Music Interventions for Dementia and Depression in ELderly care: International cluster-randomised trial (MIDDEL)

老年护理中针对痴呆和抑郁症的音乐干预：国际整群随机试验 (MIDDEL)

• 批准号: MR/T046740/1
• 负责人: Justine Schneider
• 金额: $ 50.45万
• 依托单位: University of Nottingham
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT046740%2F1
• 关键词: Music; Interventions; Dementia; Depression; ELderly

Dementia and depression are highly prevalent and comorbid conditions in older adults and are associated with individual distress, caregiver burden, and high and rising societal costs. Globally, around 50 million people were living with dementia in 2017; this number is predicted to reach 82 million in 2030 and 152 million in 2050. The societal costs of dementia are increasing accordingly. Depression is the leading cause of disability worldwide. In older adults, it co-occurs and interacts with dementia in complex ways. Depression can cause cognitive impairment and may increase the risk of developing dementia; conversely, depression is very common in the early stages of dementia and often exacerbated by admission to a long-term care facility. Psychotropic medication has limited efficacy and severe adverse effects, but is often used to reduce challenging behaviours in later stages of dementia. Among available non-pharmacological interventions that have some supporting evidence, music interventions use the ability of music to elicit emotional responses and retrieve memories. Brain regions responsible for processing music, particularly known familiar songs, may be preserved even in late-stage dementia. Two common group-based music interventions are group music therapy (GMT) and recreational choir singing (RCS). GMT requires a qualified music therapist and includes a variety of activities (ranging from singing through instrumental music-making to music listening), with a focus on interaction and communication; RCS is facilitated by a choir leader and focuses centrally on singing. GMT has more research evidence, summarized in a Cochrane review;1 RCS has emerging evidence, but is more scalable, can be conducted with larger groups, and may be more cost-effective.The primary objective of MIDDEL is to provide high-quality evidence of the comparative effectiveness of GMT, RCS, GMT+RCS, or standard care alone, for reducing depression symptoms in care home residents with dementia. Second, MIDDEL aims to examine effects of GMT and RCS on direct and downstream outcomes in residents and care staff. We hypothesise that GMT and RCS rely on a combination of biological, psychological (cognitive and emotional), and social mechanisms, but to different degrees. Emotional processing, such as using musical interactions to reflect on biographical or current relationships, may be most important in GMT, leading to finding meaning and regaining orientation, and thereby to reduced agitation and related neuropsychiatric symptoms. In contrast, cognitive processing, e.g. through learning and memorising music pieces, is a central mechanism in RCS. In summary, we expect both GMT and RCS to reduce depression symptoms, but to differ in the pattern of effects; synergistic effects of GMT and RCS may occur through co-activation of different pathways; with according differences in effects across subgroups. The present proposal includes a cost analysis and analysis of clinical effects up to 12 months. Plans for a full cost-effectiveness analysis and longer-term evaluation are beyond the scope of this proposal, but are planned separately.

痴呆症和抑郁症是老年人中非常普遍和共存的疾病，与个人痛苦、照顾者负担以及高昂且不断上升的社会成本有关。 2017 年，全球约有 5000 万人患有痴呆症；预计到 2030 年，这一数字将达到 8200 万，到 2050 年将达到 1.52 亿。痴呆症的社会成本也在相应增加。抑郁症是全世界残疾的主要原因。在老年人中，它以复杂的方式与痴呆症同时发生并相互作用。抑郁症会导致认知障碍，并可能增加患痴呆症的风险；相反，抑郁症在痴呆症的早期阶段非常常见，并且经常因入住长期护理机构而加剧。精神药物的疗效有限且副作用严重，但通常用于减少痴呆后期的挑战性行为。在有一些支持证据的现有非药物干预措施中，音乐干预利用音乐的能力来引发情绪反应和检索记忆。即使在痴呆症晚期，负责处理音乐（尤其是熟悉的歌曲）的大脑区域也可能被保留。两种常见的基于团体的音乐干预措施是团体音乐治疗（GMT）和娱乐合唱团歌唱（RCS）。 GMT 需要合格的音乐治疗师，包括各种活动（从唱歌到器乐制作再到音乐聆听），重点是互动和沟通； RCS 由唱诗班领队主持，重点关注歌唱。 GMT 有更多的研究证据，在 Cochrane 综述中进行了总结；1 RCS 有新的证据，但更具可扩展性，可以在更大的群体中进行，并且可能更具成本效益。MIDDEL 的主要目标是提供高质量的证据，证明 GMT、RCS、GMT+RCS 或单独标准护理在减少痴呆症护理院居民抑郁症状方面的比较有效性。其次，MIDDEL 旨在研究 GMT 和 RCS 对居民和护理人员的直接和下游结果的影响。我们假设 GMT 和 RCS 依赖于生物、心理（认知和情感）和社会机制的结合，但程度不同。情感处理，例如使用音乐互动来反思传记或当前的关系，可能在 GMT 中最重要，它可以帮助我们找到意义并重新获得方向，从而减少躁动和相关的神经精神症状。相反，认知处理，例如通过学习和记忆音乐作品，是 RCS 的核心机制。总之，我们预计 GMT 和 RCS 都能减轻抑郁症状，但效果模式有所不同； GMT 和 RCS 的协同效应可能通过不同途径的共同激活而发生；不同亚组的效果存在相应差异。目前的提案包括成本分析和长达 12 个月的临床效果分析。全面成本效益分析和长期评估的计划超出了本提案的范围，但需要单独规划。

项目成果

Demographic and clinical profile of residents living with dementia and depressive symptoms in Australian private residential aged care: Data from the Music Interventions for Dementia and Depression in ELderly care (MIDDEL) cluster-randomised controlled trial.

澳大利亚私人住宅老年护理中患有痴呆症和抑郁症状的居民的人口统计学和临床​​特征：来自痴呆症和老年护理（Middel）群集伴随的对照试验的痴呆症和抑郁症的数据。

• DOI: 10.1111/ajag.13104
• 发表时间: 2022-12
• 期刊: AUSTRALASIAN JOURNAL ON AGEING
• 影响因子: 1.6
• 作者: Lee, Young-Eun C.;Sousa, Tanara Vieira;Stretton-Smith, Phoebe A.;Gold, Christian;Geretsegger, Monika;Baker, Felicity A.
• 通讯作者: Baker, Felicity A.

Clinical effectiveness of music interventions for dementia and depression in elderly care (MIDDEL): Australian cohort of an international pragmatic cluster-randomised controlled trial.

• DOI: 10.1016/s2666-7568(22)00027-7
• 发表时间: 2022-03-01
• 期刊: The lancet. Healthy longevity
• 作者: Baker, Felicity A;Lee, Young-Eun C;Gold, Christian
• 通讯作者: Gold, Christian

Resource assessment in trials undertaken in residential care homes: Experiences from the Australian MIDDEL cluster randomised controlled trial research team.

• DOI: 10.1016/j.conctc.2020.100675
• 发表时间: 2020-12
• 期刊: Contemporary clinical trials communications
• 影响因子: 1.5
• 作者: Baker FA;Stretton-Smith PA;Sousa TV;Clark I;Cotton A;Gold C;Lee YC
• 通讯作者: Lee YC

The Impact of Music on Stress Biomarkers: Protocol of a Substudy of the Cluster-Randomized Controlled Trial Music Interventions for Dementia and Depression in ELderly Care (MIDDEL).

• DOI: 10.3390/brainsci12040485
• 发表时间: 2022-04-08
• 期刊: BRAIN SCIENCES
• 影响因子: 3.3
• 作者: Rasing, Naomi L.;Janus, Sarah I. M.;Kreutz, Gunter;Sveinsdottir, Vigdis;Gold, Christian;Nater, Urs M.;Zuidema, Sytse U.
• 通讯作者: Zuidema, Sytse U.

Developing consensus description of group music therapy characteristics for persons with dementia

• DOI: 10.1080/08098131.2020.1779790
• 发表时间: 2020-07-05
• 期刊: NORDIC JOURNAL OF MUSIC THERAPY
• 影响因子: 1.6
• 作者: Janus, Sarah I. M.;Vink, Annemieke C.;Zuidema, Sytse U.
• 通讯作者: Zuidema, Sytse U.