrate that IwD are 
still responsive to music even when unable to communicate verbally or recognize words. 
Additionally, music is frequently associated with life experiences. Also, literature has reported 
that memories associated with specific music would be recollected longer than memories with 
no association to music; this suggests that using music as a reminiscence element on cognitive 
stimulation programs can have a promising effect on cognition. According to the second 
assumption of CST (a2), facilitating an enriching environment for IwD using, for, music and 
reminiscence elements could impact cognitive reserve and neuroplasticity. 
In this context, Ferreira et al. developed a platform – Musiquence - that incorporates music 
and reminiscence in cognitive stimulation activities for IwD. Musiquence allows the 
gamification and personalization of 6 types of activities:  
•Reality Orientation – a quiz-like activity that includes date and time information.  
•Creative Drawings – a puzzle-like game in which the participant draws the missing pieces.  
•Activities of Daily Living (ADL) – a puzzle-like game in which the participants have to 
perform a set of chores (i.e., brush the teeth), and the missing pieces are completed with 
real physical objects (i.e., toothpaste).  
•Search Objects activity – exploration game in which the participants must find hidden 
images (e.g., cats) that are only visible through a virtual magnifying glass. 
•Knowledge Quiz – participants must select the correct answer to a question among 
incorrect ones. 
•Association activity – participants must categorize the items according to the 
instructions. For example, separate cars from motorcycles and locate them in the correct 
container. 

The platform is compatible with different technologies that allow adaptation to the patients' 
needs (motor difficulties, vision problems, tremble). Cognitive stimulation content can be 
personalized to the user since the caregivers can add text, images, and music when creating 
the tasks. 
The present study aims to clinically validate the Musiquence platform – a platform that allows 
the incorporation of music and reminiscence in cognitive stimulation activities for individuals 
with dementia.  
Inclusion Criteria: 
• 
Mild to moderate stage of dementia (with formal diagnosis); 
• 
Ability to move upper limbs; 
• 
Maintained auditory acuity; 
• 
Relatively preserved language skills. 
Exclusion Criteria: 
• 
Moderate to severe depressive symptomatology; 
• 
Moderate to severe anxious symptomatology; 
• 
Bedridden. 
Procedure 
Individuals with dementia who meet the previous criteria will perform a 14-session cognitive 
stimulation program, using Musiquence. The program will be implemented in an augmented 
reality format. 
To this end, sociodemographic data will be collected from all participants (age, education, 
diagnosis, profession) for sample characterization purposes. Data on the cognitive, emotional, 
functional, and quality of life of the participants will also be collected, through 
neuropsychological assessments, the participants performance in the cognitive stimulation 
platform used (response time, number of errors, distance from the target stimulus). 
Neuropsychological Assessment 
The neuropsychological assessment protocol will be performed in three different timings: 
• Pre-intervention: baseline assessment, immediately before the intervention. 
• Post-intervention: immediately after the intervention. 
• Follow-up: 3 months after the intervention. 
The neuropsychological assessment protocol consists of a set of scales commonly used with 
the Portuguese population and aims to assess different domains: 
1. Cognition 
 • Mini-mental state examination (MMSE; Folstein et al., 1975)  
• Alzheimer’s Disease Assessment Scale – Cognitive Scale (Adas-Cog; Rosen et al., 1984)  

• Kettler Laurent Thierrau (KLT) (Kettler et al., 1964)  
• Symbol Search and Digital Symbol Coding from Weschler Adult Intelligence Scale – Third 
Edition (WAIS-III; Weschler, 1997; 2008) 
• Semantic and Phonemic Verbal Fluencia (SVF  and PVF; Cavaco et al., 2013)  
2. Humor/Emotion 
 • Cornell Scale for Depression in Dementia (Alexpulos et al., 1988)  
• Rating Anxiety in Dementia (RAID; Shankar et al., 1999)  
3. Functionality 
 • Adults and Older Adults Functional Assessment Inventory  (IAFAI; Sousa et al., 2013)  
4. Quality of Life 
 • Quality of Life – Alzheimer’s Disease (QoL-AD, Logsdon et al., 1999)