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Abstract

Music therapy is emerging as an inexpensive, non-pharmacological alternative to drug therapy in the treatment of Alzheimer’s disease and related dementias. Several studies have identified the potential of music therapy to improve cognitive functions in patients at all stages of Alzheimer’s disease progression. However, existing reviews do not specifically evaluate the many music therapy techniques available from the perspective of a professional musician. Methods of music therapy vary in music choices, familiarity and level of participation. As such, this review aimed to systematically evaluate the impact of music therapy on cognitive function and any parameters that maximise efficacy. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines with studies published between 2010 and 2025 across nine databases. Thirty-four major studies examined the effects of music therapy on cognition in patients with Alzheimer’s disease and related dementias. Across the literature, music therapy significantly improved cognition, attention and executive function, self-awareness and perception, and short-term, working, verbal and motor memory. Thus, recent literature demonstrates beneficial impacts of music therapy on cognition in Alzheimer’s disease. Active music therapy techniques were the most effective, involving singing and rhythm exercises, and familiar and preferred music. Ultimately, music therapy is recommended as an early intervention in Alzheimer’s disease and mild cognitive impairment to prevent further cognitive decline.

Keywords

Alzheimer’s disease cognition dementias memory music therapy

Introduction

Alzheimer’s disease

Dementia is a growing source of morbidity and mortality worldwide, with a majority of cases being caused by Alzheimer’s disease (AD). In 2021, 57 million people globally had a diagnosis of dementia, with almost 10 million new cases each year since (World Health Organization, 2025). Of these cases, about 60%–80% are attributed to the neurodegenerative Alzheimer’s disease (Alzheimer’s Association, n.d.), characterised by senile plaques and neurofibrillary tangles in the brain (Moloney et al., 2021; Otero-Garcia et al., 2022).

AD causes pathological aggregation of beta-amyloid proteins into neuritic plaque structures which disrupt neural function and contribute to cognitive impairment (Breijyeh and Karaman, 2020), where cognition is defined as the collective mental processes of acquiring knowledge, including perception, recognition and reasoning. Furthermore, neurofibrillary tangles are caused by accumulations of hyper-phosphorylated, toxic forms of tau protein (Hampel et al., 2018). Synaptic proteins present in the CSF may be indicative of synapse damage causing memory impairment in the early stages of AD (Breijyeh and Karaman, 2020). These three major features of AD represented in Figure 1 contribute to symptomatic impairments of episodic memory structures which are crucial for ongoing learning (Crystal and Glanzman, 2013; Jacobsen et al., 2015).

Figure 1.

Diagram of the neuropathological structures of Alzheimer’s disease that trigger neuronal apoptosis and cause impairment of memory and cognitive functions.

In physiological ageing, natural processes induce cognitive regression due to losses in grey matter to the prefrontal cortex, hippocampus and cerebellum as well as white matter integrity and functional connectivity (Ferreira and Busatto, 2013; Hafkemeijer et al., 2012; James et al., 2020; Koops et al., 2020; Neufeld et al., 2022; Ramanoël et al., 2018). This is exacerbated by pathological hypoplasticity of the brain in AD due to decreased levels of neuroplasticity proteins (Visser et al., 2022). An amalgam of physiological and pathological hypoplasticity causes symptomatic memory loss, cognitive decline and impaired episodic memory of AD (Scheff et al., 2006).

Rate of cognitive decline is modulated by factors including nutrition, physical activity and cognitive training (Colita et al., 2024; Dominguez et al., 2021; Gil-Peinado et al., 2023; Hsu and Bai, 2022; Wang et al., 2024), and the traditional health risk factors of diabetes mellitus, hypertension and cardiovascular diseases (Devassy et al., 2023; Gil-Peinado et al., 2023; Pacholko and Iadecola, 2024; Shetty and Hari, 2025; Wu et al., 2025). For treatment, cognitive stimulation has been shown to increase general cognitive function in elderly populations with healthy cognition, mild cognitive impairment or dementia (Carbone et al., 2021; Faria et al., 2024; Gamito et al., 2019; Gómez-Soria et al., 2023; Woods et al., 2023). This article proposes music therapy as one such cognitive intervention therapy to slow the progression of AD with associated functional and emotional benefits.

Music therapy in AD and related dementias

Existing pharmacological treatment plans for AD and related dementias are complex and limited in efficacy with many potential side effects (Zucchella et al., 2018). As such, various non-pharmacological treatment options for AD and related dementias have emerged. Exercise intervention is well established alongside drug therapies for enhanced improvements in cardiovascular performance, mood and cognitive performance (Poulos et al., 2017). However, many elderly patients experience limited mobility and may have difficulties accessing exercise interventions. Consequently, recent attention has turned to potentially more enjoyable and relaxing non-pharmacological interventions. These include aromatherapy, art, massage, meditation and music therapies (Zucchella et al., 2018).

Long-term musical training has been shown to influence both physiology and functionality of the brain (Gaser and Schlaug, 2003; Groussard et al., 2014; James et al., 2020; Rus-Oswald et al., 2022; Zatorre and McGill, 2005). Cross-sectional studies have observed microstructural plasticity in response to musical training, responsible for correlational increases in grey matter volumes of musicians versus non-musicians. Grey matter volume is increased in regions including the primary motor, somatosensory, parietal and temporal cortices as well as the cerebellum (Gaser and Schlaug, 2003; Han et al., 2009; Munte et al., 2002; Penhune, 2019; Reybrouck et al., 2021; Schlaug et al., 1995; Steele et al., 2013; Zuk and Gaab, 2018). Furthermore, models of general neuroplasticity hypothesise that after primary cortical growth, functional changes take priority for increased efficiency and ability (Lövdén et al., 2013; Wenger et al., 2017). Thus, it seems likely that the acquisition of musical abilities would also follow this model of neuroplasticity, with initial changes in volume and subsequent improvements in functional capacity (Leipold et al., 2021; Liang et al., 2016; Medina and Barraza, 2019; Olszewska et al., 2021). The observed effects of long-term musical training on brain anatomy and function have contributed to the emergence of music therapy as a non-pharmacological intervention for those with declining cognitive functions and memory.

Music therapy (MT) and music-based therapeutic interventions have been implemented across a range of contexts including psychiatric, neurological and palliative care (Warth et al., 2015). It appears to have extensive benefits for pain, anxiety and mood disturbance reduction as well as improved quality of life (Archie et al., 2013). MT often involves patients working with therapists to actively engage in activities such as singing, improvisation, music-listening and rhythmic exercises (Schmid et al., 2018).

Various music therapy methods

The existing music therapy protocols for AD are typically classified as either passive music therapy (PMT), with patients listening to music, or active music therapy (AMT), where patients engage in musical tasks (Warth et al., 2015). Passive music therapy (PMT) arises from the ‘Mozart Effect’ (Rauscher et al., 1993) which associates classical music listening with improved spatial reasoning skills compared to silence. PMT often involves therapist-directed music listening with limited patient input (Gómez-Gallego et al., 2021; Lynch et al., 2021; Papatzikis et al., 2024; Street and Jaschke, 2024). Furthermore, the effects of PMT are potentially modulated by patient engagement (Gómez-Gallego et al., 2021; Maguire et al., 2015; Särkämö et al., 2014) and music familiarity or preference (Arroyo-Anlló et al., 2013; El Haj et al., 2012).

In contrast, active music therapy (AMT) techniques are widespread throughout recent literature and encourage active engagement in the creation, analysis and understanding of music (Hendry et al., 2022; Li et al., 2015; Moss et al., 2021; Schneider et al., 2022; Tamplin et al., 2019). The techniques used reflect those of professional music pedagogy, including singing, rhythm-based exercises (Ahokas et al., 2025; Frischen et al., 2019; Ghetti et al., 2024; Janzen et al., 2021) and movement-based activities (Ruotsalainen et al., 2022; Zhang et al., 2025). Although varied across studies, most AMT practices share these key components.

Finally, the familiarity and preference of music used in MT has observable impacts on cognition and memory formation, countering the popular ‘Mozart effect’ theory that advocates for the cognitive benefits of generic classical music (Ara and Marco-Pallarés, 2021; Bleibel et al., 2023; Jagiello et al., 2019; Jakubowski and Francini, 2023; Li et al., 2024; Silva et al., 2022; Zaatar et al., 2024). The effect of familiarity is particularly pronounced with patient choices (Bidelman and Feng, 2025; Castro et al., 2020; Fuentes-Sánchez et al., 2022).

Assessment of cognition

The effects of MT on cognition can be assessed by operationalising cognition as a measurable outcome across the domains of general cognition, orientation, short-term and working memory, verbal memory, attention and executive function (Ceccato et al., 2012; El Haj et al., 2015; Giovagnoli et al., 2017; Innes et al., 2017; Lyu et al., 2018; Särkämö et al., 2014). Cognitive function is evaluated with standard instruments including the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Cognitive Abilities Screening Instrument (CASI), Montreal Cognitive Assessment (MoCA) and Neuropsychiatric Inventory (NPI) (Arroyo-Anlló et al., 2013; Gómez-Gallego and Gómez-García, 2017; Li et al., 2015; Lyu et al., 2018; Miyazaki and Mori, 2020; Miyazaki et al., 2020; Narme et al., 2014; Särkämö et al., 2014, 2016; Wang et al., 2018). The MoCA evaluates mild cognitive impairment (MCI) in those at risk of AD, testing orientation, short-term memory, executive function, language, abstraction and attention (Islam et al., 2023). Similarly, CASI assesses attention, orientation, short- and long-term memory and verbal fluency (Teng et al., 1994). Finally, the Barthel Index assesses capability for complex daily activities such as feeding, bathing, dressing and mobility (Gómez-Gallego and Gómez-García, 2017). These assessments are also often combined with the Neuropsychiatric Inventory (NPI), which measures changes in Behavioural and Psychological Symptoms of Dementia (BPSD) across 12 symptom domains including agitation, delusions and depression (Kaufer et al., 2000). Throughout the literature, multiple tools are available to measure and evaluate impacts of MT on cognitive function and BPSD in AD patients.

Overall, recent reviews on this topic have largely addressed the emotional and psychosocial therapeutic benefits of MT for patients with AD and similar dementias (Fang et al., 2017; García-Navarro et al., 2022; Gassner et al., 2022; Ito et al., 2022; Leggieri et al., 2019; Moreira et al., 2018; Särkämo, 2018). However, fewer reviews substantiate the effect of MT on reduced cognitive decline in AD patients (Fang et al., 2017; Leggieri et al., 2019; Moreira et al., 2018). As existing drug therapies already minimise cognitive decline in AD, it is important to evaluate whether MT has enough potential to justify further research and investment. Furthermore, existing reviews do not yet examine the effects of various available MT techniques from the perspective of a professionally trained musician. Ultimately, this review endeavours to provide fresh perspective on the potential cognitive benefits of MT and identify the variations in methodology that may cause conflicting results.

Methods

The literature search was conducted across nine databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria for systematic reviews (Page et al., 2021). Search terms were strictly ‘(Alzheimer’s disease OR dementia) AND (music therapy) AND (cognition)’ for PubMed, ProQuest, Cochrane, EBSCO, ScienceDirect, Wiley, Web of Science, Embase and Informit databases. The search was limited to title and abstract mentions in publications between 2010 and 2025. At the recent search in August 2025, an initial 468 studies were identified alongside 14 from independent searches.

Studies were screened independently by two reviewers for selection and data collection, inclusive of randomised controlled trials specific to music therapy while excluding other non-pharmacological interventions or mixed therapies. The results of screening are outlined in Figure 2, with full inclusion and exclusion criteria listed in Figure 3. Reviewers independently extracted details of the MT methods and their relative effect sizes while assessing for potential bias. Studies were indexed by general effect, aspects of cognition assessed, demographic of patients and cognitive measures tested, seen in Supplemental Appendix 1.

Figure 2.

PRISMA flowchart with overview of screening process (Page et al., 2021).

Figure 3.

Outline of the full inclusion and exclusion criteria for PRISMA screening.

Results

This search identified 34 major studies assessing impacts of MT on cognition in patients with AD and related dementias. From an initial 482 studies, 183 were removed as duplicates and another 209 eliminated during title and abstract screening. Five further studies were unable to be retrieved, and a final 29 studies were excluded during full-text screening for reasons specified in Figure 3. Studies were excluded for incomplete text, deviation from dementia, or if they combined MT with other non-pharmacological therapies. Thus, any conclusions drawn from this review address the cognitive effects of purely musical therapies in patients with AD and related dementias. Studies across the literature were susceptible to bias by publication, responders and interviewers. These were accounted for in the reporting of sample sizes, limitations in study design and cross-examination.

Discussion

The forthcoming discussion will outline the effect of MT on the specific components of cognition, general cognition, aspects of memory, the counterargument and the different methods of MT impacting cognition.

Effects on components of cognition

Across 34 identified studies, 28 observed improvements in aspects of cognitive function including attention and executive function, short-term, working, and episodic memory (Moreira et al., 2023; Särkämö et al., 2014), autobiographical memory and self-awareness (Arroyo-Anlló et al., 2013; El Haj et al., 2012; Fraile et al., 2019), verbal memory and fluency (Palisson et al., 2015; Zhang and Liu, 2020), and motor memory (Moussard et al., 2014). In addition to cognitive function, several studies examined the impact of music therapy on behavioural and psychological symptoms of AD as secondary outcomes of MT intervention.

Two studies stratified sections of the MMSE, differentiating improvements into various cognitive domains after either singing or music-listening interventions (Moreira et al., 2023; Särkämö et al., 2014). Across these studies, improvements were observed in autobiographical, episodic and working memory, as well as attention and executive function. Although effect sizes were moderate, the benefits of MT were statistically significant for multiple aspects of cognition. Similarly, Gómez-Gallego and Gómez-García (2017) reported improved orientation and memory, modulated by the familiarity of the music played.

Executive function and working memory also improved (Miyazaki et al., 2020; Särkämö et al., 2014), measured by the FAB and MMSE-Japan. However, Miyazaki et al. (2020) denied significant effects on orientation and observed benefits modulated by baseline cognitive impairment as measured by MMSE scores. Regardless, Miyazaki et al. (2020) demonstrated significant improvements in the overall MMSE-J and FAB scores when comparing MT with a control, thus confirming the beneficial effects of MT on general cognition and executive function.

A study series confirmed beneficial impacts of music on executive function (Innes et al., 2017, 2018), examining Kirtan-Kriya meditation and MT as potential therapies for cognitive decline. Like previous studies, they observed significant improvements in memory and cognitive functions following both meditational and musical therapy. Furthermore, Innes et al. (2018) reported unexpectedly neuroprotective actions of plasma amyloid-ß. Finally, Satoh et al. (2015) also observed benefits on attention and psychomotor speed. Evidently, MT has widespread benefits for individual components of cognitive function in patients with AD and related dementias.

Assessment of general cognitive function

General cognitive function was largely measured using cognitive tests including the MMSE, MoCA, CASI and Barthel Index. Thirteen studies assessed general cognition with the MMSE and MoCA before and after MT (Chéour et al., 2023; Doi et al., 2017; Gómez-Gallego and Gómez-García, 2017; Hong and Choi, 2011; Lyu et al., 2018; Maguire et al., 2015; Miyazaki and Mori, 2020; Miyazaki et al., 2020; Moreira et al., 2023; Särkämö et al., 2014; Tang et al., 2018; Wang et al., 2018; Zhang and Liu, 2020). Four studies used the FAB or a variant (Arroyo-Anlló et al., 2013; Miyazaki and Mori, 2020; Miyazaki et al., 2020; Särkämö et al., 2014). Two studies chose the MoCA over MMSE to measure cognition after either general singing (Wang et al., 2018) or karaoke-based MT (Miyazaki and Mori, 2020), citing its sensitivity to MCI within the normal range of MMSE. Both observed significantly increased MoCA scores following treatment, indicating improved cognition and reduced MCI. Thus, it appears that a variety of instruments are effective for functional testing of cognitive impairment, although the MMSE and MoCA are the most standardised and widely used tests. A combination of two or more cognitive tests is recommended for optimal breadth and validity of results.

Effect of music therapy on MMSE scores

Among nine studies that measured MMSE, many reported total scores over stratification by cognitive domain. Miyazaki et al. (2020) observed improved MMSE-J and FAB scores following rhythmic musical training with drums and improvisation. Doi et al. (2017) observed similar improvements after 40 weeks of rhythmic, score-reading and improvisation training on percussion instruments. Wang et al. (2018) also observed MMSE and MoCA score improvements following singing training in patients with mild AD. Finally, a short study by Maguire et al. (2015) also reported improved MMSE scores after vocal training in patients with mixed dementias.

Two other studies also tested MMSE scores but found only stabilising effects of MT on cognitive function when compared to normal decline in control groups (Arroyo-Anlló et al., 2013; Tang et al., 2018). Despite marginal effects on cognition, Tang et al. (2018) observed diminished apathy in mild-moderate dementia patients following an intervention of clapping games, xylophone playing and singing nostalgic songs. Likewise, Arroyo-Anlló et al. (2013) found stabilising effects of listening-based MT on MMSE and Frontal Assessment Short (FAS) scores, though the music had to be familiar to achieve these effects. However, it should be noted that cognition was a secondary focus in these studies and not stratified in evaluation as with studies that primarily focused on the cognitive benefits of MT.

Impacts on memory

AD is a debilitating disease that targets memory, especially episodic, and important functions of language and speech. Memory is crucial in forming and maintaining relationships and preserving a sense of self. Music holds great potential for memory enhancements in youth and elderly alike, but existing research is rife with methodological inconsistencies which make it difficult to come to a definitive conclusion.

Two main areas of affected memory were identified in the literature for dementia: autobiographical and verbal memory. Studies on autobiographical memory tended to implement prolonged therapy, while those exploring verbal memory incorporated musical association in the short-term memory encoding stage. The latter were included to provide insight into the biological feasibility of improved memory via encoding associated with music. A third impacted aspect of memory was auditory-motor memory. Finally, one study addressed ‘musical memory’, operationalised as the recognition of newly introduced music, compared with long-known musical items.

Autobiographical memory

Three studies addressed the impact of MT on autobiographical memory, or the memory of personal experiences that constitute self-consciousness (Arroyo-Anlló et al., 2013; El Haj et al., 2012). El Haj et al. (2012) tested autobiographical recall in patients with mild AD immediately after exposure to either Vivaldi’s ‘Four Seasons: Spring’, compared with a familiar and favoured choice, or a silent control. Autobiographical recall was significantly improved when preceded by familiar music over ‘unfamiliar’ Vivaldi music, while both conditions surpassed silence. They also noted musical memory sparing in AD, which demonstrates a robust influence of musical association on long-term memories.

Similarly, Arroyo-Anlló et al. (2013) observed improvements in autobiographical memory following long-term MT. Forty participants with AD engaged in listening-based MT which stabilised MMSE and FAS scores and improved ‘self-consciousness’, a constitute of autobiographical memory (El Haj et al., 2012). Thus, these two studies demonstrate the benefits of MT on general cognition and sense of self.

Verbal memory

Verbal memory is another aspect of cognition that reportedly improves with musical association. Two studies linked musical association with improved verbal recall and fluency in the short term (Palisson et al., 2015; Simmons-Stern et al., 2012), and two others in the long term (Lyu et al., 2018; Pongan et al., 2017).

Simmons-Stern et al. (2012) examined content recall and recognition in two music conditions: sung text and spoken text. Twelve participants with AD and 17 healthy controls memorised either sung or spoken text. General recall was better with musical association than without, although specifics were no better remembered sung than spoken. The dual-processing model of thinking explains how musical association at encoding may form robust but vague representations of information outside the medial temporal lobe (Gronchi et al., 2024). More specific content would be stored in the temporal lobe, except for damages incurred in AD onset. Jacobsen et al. (2015) confirmed this with fMRI, observing transference of music-associated information directly into implicit memory, thus bypassing the temporal lobe, responsible for episodic memory. As such, musical association with learning may facilitate better verbal memory by representing information outside a faulty temporal lobe.

The enhancing effect of music on verbal memory was observed in a study evaluating visual and musical associations against a control (Palisson et al., 2015). Text was set to Beethoven’s ‘familiar’ ‘Ode To Joy’, contrasting with unfamiliar children’s songs used by Simmons-Stern et al. (2012). Both studies observed better free recall of content in AD patients with musical association over visual or silent conditions. Comparisons suggest that these effects on verbal memory were not contingent on the familiarity of the music. Besides this, Beethoven’s ‘Ode to Joy’ (Palisson et al., 2015), though memorable, is not definitively well-known today, so was unlikely to impact validity of the conditions. Evidently, there is a clear effect of musical association on enhanced verbal recall in AD patients.

Three further studies evaluated verbal recall and fluency in the context of long-term music-linguistic therapy, observing improvements across 3 months (Lyu et al., 2018; Pongan et al., 2017; Zhang and Liu, 2020). Lyu et al. (2018) took methodology from previous studies, separating MT, spoken lyric-reading and control groups, while Pongan et al. (2017) countered experimental singing MT with a painting control group. Both Lyu et al. (2018) and Zhang and Liu (2020) demonstrated beneficial impacts of MT on the linguistic aspects of cognition including immediate and delayed verbal recall, fluency and memory in patients with mild to severe AD. However, the designs of both studies obscured any discrete effects of music-listening and active singing. In contrast, Pongan et al. (2017) observed only stabilising effects of singing MT on verbal recall, compared to diminishing cognition in the painting group. Stabilisation is still preferrable to cognitive decline but likely suggests marginal and inconsistent benefits. Considering these results, outcomes from Lyu et al. (2018), Palisson et al. (2015) and Simmons-Stern et al. (2012) should be weighted conservatively. Still, evidence suggests a beneficial impact of MT and musical association on verbal memory and fluency.

Motor memory

Finally, auditory-motor memory is a seldom researched aspect of cognition. Moussard et al. (2014) tested patients with mild AD and healthy controls on gesture-sequence recall associated with either musical accompaniment or a metronome. The musical accompaniment was French-baroque style dance music that was familiar to these participants in Quebec. Musical association during encoding improved rates of memory in AD participants but not in the healthy controls. This effect is dependent on its role in encouraging attention and emotional attachment in participants, thereby increasing the chance of memory retention. As such, musical association is potentially beneficial in dual-task training therapy for attention control (Chen and Pei, 2018). Furthermore, motor memory may follow similar encoding pathways to other forms of memory explored in this review (Moussard et al., 2014) but favours episodic memory retention in participants with existing cognitive impairments (Jacobsen et al., 2015). From this, further research is recommended into the effects of MT on motor memory cognition in patients with AD. Evidently, music strongly recruits brain regions associated with motor functions (Moussard et al., 2014), thus reinforcing learning and motor memory in patients with AD and similar dementias.

Counter cognitive effect

Despite many studies suggesting significant cognitive benefits of MT, five major studies reported negligible effects (Giovagnoli et al., 2017; Hsiung et al., 2015; Li et al., 2015; Liesk et al., 2015; Narme et al., 2014). These studies observed insignificant or absent improvements in cognition when compared to controls.

Li et al. (2015) enrolled 41 participants with mild AD in music-listening MT using Mozart’s ‘Sonata for Two Pianos in D Major’ KV448 and Pachelbel’s ‘Canon in D’, a popular wedding piece. General cognitive ability was measured with CASI before and after MT, observing only stabilisation compared to the control. Despite this, they identified enhanced abstracting abilities after MT that may augment other cognitive improvements. Limitation included the use of generic classical music over personalised choices, which may explain some deviation from other studies.

Another three studies reported negligible effects on general cognition and memory in mild to moderate AD but observed behavioural and psychological symptomatic (BPSD) improvements (Giovagnoli et al., 2017; Hsiung et al., 2015; Narme et al., 2014). Giovagnoli et al. (2017) found that both cognitive training and neuroeducation conditions improved episodic memory and mood, while free-structured MT did not. In contrast, Narme et al. (2014) juxtaposed cooking therapy against a combined active-receptive MT where participants played percussion instruments and listened to nostalgic pop songs. Meanwhile, Hsiung et al. (2015) had no control group, but implemented a traditional structured MT protocol. All three studies observed no significant improvements in cognitive function but were limited by study designs that assigned other non-pharmacological interventions as controls, rather than continuing normal care for more valid results.

Secondarily, these studies observed improvements in emotional and behavioural outcomes. Together, these studies demonstrated benefits of MT on mood, emotional state and agitation. Narme et al. (2014) also found a reduction in NPI scores after undergoing MT, indicating a reduction in behavioural symptoms. Thomas et al. (2017) concurred with a large-scale study on the effects of a specialised Music and Memory programme involving tailored music playlists. 12,905 MT participants and 12,811 controls were compared for significant differences in mood, BPSD and use of antipsychotics and anxiolytics following the MT programme. The experimental group demonstrated reduced use of antipsychotics and anxiolytics as well as improved BPSD and mood (Thomas et al., 2017). Ultimately, these studies suggest significant benefits of MT on the behavioural and emotional symptoms of AD and related dementias.

The emotional and BPSD benefits of MT were also supported by secondary findings of many previously mentioned studies that observed cognitive improvements due to MT (Gómez-Gallego and Gómez-García, 2017; Gómez-Gallego et al., 2021; Innes et al., 2018; Lyu et al., 2018; Särkämö et al., 2014; Satoh et al., 2015; Wang et al., 2018). Two studies did counter this, reporting no improvements in either cognition or BPSD symptoms (Ceccato et al., 2012; Li et al., 2015).

Ultimately, several studies collectively suggest a significant effect of MT and musical association on improved cognitive functions. Three major studies countered these with no significant improvements, only small stabilising effect sizes, in cognitive function following MT. Notably, a wide variety of MT techniques were used across these studies, which may have confounded the observed effects on cognition. Methods varied mainly in active vs receptive MT, familiarity of the music and in the types of musical activities included in active MT.

Evaluating various music therapy methods

The current literature inadequately addresses the comparative effectiveness of various MT methods on cognitive benefits in patients with Alzheimer’s Disease. As such, this section evaluates the different MT methods, their impacts on cognition in AD and any associations with music pedagogy. The vast range of existing exercises that encompass PMT and AMT will be explored here and compared with methods used to train young and elite musicians.

Passive music therapy

Several studies have evaluated cognitive benefits of PMT in patients with AD, including six in recent years (Arroyo-Anlló et al., 2013; El Haj et al., 2012; Gómez-Gallego and Gómez-García, 2017; Gómez-Gallego et al., 2021; Lyu et al., 2018; Maguire et al., 2015; Särkämö et al., 2014). Two key studies differentiated between the effects of passive and active therapies on cognition, comparing both conditions to controls (Gómez-Gallego et al., 2021; Särkämö et al., 2014). Särkämö et al. (2014) reported marginal cognitive improvements following PMT, while Gómez-Gallego et al. (2021) observed only stabilisation of neuropsychiatric symptoms, without significant cognitive benefits. Other studies compounded PMT and AMT, confounding any isolated impacts (Lyu et al., 2018; Narme et al., 2014). Finally, Maguire et al. (2012) found AMT to be more effective than PMT in improving MMSE scores but lacked a control condition for comparison.

Two further studies assessed autobiographical memory and self-consciousness in the context of PMT with relation to music familiarity (Arroyo-Anlló et al., 2013; El Haj et al., 2012). El Haj et al. (2012) observed that preferred music outperformed both general classical music and silence in autobiographical recall and self-consciousness. Similarly, Arroyo-Anlló et al. (2013) noted that familiar music in PMT enhanced self-consciousness, potentially augmenting autobiographical memory and cognition (Martin, 2023; Mograbi et al., 2024; Palmier-Claus et al., 2013), but did not compare against a silent control. In contrast, Lyu et al. (2018) combined singing and listening in therapy resulting in improved verbal fluency and linguistic recall but was also unable to isolate PMT. Overall, six studies demonstrate modest and heterogenous effects of purely passive MT on cognition in AD and related dementias.

Li et al. (2015) fully rejected any improvements in general cognition or behavioural symptoms following twice-daily classical music listening, though abstract reasoning improved. As abstraction constitutes reasoning, flexibility and higher executive functions, this may partially account for improved CASI scores across other studies (Guarino et al., 2019; Li et al., 2015; Silva et al., 2022; Yoshiura et al., 2011). Furthermore, studies on PMT vary greatly in testing methods and experimental conditions, yielding contentious outcomes on general cognition. The cognitive benefits of the ‘Mozart effect’ may conversely reflect emotional or psychological influences in and beyond AD (Blasco-Magraner et al., 2021; Gao et al., 2024; Snowdon, 2021; Vincenzi et al., 2022).

Active music therapy

Across 13 studies on AMT, most featured structured sessions of active MT involving singing, clapping, movement to music and music-based quizzes (Giovagnoli et al., 2017; Gómez-Gallego and Gómez-García, 2017; Gómez-Gallego et al., 2021; Li et al., 2015; Lyu et al., 2018; Maguire et al., 2015; Palisson et al., 2015; Pongan et al., 2017; Särkämö et al., 2014; Satoh et al., 2015; Simmons-Stern et al., 2012; Tang et al., 2018; Wang et al., 2018). Of these, 11 studies reported positive effects of AMT on aspects of cognition, while 2 studies observed only stabilisation of cognitive decline in mild to moderate AD with no effect in severe AD (Giovagnoli et al., 2017; Hsiung et al., 2015). Finally, another study observed individual but no group significance (Li et al., 2015). Evidently, AMT has some benefits on cognition in AD patients, although discrepancies should be resolved with further testing of various therapy techniques.

Several studies featured unique features comparable with music pedagogy, such as professional choral direction (Pongan et al., 2017), musical theory (Maguire et al., 2015), karaoke (Satoh et al., 2015), educational lyrics (Palisson et al., 2015; Simmons-Stern et al., 2012) and notably a structured performance (Pongan et al., 2017). Significantly, the only study with no improvements in cognition featured a free-structured AMT method, which may account for the contention (Giovagnoli et al., 2017). Ultimately, variations in AMT methods may preclude direct comparison but contribute to a growing repertoire of available therapy techniques.

Five additional studies explored the benefits of AMT in broader cognitive decline (Ceccato et al., 2012; Chen and Pei, 2018; Doi et al., 2017; Miyazaki and Mori, 2020; Miyazaki et al., 2020). In mild to moderate AD, improved outcomes included MMSE (Doi et al., 2017), frontal function, inhibitory control (Miyazaki and Mori, 2020), executive function, auditory processing, working memory, verbal skills and dual-task performance (Chen and Pei, 2018; Miyazaki et al., 2020). Beyond AD, patients with general dementia benefitted from movement and rhythm-based MT in attentional and prose memory (Ceccato et al., 2012). Methods such as rhythm augmentation and diminution, call-and-response, improvisation and dual-task exercises were effective. Evidently, the same techniques effective for AD could also be used for other dementias and prophylactically before onset.

Overall, the literature supports the benefits of PMT, especially music listening, on minimising the cognitive and emotional symptoms of AD. However, AMT demonstrates greater effects in AD patients and those at risk of developing AD and other dementias. Currently, the most effective AMT methods are structured sessions involving singing, rhythmic exercises and movement to music, while free-form sessions of independent sound creation and improvisation have less impact.

Preferred (familiar) versus non-preferred (unfamiliar) music

A final key variation in MT methods is the familiarity and personal preference of music used in therapy. Several studies suggest that familiar music is experimentally more impactful on cognition and memory formation than generic classical music, and stronger still with personal choices made by patients.

Only two studies explicitly compared the effects of familiar versus unfamiliar music in AD patients (Arroyo-Anlló et al., 2013; El Haj et al., 2012). Both observed superior cognitive outcomes with familiar music over unfamiliar, though Arroyo-Anlló et al. (2013) observed smaller effect sizes bordering on stabilisation. In El Haj et al. (2012), familiar and unfamiliar music-listening both resulted in better autobiographical memory than silence, though familiar music was favoured. However, such direct comparisons remain scarce and are limited to PMT.

In a systematic review of PMT for AD, four out of seven studies allowed patients to select music to varying degrees (Gómez-Gallego and Gómez-García, 2017; Gómez-Gallego et al., 2021; Lyu et al., 2018; Särkämö et al., 2014) and reported positive cognitive outcomes. One study featured mostly familiar songs including ‘Somewhere Over the Rainbow’ but integrated unspecified new songs such that the individual effects were unclear (Maguire et al., 2015). Only one study on AD patients specifically tested classical music in isolation, with no observable impacts on improved cognition in AD patients, potentially due to the use of generic music (Li et al., 2018). Thus, it appears that for PMT, familiar and preferred music has the greatest efficacy for improved cognition in patients with AD.

Furthermore, while the literature does not directly compare familiar and unfamiliar music in AMT for AD, there is sufficient research to effectively compare the two. From 12 studies on AMT, 6 explicitly considered patient music preferences (Gómez-Gallego and Gómez-García, 2017; Gómez-Gallego et al., 2021; Särkämö et al., 2014; Satoh et al., 2015; Lyu et al., 2018; Pongan et al., 2017). Another four featured culturally relevant music, including Beethoven’s ‘Ode to Joy’ and Chinese revolutionary songs or Cantonese opera (Maguire et al., 2015; Palisson et al., 2015; Tang et al., 2018; Wang et al., 2018). Finally, Simmons-Stern et al. (2012) alone used unfamiliar music in AMT, pairing educational lyrics with obscure children’s songs. Despite varied approaches to music choice, all studies on AMT reported significant improvements in cognition except one that incorporated free sound creation rather than music (Giovagnoli et al., 2017). This methodological inconsistency may explain the lack of cognitive improvements in this case and the alleviation of behavioural and emotional symptoms.

Ultimately, research demonstrates greater cognitive improvements associated with the use of familiar and patient-selected music over unfamiliar classical music in MT. Across recent literature, the most effective components of music therapy were singing and activities alongside rhythm and movement exercises, using music that is both familiar and selected by patients. In future research, care should be taken to emulate MT methods of previous studies and reduce confounding variables for more seamless comparisons across the literature. Classification music as either ‘familiar’ or ‘unfamiliar’ should be standardised to avoid cases where music like Vivaldi’s ‘Four Seasons: Spring’ was deemed unfamiliar despite its prolific use in advertisements. Even an unconscious familiarity with the music may have skewed any observed effects on memory. In general, however, there do not seem to be any significant biases in methodology that would have influenced the results of this review.

Conclusion

Throughout the literature, there appears to be almost unanimous support of a relationship between long-term MT and improved cognitive functions in patients with AD and related dementias. Twenty-eight randomised controlled trials on long-term MT observed beneficial effects on general and specific aspects of cognition, including attention and executive function, orientation, short-term and working memory, self-awareness and perception, and verbal and motor memory. These significant and varied findings were countered by five studies reporting an insignificant effect of MT on cognition. This was sometimes framed as stabilisation and at other times as slightly reduced cognitive decline compared to control groups.

Ultimately, most studies substantiated a relationship between MT and improvements in cognitive function for AD and related dementia patients, while maintaining existing drug treatment plans. Thus, these findings support the potential for MT to be used as a non-pharmacological treatment, supplementary to existing pharmacological treatments.

Several limitations and potential biases temper the unanimity of these conclusions. Methodological heterogeneity across studies precludes robust meta-analysis at this stage (Van der Steen et al., 2018). Furthermore, any emerging and exciting area of research is vulnerable to significant publication bias, with a tendency to publish studies that report novel findings over those that reject this potential therapy.

Future research should take extra care to match methodologies with recent studies into MT and cognition. This concerns both research methodology and MT techniques, which together target different cognitive abilities. These changes would allow for more decisive meta-analyses that could quantify the impact of MT on cognition across the literature. Furthermore, there needs to be investigation into the impact of familiar versus unfamiliar music in the context of long-term MT. This will assist in refining MT methods so that any implemented MT programmes have the greatest possible effect on cognition for AD patients.

To conclude, MT shows great potential as a non-pharmacological intervention against cognitive decline in AD patients. Studies of the last 10 years strongly support the beneficial impact of MT on cognition and memory in patients with AD and related dementias, as well as emotional and psychological improvements. Thus, MT should be implemented at the onset of AD and even in healthy elders to reduce the likelihood of significant cognitive deterioration. Music therapy is an enjoyable, relatively inexpensive intervention method with no side effects and should be well considered for application in AD patients and further research.

Supplemental Material

sj-docx-1-bjm-10.1177_13594575261424462 – Supplemental material for The impact of music therapy on cognitive abilities in patients with Alzheimer’s disease and related dementias: A systematic review

Supplemental material, sj-docx-1-bjm-10.1177_13594575261424462 for The impact of music therapy on cognitive abilities in patients with Alzheimer’s disease and related dementias: A systematic review by Emily Su and Leanne Kenway in British Journal of Music Therapy

Footnotes

ORCID iDs

Emily Su

Leanne Kenway

Ethical considerations

Not applicable as the article is a systematic review.

Consent to participate

Not applicable as the article is a systematic review.

Consent for publication

All figures included are original work of the author(s).

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Supplemental material

Supplemental material for this article is available online.

Author biographies

Emily Su is a multiple award-winning violinist currently studying a Doctor of Medicine. She graduated with a Master of Arts (Distinction) from the Royal Academy of Music before building an international career as a soloist and chamber musician. Emily previously graduated with a Bachelor of Medical Science (Distinction) from Griffith University where she now continues her medical studies. At Griffith, Emily is a top performing student, selected as an anatomy tutor and Director of Surgical Skills for Queensland’s largest student surgical society.

Leanne Kenway is an Associate Professor of Anatomy & Physiology in the School of Pharmacy and Medical Sciences at Griffith University. Her clinical experience as a physiotherapist enables her to provide an authentic context for her undergraduate health students in her large first year Anatomy and Physiology course. She is published in the field of behavioural Neuroscience, the use of digital software applications to anatomy teaching to undergraduate allied health students and has developed 3D digital cadavers to enhance student learning, online engagement and success. She is currently exploring the use of a translanguaging pedagogical approach to anatomy learning to foster the superpowers of multilingual learners. Leanne has been awarded for her excellence in University Teaching in Australia, and recognised internationally with Senior Fellowship of the Higher Education Academy.

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