Across the world, about 50 million people have suffered from dementia, and the number will be increased to about 3 times by 2050 [1]. Japan has been an aged country, and increasing population will be dementia and/or mild cognitive impairment (MCI) including Alzheimer's disease (AD), Lewy body dementia (LBD), vascular dementia and front temporal dementia. They show behavioral and psychological symptoms of dementia (BPSD), and non-pharmacological therapeutic options have been recommended, such as music therapy and/or associated with reminiscence therapy interventions. Authors have continued managing Shikoku Island division of Integrative medicine Japan (IMJ) [2,3]. Furthermore, we have majored in music therapy, art therapy and various related procedure practices in Integrative medicine (IM). In this article, recent trend on the perspectives of dementia and music therapy will be discussed.

In order to study whether music therapy gives positive effect on some symptoms in AD cases, systematic review was conducted [4]. As a result, 15 reports (1196 cases) were investigated for clinical effect of music therapy on neuropsychiatric symptoms, and it showed great interest. From complex situation due to COVID-19 pandemic, novel trials for online physical exercise program with music activities were performed [5]. Music therapy group (n=228) and control (n=60) were compared resulting significant effectiveness. This direction will bring a remote music/exercise session using internet communication training (ICT). It included several neuropsychological exams of Mini Mental State Examination (MMSE), graphic imitation, Behavioral Memory Test, Raven’s Colored Progressive Matrices (RCPM) and others. Further, subtle cognitive decline was investigated with word/number memory, the N-back task, and spatial grasp. Among them, N-back task showed significant improvement in music group compared with control group.

Concerning the evaluation methods in the research of music therapy for the elderly, several methods have been used, which are MMSE, Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB) Rey Auditory Verbal Learning Test (RAVLT) and Autobiographical Memory Test (AMT). Recently, a mobile music app has been used as digital devices in music therapy to maintain and improve cognitive function [6]. It can link the provision of songs with starting instructions, and activating QOL/ADL with related previous memory in the applicant. However, it remained at the trial study or observational report level, and no additional studies on large-scale planning have been shown yet. From some meta-analyses, music interventions can alleviate anxiety and depression in the elderly with dementia/MCI, where short interventions of 45 minutes or more, once a week seems to be effective [7]. Furthermore, clinically positive effects on sleep were observed in six of eight studies by the review [8]. It showed the reductions in nighttime sleep disorders, increases in daytime alertness, and improvements in sleep quality in particular.

The latest report was found from the study of Cochrane review in 2025 [9]. The purpose was to evaluate the efficacy of music-based interventions (MBIs) for dementia elderly on QOL and emotional well-being. The searched area included Dementia and Cognitive improvement group of Cochrane, MEDLINE, PsycINFO, Embase, ISI Web of Science, CINAHL, LILACS, and so on. As a result, 30 studies (1720 randomized cases) from 15 countries were analyzed. When compared MBIs with usual care, depressive symptoms showed improvement with standardized mean difference (SMD) -0.23, and improved behavioral problems with SMD -0.31. As low-certainty evidence, MBIs seemed to show more effective than the other activities for social behavior with SMD 0.52. Furthermore, positive efficacy on anxiety probably had low-certainty evidence with SMD -0.75. On the other hand, the music-based interventions could not probably reduce agitation or aggression with SMD -0.05.

MBIs have been the recommended non-pharmacological treatment for AD and AD-related dementias (AD/ADRD). The purpose was to identify clinical effect of MBIs for beneficial aspects for cases of AD/ADRD [10]. As a result, recorded and live music was applied for active and passive music session, and the applicants have perceived to increase the engagement, stimulate memory and energize or calm themselves when necessary. Clinical staffs for elderly care have found methods to integrate music, since they believe it to be useful and helpful. Medical evidence for beneficial MBIs has been increased, and future evaluation will be required for develop adequate guidelines for incorporating MBI to elderly care. In the actual medical practice and IM, music has been beneficial for many residents living with AD/ADRD [11]. Music therapy has been economical, adaptable and accessible for our usual lives. Music could be used easily in broad situations to improve our QOL for residents and medical staffs in elderly care communities. Whether music would be passive or active, it can bring psychological stability and relief for each individual or certain group in clinical practice [12].

For the patients with dementia, about 33% of them have anxiety disorder, where it is regarded as psychological problem of cognitive decline [13].  MBIs has been non-pharmacological alternative and widely utilized for anxiety disorders [14]. Whether passive music therapy (PMT) or active music therapy (AMT), MBIs contribute clinical improvement due to its accessibility, affordability and no adverse effects [15]. Concerning music intervention projects, 13 meta-analysis with randomized controlled trials (RCTs) were performed for 827 cases [16]. They included 4 major databases that were EMBASE, PubMed, Cochrane and Web of Science. For search strategy, medical terms were dementia/AD, music and anxiety. As a result, MBIs have decreased anxiety significantly with SMD -0.67, where AD (p=0.007) and mixed type dementia (p<0.001). Furthermore, they showed significant improvements for depression (p<0.001) and agitation (p=0.021).

The elderly with dementia often shows BPSD that often affect QOL and well-being. Recent report has focused the effect of MBIs on BPSD and the comparison of different types of interventions on the outcomes [17]. The methods included network meta-analysis (NMA) and systematic review (SR), and the results included PRISMA NMA extension and preferred reporting items for SR and meta-analysis protocols (PRISMA-P). Furthermore, the combination of multivariate analysis approach will bring the identification of clinical efficacy in MBIs for providing the treatment of BPSD.

For evaluating the evidence of music therapy on cognitive functions in dementia, a systematic literature search was conducted for 10 years [18]. Among 144 met inclusion criteria, 8 studies were studied including 689 participants. As a result, therapy group showed improvement for cognitive functions by music intervention compared with control groups. When patients were involved for music making during active music intervention (AMI), clinically greater efficacy was recognized. From the announcement of National Institute for Health and Care Excellence (NICE), the first line of therapy for distress behaviors in dementia care would be non-pharmacological and psychosocial interventions such as MBIs [19]. Generally, there are two situations for music activities. One is music therapy delivered by a registered music therapist (narrower definition), and another is music-based interventions that is conducted by someone who is not trained therapist (wider definition) [20].

Dementia has been a global health problem and priority, which shows increasing ratio of overall hospital beds occupied by patients with dementia and MCI. In the acute hospital setting, clinical efficacy of MBIs was evaluated which was designed to improving well-being, reducing anxiety and allowing better ADL and QOL with adequate care. A systematic research project was conducted followed by the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. As a result, 15 reports were selected for the eligibility criteria that include totally 581 patients with dementia. Their quality were various with moderate to good quality. Among them, 3 studies showed RCT, and 1 was blinded to the intervention. From the review, clinical effectiveness seemed to exist for MBIs for lowering various anxiety of dementia people in the acute care situations. Further, it highlighted the robust need for higher quality trials for future challenging environment.

In summary, this article introduced recent topics concerning effectiveness of music therapy or MBIs. The authors have been involved in MBIs and music therapy for many years, and conduct music therapy sessions for elderly people who are healthy, dementia or MCI (Figure 1). Using both music and conversation, we always provide music and reminiscence therapy, associated with mutual heart-to-heart communication. Patients with dementia, MCI and related disorders have shown various symptoms and signs for BPSD and others. The accumulations of medical evidences will bring clinical and social benefits for all elderly and patients.

Figure 1: The Activities of Music-Based Interventions (MBIs).

Conflict of interest: The authors have read and approved the final version of the manuscript. The authors have no conflicts of interest to declare.

Funding: There was no funding received for this paper.

1. Zhong S, Xiao C, Li R, Lan Y, Gong C, Feng C, et al. The global, regional, and national burdens of dementia in 204 countries and territories from 1990 to 2021: A trend analysis based on the Global Burden of Disease Study 2021. Medicine. 2025; 104: 1-17.
2. Fukuda Y, Kotani K, Okamura T, Saeki E, Nakamura S, Narahara T, et al. Various Changes in Behavioral and Psychological Symptoms of Dementia (BPSD) Through Music Listening. Int J Case Rep Clin Image. 2025; 7: 1-5.
3. Uchida Y, Bando H, Nishikiori Y, Bando M, Yoshioka A. Assertive Thinking May Bring Beneficial Human Relationship in The Light of Psychosomatic Medicine and Hinohara-Ism. Int J Case Rep Clin Image. 2025; 7: 1-3.
4. Rossi E, Marrosu F, Saba L. Music Therapy as a Complementary Treatment in Patients with Dementia Associated to Alzheimer’s Disease: A Systematic Review. J Alzheimers Dis. 2024; 98: 33-51.
5. Tabei KI, Ogawa JI, Kamikawa C, Abe M, Ota Y, Satoh M. Online physical exercise program with music improves working memory. Front Aging Neurosci. 2023; 15: 1146060.
6. James CE, Stucker C, Junker-Tschopp C, et al. Musical and psychomotor interventions for cognitive, sensorimotor, and cerebral decline in patients with Mild Cognitive Impairment (COPE): a study protocol for a multicentric randomized controlled study. BMC Geriatr. 2023; 23.
7. Ting B, Chen DT, Hsu WT, Liang CS, Malau IA, Li WC, et al. Does Music Intervention Improve Anxiety in Dementia Patients? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2023; 12: 5497.
8. Mu CX, Lee S, Boddupalli S, Meng H. Effects of music interventions on sleep in people with dementia?A systematic review. Dementia. 2022; 21: 2053-2071.
9. van der Steen JT, van der Wouden JC, Methley AM, Smaling HJA, Vink AC, Bruinsma MS. Music-based therapeutic interventions for people with dementia. Cochrane Database Syst Rev. 2025; 3: CD003477.
10. Hess BJ, Zatloukal A, Taylor JM, Neidens M, Williams KN, Lepping RJ. A qualitative study of music-based intervention use for Alzheimer's disease in elder care communities. J Alzheimers Dis Rep. 2025; 9: 1-10.
11. Fukuda Y, Kotani K, Okamura T, Saeki E, Nakamura S, Narahara T, et al. Event Scale Evaluation of Medical Staff Against Dementia Patients Receiving Music Therapy. Asp Biomed Clin Case Rep. 2025; 8: 100-104.
12. Orgeta V, Leung P, Del-Pino-Casado R, Qazi A, Orrell M, Spector AE, et al. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev. 2022; 4: CD009125.
13. Sun Y, Ji M, Leng M, Li X, Zhang X, Wang Z. Comparative efficacy of 11 non-pharmacological interventions on depression, anxiety, quality of life, and caregiver burden for informal caregivers of people with dementia: A systematic review and network meta-analysis. Int J Nurs Stud. 2022; 129: 104204.
14. Zhu X, Lazarov A, Dolan S, Bar-Haim Y, Dillon DG, Pizzagalli DA, et al. Resting state connectivity predictors of symptom change during gaze-contingent music reward therapy of social anxiety disorder. Psychol Med. 2023; 53: 3115-3123.
15. de Witte M, Nategh L, Antipas H, Westphal A, Lautenschlager NT, Baker FA, et al. The effects of music-based interventions on behavioural and psychological symptoms of people living with dementia: a systematic review and network meta-analysis protocol. Aging Ment Health. 2024; 28: 1726-1732.
16. Bleibel M, El Cheikh A, Sadier NS, Abou-Abbas L. The effect of music therapy on cognitive functions in patients with Alzheimer's disease: a systematic review of randomized controlled trials. Alzheimers Res Ther. 2023; 15.
17. National Institute for Health and Care Excellence (NICE). Dementia. 2019.
18. Thompson N, Odell-Miller H, Underwood BR, Wolverson E, Hsu MH. How and why music therapy reduces distress and improves well-being in advanced dementia care: a realist review. Nature Mental Health. 2024; 2: 1532-1542.
19. Bando H, Yoshioka A, Bando M, Nishikiori Y. The Fusion of Music and Medicine Moves Human Hearts As Art and Science. Global J Arts Social Sci. 2025; 7: 1-2.
20. McArthur V, Everington S, Patel M. Effectiveness of music-based interventions in acute care settings for people living with dementia to reduce anxiety and enhance the care experience: A systematic review. Arc Geront Geriat Plus. 2024; 1: 100087.