JoumalofMusfc Therapy, XUll (4), 2006, 317-333

�9 2006 bY the American Music Therapy Association

Long-Term Effects of Music Therapy on

Elderly with Moderate/Severe Dementia

Takiko Takahashi, PhD

Juntendo University School of Medicine

Hiroko Matsushita, M.D., M.S.

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School of Nursing, Faculty of Medicine, Toho University

Over a period of 2 years we assessed the long-term effects

of group music therapy carried out once weekly on the el-
derly (mean age: 83 years) suffering from moderate or severe
dementia by observing changes in the cortisol level in saliva
and in blood pressure and by an intelligence assessment.
Systolic blood pressure determined 1 and 2 years after the
start of therapy increased significantly in the nonmusic
therapy group compared with that in music therapy group
(p < .05). Systofic blood pressure increases with aging; the
systolic blood pressure was significantly lower in participants
who received music therapy. No significant differences in
cortisol level in saliva or intelligence assessment score were
observed, but the music therapy group maintained their
physical and mental states during the 2-year period better
than the nonmusic therapy group. This result indicates the
lasting effect of once-a-week continuous music therapy.
Even the elderly with moderate or severe dementia were able
to participate in the group music therapy, and results sug-
gest that enjoying singing and playing musical instruments in
a concert was effective in preventing cardiac and cerebral
diseases.

S o m e s t u d i e s r e g a r d i n g t h e effects o f m u s i c t h e r a p y o n t h e el-
derly dementia patient have been carried out using psychological

We wish to express our gratitude to Professor Yutaka Inaba,Juntendo University De-

partment of Epidemiology for guidance, and to Mr. ~hji Takano, Department of Psy-
chology, Senshu University for assistance in statistical analyses. We also wish to ex-
press our gratitude to all the staff members of the nursing home and for the
subjects' cooperation. This research was funded by the Japanese Music Therapy As-
sociation.
 318 Journal of Music Therapy

and physiological indexes. In studies using psychological indexes,

decreased aggressive behavior, emotional stability and alleviated
depressive symptoms have been reported as the effects of music
therapy. Clark, Lipe, and Bilbrey (1998) reported that, while the el-
derly with dementia bathed, listening to the music of their prefer-
ence in a bathroom resulted in significantly decreased aggressive
behavior. Gerdner (1999) recommended that, to reduce agitation,

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it was advisable to have patients listen to the music they personally
liked, which was determined from the assessment of their back-
ground and preference, approximately 30 minutes before the agi-
tation peak.
Ashida (2000) assessed 20 elderly depressed patients with de-
mentia to determine the relationship between depression and
changes before and after music therapy using a depression scale
and reported that depressive symptoms were decreased by reminis-
cence music therapy. The influence of music therapy on food in-
take and the somniferous effect of music have also been reported.
Rangneskog, Brane, Karlsson, and Kihlgren (1996) reported that,
although elderly dementia patients were likely to exhibit an
attenuation of their reduced concentration and incomplete execu-
tion of motions due to decreased cognitive function, Swedish
music in the 1920s and 1930s or pop music played during dinner
contributed to an increased food intake; in particular, the con-
sumption of dessert significantly increased.
Regarding physiological indexes, Kumar et al. (1999) carded out
music therapy on 20 patients five times a week for 4 weeks and col-
lected blood samples before the start of the therapy to obtain base-
line levels (baseline stage), immediately after and 6 weeks after the
end of a 4-week session. T h e results showed that blood melatonin
levels increased significantly. In the comparison of event-related
potentials (P300) before the start of music therapy and after the
completion of 10 sessions of music therapy, Mihara, Mihara,
Hozumi, and Kubo (2000) reported that an improved cognitive
function in the music therapy group compared with the nonrnusic
therapy group was suggested. Music therapy for one hour was con-
ducted twice weekly in group session of a small number of elderly
with dementia. The content of music therapy covered singing
�9 songs, finger exercise, music appreciation, and playing a musical
instrument.
Kubota and Hasegawa (1999) reported that natural killer (NK)
VoL XLIII, No. 4, Winter2006 319

cell count in the elderly with dementia increased significantly fol-

lowing music therapy. NK cell count serves as an index of im-
munocompetence. It is considered that NK cell count in the body
and changes in NK activity are closely related to resistance to viral
infection, the onset of cancer and the rate of metastasis. A reduced
spontaneity was observed in the elderly with dementia with a de-
crease in ADL, but NK cell count was also reported to increase as a

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result of exercise. The investigators concluded that music therapy
including vocalization, singing and playing a musical instrument
resulted in moderate exercise effects on the elderly with dementia,
leading to an increase in NK cell count. In this study, group ses-
sions of music therapy were conducted u n d e r a music therapist's
guidance. In a previous study, songs to which subjects could keep
pace with the tempo were selected, but the tempo of songs subse-
quently chosen became quicker as the n u m b e r of sessions of music
therapy increased.
Suzuki et al. (2004), who studied chromogranin A from the en-
dochrinological point of view, reported that the mean chromo-
granin A level in 10 participating elderly patients with dementia de-
creased significantly after the end of music therapy that ran for 16
sessions. Music therapy was conducted twice weekly for 8 weeks.
In previous studies regarding the effects of music therapy, re-
searchers investigated primarily the short-term effect of music
therapy, whereas few studies dealt with its lasting effects. As a long-
term study, Berger et al. (2004) investigated the behavioral and
mental changes in patients with dementia and the burden placed
on their caregivers over a period of 2 years. In this study, 18 elderly
people who received a combination of m e m o r y training by music
therapists and care by staff members were compared with a control
group of 18 elderly people without music therapy. This study, how-
ever, failed to conclude that music therapy had a clear effect.
Takahashi (1997b) conducted studies on the effect of active remi-
niscence music therapy by employing an applied behavioral analy-
sis. It was reported that the frequency of "negative behavior" of the
elderly with dementia decreased and that the frequencies of their
"behavior on their own initiative directed to other people (direct
behaviors)" including "smiling" and "speaking" and "behavior in-
volving themselves (positive behaviors)" including "reading a news-
paper" and "watching TV" increased and were maintained. In
weekly group sessions of a small number of elderly with dementia,
320 Journal of Music Therapy

the frequencies of direct behavior and positive behavior increased

following music therapy, and it was suggested that the improved be-
haviors were retained (Takahashi & Hagiya, 1998). It was difficult,
however, to m a i n t a i n these r e t e n t i o n effects with biweekly g r o u p
sessions (Takahashi, 1999). T h e effects of weekly g r o u p sessions
were c o n f i r m e d to remain u p to 7 weeks after the start of the first
session, a n d it was considered necessary to verify the long-term ef-

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fects of the weekly g r o u p sessions. In view o f the above investiga-
tions, we c o n d u c t e d a study with the aim of investigating the lasting
effects o f music therapy in terms of physiological and psychological
indexes. In a g r o u p of elderly with d e m e n t i a and a control group,
cortisol level in saliva, collected f r o m the participants in a psycho-
logically less invasive way, a n d b l o o d pressure were m e a s u r e d as
physiological indexes, a n d the severity of d e m e n t i a , types o f de-
mentia, physical condition a n d lifestyle were m e a s u r e d as mental
indexes.
Method
Subjects
Subjects were 43 elderly patients with d e m e n t i a who live in a spe-
cial h o m e for the aged where music therapy will be i n t r o d u c e d in
the future. For convenience, subjects for music therapy were se-
lected a m o n g elderly patients who stayed on floors different f r o m
those of subjects for the control. Music therapy was applied to 24
subjects (hereafter called the MT group). T h e control g r o u p con-
sisted o f the 19 r e m a i n i n g subjects who did not participate in the
therapy (hereafter called the n o n M T group). T h e MT g r o u p com-
prised 5 m e n a n d 19 w o m e n , a n d the m e a n age was 82.7. T h e
m e a n d e m e n t i a score was 6.0 a c c o r d i n g to the Revised Hasegawa
D e m e n t i a Scale (HDS-R)*. Subjects with cerebrovascular d e m e n t i a
(CVD) were eight in number, those with Alzheimer-type d e m e n t i a
(AD) 15, a n d those with Parkinson-type d e m e n t i a (P) 1. T h e
n o n M T g r o u p comprised 5 m e n a n d 14 women, and the m e a n age
was 84.9. T h e m e a n HDS-R score was 6.1. Subjects with cerebrovas-
cular d e m e n t i a (CVD) were 7, those with Alzheimer-type d e m e n t i a

* The revised version of Hasegawa Dementia Scale (HDS-R) is the most common
screening test for dementia inJapan. The highest score of the scale is adjusted to 30,
and an individual with a score of less than 21 is suspected of having dementia. The co-
efficients of correlation between HDS-Rand mini-mental state examination (MMSE)
are very high, 0.92 and 0.94, respectively,and concurrent validityis also high.
Vol. XLIII, No. 4, Winter 2006 321

(AD) 11, and those with Parkinson-type dementia (P) 1. The facili-
ties opened in April 2001, and most of the subjects were admitted
to the facility in April or May 2001. The MT group had already
stayed in this facility for 477.5 days on average before their first day
of music therapy; therefore, there is no question regarding their
anxiety in a new environment. Moreover, the n o n M T group had
similarly stayed for 450 days, except for one subject who entered

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the facility in September 2002.
There was no significant statistical difference in the age of the el-
derly with dementia or the n u m b e r of days after admission to the
facility between the MT and nonMT groups.

Procedures
Saliva samples were collected from the elderly in the MT group
and their blood pressure was measured before and after the first
music therapy session. A music therapy session was held once
weekly, and saliva sampling and blood pressure measurement were
carried out before and after music therapy for 6 months and one
and two years after the first session of music therapy. For the
n o n M T group, saliva sampling and blood pressure measurement
were carried out before the start of the first therapy session to ob-
tain baseline levels (hereafter referred to as the baseline stage), at
6 months, and 1 and 2 years after the therapy. (Saliva samples were
collected between 13:30 and 15:30 in the afternoon from both
groups.)
The intervention was conducted by employing an active remi-
niscence music therapy, and the MT group (24 subjects) under-
went this therapy for approximately one hour once a week. A mu-
sic therapist authorized by the Japanese Music Therapy Association
after having received training led the therapy sessions. An assistant
music therapist authorized by the Japanese Music Therapy Associa-
tion accompanied her on the piano. The singing sessions were live,
and the leader sang songs, led the activity and brought forth the
subjects reminiscences. The following items on the program were
carried out: exchange of greetings, light exercises that the subjects
could perform in a sitting position, vocalization, singing songs (sea-
sonal songs and familiar songs), and playing in a concert. Songs
learned in school were used as the seasonal songs. They then sang
a few familiar songs. It was defined that familiar songs were elderly
persons' favorite songs, those associated with memories, and those
322 Joumal of Music Therapy

that they used to sing (Takahashi, 1997a). It was also reported that
after singing these songs, the elderly reminiscenced and that the
songs contributed to greater improvements in their activity level
than new songs (Takahashi, 1996). This study was designed to en-
courage recollection brought about by this method, and efforts
were made to promote exchanges among the subjects with topics
centering on those reminiscences. They then participated in a con-

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cert playing percussion instruments, particularly Japanese drums
and singing folk songs among others. The types of song included
school songs, children's songs (those written mainly in the 1910s
and 1920s), Japanese ballads, and folk songs (traditional songs lo-
cally passed on from generation to generation, frequently paired
with dances).

Intelligence test
The MT and nonMT groups were given the same intelligence
test (HDS-R) before the start of the first therapy session to obtain
the baseline levels, 6 months and 1 and 2 years after the first music
therapy session by consulting a psychiatric counselor. The psychi-
atric counselor, a staff member at the facility, established a rapport
with the subjects. The psychiatric counselor conducted a one-on-
one examination of all subjects. The test consisted of nine items in-
cluding recollection and memorization.

Cortisol
Cortisol is an adrenocortical hormone, the level of which in-
creases with stress (Bassett, Marshall, & Spilane, 1987; Stahl &
Dorner, 1982) and is widely used as a stress index. For the cortisol
measurement, the saliva was collected with a cylindrical cotton
swab (Salivette, product of Sarstedt, Germany). The advantages of
saliva collection are the following; (a) highly stressful procedures
such as injections are not necessary in the collection of saliva and
(b) the time of saliva sample collection is flexible, and a more ac-
curate value is obtained using saliva samples than using urine sam-
ples. Therefore, if cortisol level in saliva is used as an index of
stress, we can avoid specific problems such as the induction of ad-
ditional stress in response to needle stimulation and other ethical
problems. Cortisol levels in saliva and blood are highly temporally
correlated (Kirshbaum & Hellhammer, 1989), and cortisol level in
saliva reflects that in blood after a delay of 1-2 minutes (Walker,
VoL XUII, No. 4, Winter 2006 323

Raid-Fahmy, & Read, 1978). Cortisol level in saliva changes during

the day; it is highest immediately after waking up, it decreases in
the morning, and steadily decreases in the afternoon. During wak-
ing up (7:00-8:00), the cortisol level in the saliva of healthy adults
is 0.47-1.15 lag/dl. It decreases gradually thereafter, and it reaches
a range of 0.02-0.13 pg/dl at about 22:00 (Fujibayasi, Harimura,
Nomura, Sato, & Yoshida, 1983).

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Cortisol analysis
A special cotton swab on which the patient's saliva sample was
collected was refrigerated at 4~ and the saliva was separated on
the day of sampling. The separated saliva was kept frozen in a
freezer below -40oc until it was evaluated by enzyme-linked im-
munosorbent assay. The results including salivary cortisol level,
HDS-R and systolic blood pressure were statistically analyzed using
Student's t-test and analysis of variance.
Ethical consideration
Written informed consent was obtained from the subjects and
their families by the chief of the facility with regard to the ethical
aspect. A representative of the facility encoded all information on
a subject such as name, disease, and educational background,
saved the information on a magnetic disk and kept it strictly confi-
dential during the research period in his/her house so that the
subjects' confidential information would not leak. After the re-
search ended, the representative destroyed the information imme-
diately. The following guidelines were specified. It shall be possible
for the subjects to freely stop participating in this study and the
subjects shall be in no way disadvantaged if they stop participating.
It shall be possible for the subjects in the nonMT group to later
participate in the music session if they wish so; however, there were
no such cases in this study. The approval of the Japan Epidemio-
logical Association Ethical Review Board was obtained.

Results
Descriptive analysis and assessment of uniformity of M T and
nonMT groups
Table 1 shows the mean salivary cortisol levels, systolic blood
pressures, and intelligence assessment scores (HDS-R) before the
324 Journal of Music Therapy

Table 1
Changesin CortisolLeve~ SystolicBloodPressureand PlDS-RScorein MT and NonMT
Groups
~ r group
pre post nonMT group
Year M SD M ~ N M SO N

Cortisol 0 .27 .26 .26 .17 22 .19 .16 18

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(pg/dl) 0.5 .24 .25 .17 .10 18 .17 .14 14
1 .25 .23 .18 .13 17 .34 .34 13
2 .19 .13 .17 .06 10 .31 .24 10

Systolic 0 133.8 24.2 148.2 27.2 24 125.9 23.3 19

blood 0.5 141.0 29.0 141.4 24.3 23 130.0 29.9 17
pressure 1 138.5 23.8 145.7 27.3 20 143.0 27.8 16
(mmHg) 2 138.3 25.6 141.7 26.1 18 147.0 14.8 12

HDS-R 0 6.0 6.1 24 6.1 6.8 19

0.5 5.3 6.7 23 4.3 4.8 17
1 5.8 6.4 20 3.7 4.4 16
2 5.6 7.0 16 3.2 3.7 " 10
Note. MT group, experimental; nonMT group, control.

first m u s i c t h e r a p y session ( o r at t h e b a s e l i n e s t a g e ) , a t 6 m o n t h s
a n d a t 1 a n d 2 y e a r s after t h e t h e r a p y sessions.
T h e m e a n s a l i v a r y c o r t i s o l levels a t t h e p r e m u s i c session (base-
l i n e stage) w e r e 0.27 p g / d l in t h e M T g r o u p a n d 0.19 p g / d l in t h e
n o n M T g r o u p as s h o w n in T a b l e 1. T h e m e a n systolic b l o o d pres-
s u r e s at t h e b a s e l i n e stage w e r e 133.8 m m H g in t h e M T g r o u p a n d
125.9 m m H g in t h e n o n M T g r o u p . T h e m e a n H D S - R scores at t h e
b a s e l i n e s t a g e w e r e 6.0 in t h e M T g r o u p a n d 6.1 i n t h e n o n M T
g r o u p . N o s i g n i f i c a n t statistical d i f f e r e n c e was o b s e r v e d in t h e
m e a n salivary c o r t i s o l level, m e a n systolic b l o o d p r e s s u r e o r m e a n
H D S - R s c o r e b e t w e e n t h e M T a n d n o n M T g r o u p s . T h e r e was n o
s i g n i f i c a n t statistical d i f f e r e n c e in a g e o r t h e n u m b e r o f days a f t e r
a d m i s s i o n to t h e facility b e t w e e n t h e M T a n d n o n M T g r o u p s as
s h o w n in s e c t i o n 2.

Immediate effects on M T group before and after music therapy

To assess t h e i m m e d i a t e effect o n t h e i n d e x e s after m u s i c therapy,
analysis o f v a r i a n c e was c o n d u c t e d f o r t h e p r e a n d p o s t m u s i c t h e r -
a p y m e a s u r e m e n t s in the M T g r o u p . N o s i g n i f i c a n t d i f f e r e n c e was
VoL XLIII, No. 4, Winter 2006 325

observed between the pre and postmusic therapy salivary cortisol

levels at the time of the first therapy, at 6 months or at 1 or 2 years
after that. However, the effect of the active reminiscence music
therapy p e r f o r m e d by the group could only be observed in indi-
viduals in whom a functioning intelligence was maintained to a cer-
tain degree. In consideration of this, the subjects in the MT group
were divided into those having low HDS-R scores (HDR-S scores 0

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to 5) and those having i n t e r m e d i a t e / h i g h HDS-R scores (HDR-S
scores 6 to 20), and analysis of variance was conducted for two fac-
tors in these groups--a h i g h / l o w HDS-R score factor and the
pre/postmusic therapy factor. Eleven subjects in the MT group
were in the low-intelligence group and 13 were in the high-intelli-
gence group. Eleven subjects in the nonMT group were in the low
intelligence group, and eight subjects in the high-intelligence
group. Results showed significant interactions between the HDS-R
score factor and the pre/postmusic therapy factor, F(1, 19) = 3.72,
p <. 1). The simple primary effect of each of the factors was analyzed,
and it was shown that subjects with intermediate/high I-IDS-R scores
tended to have increased salivary cortisol levels at post-music
therapy compared with those with low HDS-R scores (see Table 2).
Regarding systolic blood pressure, analysis of variance of the
pre/postmusic therapy factor and measurement time (the first
t h e r a p y / 6 m o n t h s / 1 year/2 years after the therapy) showed that
the primary effect of the pre/postmusic therapy factor was signifi-
cant, F(1, 16) = 11.30, p< .01. No primary effect of the time of mea-
surement was noted, F(3, 48) = 1.18, n. s. Interactions between the
pre/postmusic therapy factor and the time factor tended to be sig-
nificant, F(3, 48) = 2.71, p < .10. The simple primary effect of the
respective factors was analyzed, and it was shown that systolic blood
pressures after the first therapy, 1 year and 2 years after the therapy
were significantly different and that systolic blood pressure in-
creased postmusic therapy.
An analysis of variance of two factors, namely, the h i g h / l o w
HDS-R score factor and the pre/postmusic therapy factor, was also
conducted for systolic blood pressure as it was conducted for sali-
vary cortisol levels. Interaction between the two factors, however,
were n o t significant. Next, the subjects were classified into three
groups in terms of their systolic blood pressure: (a) the high-blood-
pressure group (systolic blood pressure: 160 m m H g or higher); (b)
the intermediate-blood-pressure group (systolic blood pressure:
326 Journal of Music Therapy

TABLE 2
Analysis of Variance of Cortisol Level with (HDS-R high-low) x (preVost)
~u~e ~ ~ MS F

between subjec~
HDS-R(A) 0,07 1 0.07 1.07 ns
Error 1,31 19 0.07

within subjecu

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Pre.Pos~(B) 0.07 1 0.07 3.28*
A x B 0.08 1 0.08 3.72*
Error 0.43 19 0.02

Total 1.97 41

Nou.*p< .10.

over 100 to 160 mmHg); and (c) the low-blood-pressure group (sys-
tolic blood pressure: less than 100 m m H g ) . Changes in systolic
blood pressure pre and postmusic therapy were calculated as de-
scriptive statistics for assessment. One elderly person was classified
into the high-blood-pressure group in the first measurement (base-
line stage); h i s / h e r blood pressure decreased from 190 m m H g at
premusic therapy to 183 m m H g at postmusic therapy. Eight elderly
persons were classified into the high-blood-pressure group in the
second m e a s u r e m e n t carried out 6 months after the first session,
and their mean blood pressure postmusic therapy decreased sig-
nificantly (p < .05). Two elderly persons were classified into the
high-blood-pressure group 1 year and 2 years after the first music
therapy. The m e a n blood pressure of the two persons decreased
from 180 m m H g premusic therapy to 165 m m H g 1 year after the
first session, and that of the other two elderly persons decreased
from 173 m m H g premusic therapy to 167 m m H g 2 years after the
first session. There were two elderly persons placed into the low-
blood-pressure group after the first music therapy session. Two oth-
ers were placed at 6 months and finally two more after 2 years re-
sulting in six persons in all. Of these six, the mean blood pressure
of the two increased from 93 m m H g at pre-first music therapy ses-
sion to 99 m m H g at post-first music therapy. That of two other per-
sons increased from 86 m m H g at pre-first music therapy to 99
m m H g at post-first music therapy session 6 months after the first.
T h a t of yet two other persons increased from 98 m m H g at pre-first
music therapy to 110 m m H g at post-first music therapy session 2
VoL XLIII, No. 4, Winter 2006 327

TABLE3
Analysis of Varmnceof SystolicBloodPressurewith (MT- nonMT) x (time)
Source SS df MS F

between subjec~
MT/nonMT(A) 15.61 1 15.61 0.01 ns
error S 40071.74 28 1431.13

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within subjec~
time(B) 2348.16 3 782.72 3.96*
Ax B 2195.22 3 731.74 3.70*
Sx B 16627.99 84 197.81

Toml 61247.99 119

Note. *p < .05.

years after the first. As a result of music therapy, systolic blood pres-
sure decreased in the high-blood-pressure group and increased in
the low-blood-pressure group. Seven and six subjects in the MT
and n o n M T groups, respectively, were given antihypertensive
drugs, and all of them c o n t i n u e d to take the drugs during the
study period.

Effects of 2-year-long continuous music therapy

T h e r e were 18 persons in the MT group and 14 persons in the
n o n M T groups who continued with the therapy for 2 years. To in-
vestigate the effect o f 2-year-long continuous music therapy, a 2 x 4
mixed plan was carried out using =participation in music therapy
(MT) (MT g r o u p / n o n M T group)" and "measurement time (first
t i m e / 6 m o n t h s a f t e r / 1 year a f t e r / 2 years after)" as i n d e p e n d e n t
variables and the indexes (salivary cortisol level, systolic blood pres-
sure, and HDS-R score) as d e p e n d e n t variables. Analysis of vari-
ance using "systolic blood pressure" as the d e p e n d e n t variable
showed the interactions between the "participation in MT" factor
and the " m e a s u r e m e n t time" factor were statistically significant,
F(3, 84) = 3.70, p < .05. Analysis o f the simple primary effects of the
factors was then carried out, and the results showed that systolic
blood pressure at postmusic therapy 2 years after the first music
therapy session was significantly higher in the n o n M T group than
in the MT g r o u p (see Table 3). No significant differences in sali-
vary cortisol level or HDS-R score were observed. Figures 1, 2, and
3 show the 2-year mean cortisol level, systolic blood pressure, and
328 Joumal of Music Therapy

0.4
0.35 i- .~ .~
0.3 Im
MT group
"~ 0.9-5
0.2 ~
~�9 0.15 " "ill" " Ngr~ [

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~ o.1
0.05

i 2
year
FIGURE 1.
C h a n g e in cortisol level in MT a n d n o n M T groups.

HDS-R score of the persons in the MT and nonMT groups after the
first music therapy session, 6 months and 1 and 2 years after the
first therapy.
Discussion
Matsushita et al. (2002) reported that the mean cortisol level in
saliva sampled from the healthy elderly (N= 31; mean age, 75.2
years; without stress; taking drugs) between 12:0.0 and 15:00 was
0.18 lag/dl. In this study, the mean salivary cortisol levels at the
baseline stage were 0.27 and 0.19 p g / d l in the MT and nonMT
groups, respectively. The results, therefore, suggest that salivary
cortisol level did not differ between the elderly with dementia and
the healthy elderly. However, salivary cortisol level increased at
postmusic therapy in persons having intermediate/high HDS-R
scores compared with persons having low HDS-R scores. It was re-
ported that salivary cortisol level is related to not only mental stress
but also physical stress (Iwanaga, Ikeda, & Iwaki, 1996). The per-
sons with intermediate/high HDS-R scores actively participated in
music therapy and eagerly played musical instruments compared
with those with low HDS-R scores. Those who participated enthusi-
astically in the active music therapy were stimulated by the therapy
and exhibited increased salivary cortisol levels immediately after
the therapy. The long-term examination of changes in salivary cor-
Vol. XLIII, NO. 4, Winter 2006 329

~ 150 I
---<k--- MT group

130 i..-'-" ---"--- NowMT

i 125 "
120 T

group

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0 1 2

year
FIGURE 2.

Change in systolicblood pressure in MT and nonMT groups.

tisol level showed t h a t cortisol level increased in the n o n M T g r o u p

over 2 years but d e c r e a s e d in the MT group, a l t h o u g h no statisti-
cally significant difference was observed (see Fig. 1).
T h e m e a n systolic b l o o d pressure increased significantly in the
n o n M T g r o u p 2 years after the baseline stage as c o m p a r e d with the
MT g r o u p (see Table 3). T h e m e a n systolic b l o o d pressure o n e
year after the baseline stage also increase in the n o n M T g r o u p
c o m p a r e d with the MT g r o u p (Takahashi 8,: Matsusita, 2005).
Kannel (1999) r e p o r t e d that the risk o f cardiovascular p r o b l e m s
increases w h e n systolic b l o o d pressure rises. A low systolic b l o o d
pressure is said to be related to not only the decrease in the risk of

6
5
M T group
,*:4
~-- 3 . . 41- - N o n - M T
group
2

0 1 2

year

FIGURE 3.

Change in HDS-Rscore in MT and nonMT groups.

330 Journal of Music Therapy

cardiac diseases but also in that of cerebral apoplexy (Staessen,

2003). Systolic blood pressure increases with age. The finding that
music therapy has a lowering effect on systolic blood pressure
means that the therapy may potentially prevent cardiac and cere-
bral diseases. To eliminate the high blood pressure risk factor, lim-
iting salt and sodium intake, moderate exercises and relaxation
have been generally recommended. Because the nonMT and MT

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groups had the same meals at the same facility, they had the same
salt intake; hence, music therapy was considered to have served as
a moderate exercise and relaxation. Playing a musical instrument
is exercise and diminishes stress. Singing requires breathing out
long and controlling exhalation similar to Chinese shadow boxing
and Qigong, and provides relaxation. Systolic blood pressure
immediately after the music therapy was significantly higher than
that before music therapy in the MT group. When the subjects
were classified into the high-blood-pressure group (more than 160
mmHg) and the low-blood-pressure group (less than 100 mmHg),
systolic blood pressure decreased after music therapy in the high-
blood-pressure group, however, increased in the low-blood-
pressure group. This suggests that music therapy has a homeostatic
effect of bringing systolic blood pressure closer to the normal
value. It can also be said that biological prohomeostasis was in-
duced by music. The prohomeostatic effect is not only provided by
passive music therapy through listening to music (Nagata, 1996),
but it is also produced by active music therapy, as demonstrated in
this study.
HDS-R scores were maintained in the MT group 2 years after the
therapy, whereas it declined in the nonMT group over the 2-year
period, although no statistically significant difference was observed
between the two groups. The elderly with moderate dementia who
participated in music therapy actively showed an increase in HDS-
R score. These persons spoke a lot, enjoyed singing and partici-
pated eagerly in playing musical instruments. This behavior was
considered to have contributed to their cognitive function im-
provement. In this study, the active reminiscence music therapy by
the familiar-song singing method was carried out. The elderly with
dementia in the MT group met together once a week and talked
about their recollections evoked by the familiar songs they sang.
This contributed to their emotional stability, their active exchanges
with other people a n d improvements in their socialization as they
Vol. XLIII, No. 4, Winter 2006 331

m a d e friends in the facility. It was believed that these sessions fur-

ther led to the maintenance of their physiological functions such as
n o r m a l systolic b l o o d pressure a n d cortisol level in saliva a n d the
m a i n t e n a n c e of cognitive function.
Regarding the m e t h o d o l o g y used, physiological indexes, namely
blood pressure and cortisol level in saliva, were chosen as objective
measures o f the long-term effects of music therapy, because these

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indexes are less invasive for the elderly with dementia. From the re-
suits, b l o o d pressure m e a s u r e m e n t was easy a n d capable o f show-
ing the effects of the music therapy. However, salivary cortisol level
showed m a r k e d variations a n d c h a n g e d d u e to several factors;
hence, it was difficult to obtain clear correlations f r o m them. An-
o t h e r reason for the difficulty in detecting changes s e e m e d to be
that the subjects were elderly with severe or m o d e r a t e dementia.
In this study, music therapy was carried out on the elderly ( m e a n
age, 83 years) with m o d e r a t e or severe d e m e n t i a ( m e a n HDS-R
score, 6.0) o n c e a Week. T h e long-term effects of the therapy were
also investigated. Even the elderly people with m o d e r a t e or serious
d e m e n t i a were able to participate in music therapy. T h e y enjoyed
singing songs a n d playing a musical instrument. In summary, the
results suggest that music therapy, during which the elderly p e o p l e
with m o d e r a t e or severe dementia can enjoy themselves, is effective
in preventing cardiac and cerebral diseases.
J a p a n is well on the way to b e c o m i n g a s u p e r aging society. In
2030, it is e s t i m a t e d that those aged 65 years or older will account
for 29.6% o f the total population. T h e n u m b e r o f elderly persons
with d e m e n t i a will increase as the elderly population increases. In
a future study, we intend to d e t e r m i n e the effects o f music therapy
on the n o r m a l elderly from the viewpoint o f protecting t h e m f r o m
dementia.

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