Noise promotes disengagement in dementia patients during non-invasive neurorehabilitation treatment

Introduction:The lack of engagement and the shortage of motivation and drive, also referred to as apathy, negatively impacts the effectiveness and adherence to treatment and the general well-being of people with neurocognitive disorders (NCDs), such as dementia. Methodology:The hypothesis raised states that the engagement of people with dementia during their non-invasive treatments for NCDs is affected by the noisy source levels and negative auditory stimuli present within environmental treatment settings. An online survey was conducted with the study objectives to assess 1) the engagement levels of dementia patients while interacting with others at home versus in therapy facilities, 2) the emotions perceived when interacting with people at home compared to therapy sessions, 3) the perceived loudness of the environment at home versus in therapy facilities, and 4) which source sounds negatively impact the patients at home and during therapy sessions. A purposive sampling (n=62) targeting relatives, friends, and caregivers of dementia patients was conducted via online community forums in the DACH region. Moreover, a recording session was conducted in a psychotherapist’s office to verify the answer tothe questionnaire on the noise sources perceived in therapy facilities. Results and Discussion:The raised hypothesis that disruptive auditory stimuli and noise levels influence the engagement levels of demented individuals during treatment is confirmed as the engagement is affected by the perceived noise disruptions when comparing perceived noise levels and engagement at home to those in treatment facilities.Significant statistical results were found between the lower engagement of demented individuals when interacting with people during therapy sessions compared to higher engagement in-home interactions. Furthermore, negatively perceived sound sources can be found in both therapy facilities and home settings. The noise sound sources identified, such as human voices, household appliances and household noises, while recording inthe psychotherapist’s office align with the questionnaire responses received on this topic. The findings indicate that the perceived heightened noise levels in therapy facilities stand in correlation with the lowered engagement rate perceived during the therapy session compared to the lower noise level and higher engagement encountered when demented individuals interact at home. Conclusion:If the identified noise elements are masked or replaced by other auditory stimuli that promote a soothing soundscape, the original disturbances encountered during therapy and the lack of engagement can possibly be minimized. Further studies need to be conducted in the prototyping of a noise intervention tool to analyze the impact on lack of engagement through noise disturbances.Keywords. Noise, Engagement, Dementia, Therapy, Apathy.INTRODUCTIONNeurocognitive disorders (NCDs) are a steadily rising global public health concern. In 2020, around 50 million people worldwide lived with major NCDs, specifically dementia, with nearly 10 million new cases per year1NCDs can be found in many diseases, including Alzheimer, Parkinson, Huntington, and Creutzfeldt-Jakob (Reith, 2018). The causes of NCDs are typically associated with advanced age. Still, it can occur from incidents such as traumatic brain injuries, infections, thyroid problems, damage to the blood vessels, and other causes (Kane et al., 2017), increasingly affecting a wide range of people and age groups. Successful treatment methods are limited and can be split into two main categories, invasive and non-invasive methods.Invasive treatment methods are surgical procedures, such as Deep Brain Stimulation (DBS), a neurosurgical procedure in which a neurotransmitter is placed in the brain to send electrical 1World Health Organization, Dementia [website] https://www.who. int/news-room/fact-sheets/detail/dementia(accessed 12 April 2021)