Title: MusiCare: Protecting Cognitive Functions and Wellbeing Using Music Therapy & Innovative Technology with an Aging Population
Funder: Dunhill Medical Trust

Abstract: Music therapy (MT) is a non-pharmacological intervention suitable for social prescribing that has been shown to provide significant benefits for individuals with cognitive decline living in care homes, enhancing social-cognitive functions and reducing behavioural symptoms (Brotons & Koger, 2000; Hsu et al., 2015; Zhang et al., 2017). However, RCT studies on the effectiveness of MT are scarce and often methodologically weak, with limited generalizability of results (Fusar-Poli, 2018; Fischer, 2019). In order to develop a robust empirical approach, endeavouring to probe the effectiveness of MT interventions when calibrated on participants’ needs, this study aims to provide convergent evidence based on behavioural measures and biomarkers. Furthermore, recent developments in robotic assistive technologies having shown potential in healthy +65 (Cooper et al., in preparation), we need to test their applicability to support MT in care-home settings. Therefore, we will investigate how these technologies could be integrated within the care routines associated with MT (musical games), to facilitate therapists and caregivers’ work, and potentially offer novel forms of interaction within communities (families etc.). Based on our recent research (Mangiacotti et al., 2019a), a 3-part project is proposed, with Studies 1 & 2 (three-arm RCT-design) comparing two types of 5-month-intervention with weekly sessions: i) one2one MT, ii) small-group active MT, with iii) standard care (control), which includes large group music-listening. The participants will be, for Study 1: healthy older adults, and for Study 2: participants with mild to severe cognitive impairment. Study 3 will investigate the benefits of a 2-month MT intervention combined with robotic assistive technology (QT robot–LuxAI) in participants with mild cognitive impairment living in care homes. Throughout the research, a pre/post design will be adopted, with data collected for variables successfully measuring MT effects in previous work: [i] neuropsychological standardised tests measuring general cognitive function, attention and executive functions; [ii] wellbeing measures assessing psychiatric behavioural symptoms, mood, social abilities, and quality of life; [iii] measure of autonomic regulation, Respiratory Sinus Arrhythmia (Thayer & Lane, 2009); [iv] Salivary cortisol/DHEA ratio (Biggio, Mostallino, 2013; Fancourt at al., 2016); [v] EEG: cortical entrainment measures (Di Liberto et al., 2015). The results will elucidate the relationship between different types of MT and bio-psychosocial-cognitive benefits in function of the cognitive impairment of the participant, highlighting also how MT could be adapted for social prescribing and community work. Furthermore, results will raise awareness on the feasibility of prevention programs to reduce negative impacts of cognitive ageing.

Lay abstract: The acceleration in the number of older people living with cognitive impairment or dementia has increased the need for simple, inexpensive interventions to improve the quality of life for such individuals and their families. Policy-makers sensitive to issues associated with mental-health challenges in aging have embraced social prescribing, and a wealth of research has flourished to study non-pharmacological forms of preventative intervention. Can music therapy (MT) be one of them? We know that music stimulates a range of cognitive and social functions. However, scientific studies assessing the value of MT for those who need support in later life are limited, and rigorous research is required to generate robust scientific evidence. The focus of this study is on developing novel forms of intervention for older adults who are healthy or experiencing mild-to-severe cognitive decline, aiming at [i] understanding whether MT could be used in preventive programs to support cognitive functions and wellbeing, [ii] identifying the best match between types of MT and levels of cognitive decline. Moreover, recent exciting developments of new robotic assistance technologies offer the opportunity to explore how such technologies may be used to contribute to older adults’ wellbeing when integrated within care routines to facilitate MT delivery, caregivers’ work or intergenerational communication (e.g. with family). Spanning across three studies, we will investigate the psychosocial benefits of 5-month MT interventions (one2one vs a more economical small-group MT) in healthy older adults and impaired older adults in care-homes (mild/severe), compared to standard care. This latter group will receive MT afterwards. Further, we will investigate whether robotic assistive technology may enrich our interventions and have additional benefits for the participants and translatability for community-based services/organizations. In order to measure these effects, psychological (cognitive functions, wellbeing, quality of life) and physiological (hormonal, cardiovascular and brain activity) measures will be compared before/after the intervention. Results will be delivered through a multi-disciplinary framework based on consolidated collaborations and pilot work, and by developing a previous study conducted in partnership with MHA care-homes UK, involving multiple stakeholders/specialists. The study will elucidate the relationship between different types of MT and benefits to participants’ wellbeing, cognitive functions and social engagement, as well as the impact of robotic assistive technologies in public health services and social care. Impact activities will raise community awareness of the effects of MT on reducing the risks of problems arising with aging, as recommended in the WHO/Europe report on Art and Health.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: GENERIC HEALTH RELEVANCE;MENTAL HEALTH;NEUROLOGICAL