Research Article · Originalarbeit
Complement Med Res 2019;26:22–30
DOI: 10.1159/000490348
Effects of Music Therapy on the Care Burden of
In-Home Caregivers and Physiological Parameters of Their
In-Home Dementia Patients: A Randomized Controlled Trial
Hacer Gok Ugur a Oya Sevcan Orak b
Okan Saglambilen e
a
Faculty of Health Sciences, Ordu University, Ordu, Turkey;
b
Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey;
c Faculty of Health Sciences, Giresun University, Giresun, Turkey;
d
Faculty of Medicine, Ordu University, Ordu, Turkey;
e
Faculty of Music and Performing Arts, Ordu University, Ordu, Turkey
Keywords
Caregiver burden · Dementia patient · Home care · Music
therapy · Physiological parameters
Summary
Objectives: This study was conducted to explore the effects
of classical Turkish music therapy on both the caregiver
burden and physiological parameters of patients with de-
mentia. Methods: The study was a randomized controlled
trial. It was conducted with dementia patients (n = 75) and
their caregivers who were registered at in-home care ser-
vices of the General Secretariat of the Association of Public
Hospitals in Ordu. The study sample consisted of 30 control
and 30 music group patients and their caregivers who satis-
fied the inclusion criteria for the study conducted between
April 2015 and April 2016. The primary outcome of the
study was to measure the care burden of in-home caregiv-
ers, and the secondary outcome was to measure physiolog-
ical parameters, including systolic and diastolic blood pres-
sure, heart rate, and respiration rate in patients with demen-
tia. Results: The mean scores of the post-test caregiver bur-
den in the music group were found to be significantly lower
than those of the control group (t = –4.478, p = 0.001). The
differences in the post-test systolic and diastolic blood pres-
sures between the patient groups were found to be statisti-
cally significant (t = –4.603, p = 0.001; t = –2.656, p = 0.010).
Conclusions: Classical Turkish music intervention in in-
home dementia patients decreased the care burden of care-
givers and the patients’ blood pressures were brought
under control. In parallel with these results, it is recom-
mended that more studies to reveal the effects of classical
Turkish music on care burden should be conducted.
© 2018 S. Karger AG, Basel
© 2018 S. Karger AG, Basel
Fax +49 761 4 52 07 14
Information@Karger.com Accessible online at:
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Published online: November 30, 2018
Yesim Yaman Aktas c Ozgür Enginyurt d
Schlüsselwörter
Belastung von Pflegenden · Demenzpatient · Hauspflege ·
Musiktherapie · Physiologische Parameter
Zusammenfassung
Ziele: In dieser Studie sollten die Effekte einer Therapie mit
klassischer türkischer Musik sowohl auf die Belastung der Pfle-
genden als auch auf physiologische Parameter von Patienten
mit Demenz erforscht werden. Methoden: Diese randomisiert-
kontrollierte Studie wurde mit Demenzpatienten (n = 75) und
ihren Pflegekräften durchgeführt, die bei Hauspflegediensten
des Generalsekretariats der Vereinigung Öffentlicher Kranken-
häuser in Ordu registriert waren. Die Studienpopulation be-
stand aus 30 Kontroll- und 30 Musikgruppenpatienten und
ihren Pflegekräften, die die Einschlusskriterien für die Studie
erfüllten, die von April 2015 bis April 2016 durchgeführt
wurde. Der primäre Endpunkt der Studie war die Erfassung
der Pflegelast der zu Hause tätigen Pflegenden. Der sekundäre
Endpunkt war die Messung physiologischer Parameter ein-
schließlich des systolischen und diastolischen Blutdrucks, der
Herzfrequenz und der Atmungsfrequenz der Demenzpatienten.
Ergebnisse: Es stellte sich heraus, dass die durchschnittlichen
Ergebnisse der Post-Test-Belastung der Pflegenden in der
Musikgruppe signifikant niedriger waren als diejenigen der
Kontrollgruppe (t = –4,478, p = 0,001). Die Differenz in den
Post-Test-Blutdruckwerten (systolisch und diastolisch) zwi-
schen den beiden Patientengruppen war statistisch signifikant
(t = –4,603, p = 0,001; t = –2,656, p = 0,010). Schlussfolgerun-
gen: Die Intervention mit klassischer türkischer Musik bei zu
Hause betreuten Demenzpatienten verringerte die Pflegelast
der Betreuenden und der Blutdruck der Patienten konnte unter
Kontrolle gebracht werden. Neben diesen Ergebnissen wird
empfohlen, weitere Studien durchzuführen, die die Wirkung
von klassischer türkischer Musik auf die Pflegelast aufzeigen.
Dr. Hacer Gok Ugur
Faculty of Health Sciences, Cumhuriyet Campus
Ordu University
Ordu, Turkey
hacer32 @ gmail.com
 Introduction
The incidence of dementia is increasing, and dementia is a
major health problem in an ageing society [1]. Dementia is a syn-
drome that is characterized by progressive cognitive decline, asso-
ciated dysfunction and cognitive deterioration [2]. As each stage of
dementia progresses, both cognitive and behavioral disturbances
are experienced by patients along with dementia, depending on the
neurodegenerative alterations [3]. Both the incidence and the se-
verity of the behavioral disturbances increase as the disease pro-
gresses [1, 4]. The incidence rate of behavioral disturbances in in-
dividuals with dementia is 56–96% [3]. The symptoms of both de-
pression and anxiety vary according to the stage of the disease; in
early-stage patients, they are more prominent whereas moderate-
dementia patients are frequently paranoid and tend to display be-
havioral disturbances such as delusions, irritability, and constant
and aimless wandering. Purposeless repetitive behaviors and ap-
parent apathy can be observed in advanced-stage patients [1, 5].
Behavioral disturbances complicate the health care of dementia pa-
tients [4]. Caregivers of dementia patients have reported that they
encounter difficulties in providing patient care due to behavioral
disturbances [6–8]. Behavioral disturbances in dementia patients
increase both the depression level and care burden while decreas-
ing the quality of life of the caregivers [9–11].
Pharmacological and non-pharmacological methods are used to
treat behavioral disturbances in patients with dementia [12]. Phar-
macological agents that are used for dementia patients are antipsy-
chotics, antidepressants, sedatives, and neuroleptic drugs [13].
However, although pharmacological agents are typically used to
treat such behaviors, evidence to support their use is modest and
associated with potential side effects, including sedation, falls, ex-
trapyramidal symptoms, and reduced quality of life of the patients
[14, 15]. Furthermore, these agents deteriorate cognitive functions
and complicate the activity of daily living in patients with dementia
[14]. It is recommended to use non-pharmacological methods, in-
cluding mental health consultation and treatment planning, exer-
cises, recreational activities, and music therapy (MT), because
these techniques decrease the behavioral problems, do not lead to
side effects and do not have negative effects on the patients’ quality
of life [1, 3, 8, 14, 16, 17].
MT is one of the non-pharmacological methods used in the
health care of dementia patients [1, 18, 19]. Music induces alpha
waves (8–12 Hz) in the brain, which are especially prominent when
the eyes are closed and during relaxation [20]. Music stimulates re-
lieving positive emotions, and these are connected with the activa-
tion of the limbic system [21]. Meta-analyses have shown that MT
may improve behavioral and psychological symptoms of dementia
(BPSD) and both cognitive and motor performance in dementia
patients [3, 22]. Raglio et al. [23] evaluated the effects of an MT ap-
proach. Their results showed a significant reduction in BPSD in-
cluding delusions, agitation, anxiety, apathy, irritability, aberrant
motor activity, and sleep disorders in dementia patients receiving
MT. Moreover, Choi et al. [24] found that MT improved BPSD sig-
nificantly, especially agitation in dementia patients. However, stud-
Effects of Music Therapy on Dementia Patients
and Their Caregivers
ies examining the effect of MT on the caregiver burden in case of
patients with dementia are limited. Only 1 study has been con-
ducted to evaluate the effectiveness of MT on caregiver burnout in
relation to dementia patients [25].
Music can also influence the autonomic-emotional integration
system (involves limbic pathways). Here, the autonomic nervous
system and emotions are wired together [26]. Given this neuroana-
tomic and neurophysiologic evidence, an association of music with
emotions, neurotransmitter and stress hormone production, auto-
nomic responses, behavior, and mood states becomes reasonable, if
not obvious. The influence of music on vital functions such as the
heart rate (HR), the respiration rate (RR), and the systolic and dias-
tolic blood pressure (SBP/DBP) may lead to a different self and
body experience, a different ‘consciousness’ or altered state of
mind [27]. It is possible that MT may also regulate and normalize
physiological parameters, including SBP and DBP, by activating
the parasympathetic nervous system and decreasing catecholamine
secretion [28]. Furthermore, Gagner-Tjellesen et al. [29] reported
that music could lead to physiological changes such as decreased
blood pressure and HR. Raglio et al. [30] evaluated the effects of
MT on BPSD and physiological parameters such as the HR in de-
mentia patients. In patients receiving MT, an increase in HR vari-
ability was observed. Takahashi and Matsushita [31] performed a
randomized controlled study examining the effect of MT interven-
tion in moderate to severe dementia. Also, SBP levels were signifi-
cantly lower in participants who received MT than in others.
In line with the literature, MT has positive effects on the BPSD
of dementia patients and, thus, further studies examining the care
burden of caregivers under these conditions should be conducted.
It is thought that this situation may cause a decrease in caregiver
burden since the effects of MT reduce the BPSD in patients with
dementia. Therefore, this study was conducted to explore the ef-
fects of therapy with classical Turkish music on the caregiver bur-
den and on physiological parameters (SBP, DBP, HR, RR) in pa-
tients with dementia.
Hypotheses
Hypothesis 1: MT decreases the caregiver burden in case of pa-
tients with dementia.
Hypothesis 2: MT regulates physiological parameters, including
SBP, DBP, HR, and RR, in patients with dementia.
Methods
Trial Design
This study was a randomized, controlled, single-blind trial. Participants
were randomly assigned to either the music group or the control group where
the participants were blinded to the intervention allocation.
Participants
The study population consisted of 75 dementia patients and their caregivers
registered at in-home care services of the General Secretariat of Public Hospi-
tals Association in Ordu, Turkey. No sample size calculation was performed,
and all dementia patients and their in-home caregivers were included in the
current study [32]. The sample included 60 dementia patients and their caregiv-
Complement Med Res 2019;26:22–30 23
DOI: 10.1159/000490348
 STUDY PLAN

Assessed for Eligibility (n = 75)

Excluded (n = 5)
Patients who do not have Alzheimer-type
dementia (n = 5)

Randomization (n = 70)

Music Group (n = 35) Control Group (n = 35)

Accepted to enroll in the music group (n = 35) Accepted to enroll in the control group (n = 35)
Did not want to listen to music in the music group (n = 2) Patients who moved to another city (n = 1)
Patients who died (n = 3) Patients who died (n = 4)

Music Group (n = 30) Control Group (n = 30)

Pre-test Pre-test
Patient and Caregiver Information Form Patient and Caregiver Information Form
Standardized Mini-Mental Test Standardized Mini-Mental Test
Activities of Daily Living Scale Activities of Daily Living Scale
Caregiver Burden Scale Caregiver Burden Scale
Physiological Parameters Form Physiological Parameters Form

Music Therapy Intervention

3 Months (90 days)

Music therapy (Rast, Buselik, Isfahan maqams) was performed for 30 min in
the morning on Mondays, Wednesdays and Fridays.

Music Group (n = 30) Control Group (n = 30)

Post-test Post-test
Caregiver Burden Scale Caregiver Burden Scale
Physiological Parameters Form Physiological Parameters Form

Fig. 1. Study plan.

ers (30 in the music group and 30 in the control group) who met the inclusion
criteria for the study conducted between April 2015 and April 2016. Eligible
were all dementia patients who had dementia-type Alzheimer’s disease and all
their caregivers who were literate and who were primarily responsible for the
care of the patient. Exclusion criteria included dementia patients who had any
hearing loss (fig. 1).
Randomization
Initially, a specialist in nursing excluded ineligible participants based on the
aforementioned criteria and listed eligible participants (n = 70) in the study.
Subsequently, we used this list to allocate patients to groups depending on the
participant numbers. A computer-generated list of random numbers was used
to allocate the participants. Participants were then randomly assigned by simple
randomization procedures (computerized random numbers) to the music and
control groups. The first 35 patients were recruited as the control group, and
the subsequent 35 patients formed the music group. The study was completed
with 60 dementia patients (30 control group, 30 music group) (fig. 1).
Ethical Considerations
Ethical approval was obtained from the Clinical Research Ethics Committee
of Ordu University, and written permission was obtained from the General Sec-
retariat of the Association of Public Hospitals in Ordu, Turkey. Written consent
was obtained from the caregivers of dementia patients who agreed to enroll in
the study. All participants were informed about both the purpose and the de-
sign of the study and were guaranteed anonymity and confidentiality. Participa-
tion in the study was voluntary. Furthermore, patients in the control group did
not receive MT in the study. In addition, patients in the control group received
the same MT after the study in accordance with the ‘the principle of equality’.
Instruments
Patient and Caregiver Information Form: The demographic characteristics
of the dementia patients and their caregivers were determined by using the Pa-
tient and Caregiver Information Form, which was prepared by researchers in
line with the literature [1, 3, 6, 9, 11]. The form is composed of 7 questions ask-
ing for age, gender, marital status, educational status, the duration of the dis-
ease, the stage of the dementia, and the presence of any additional disease other
than dementia. Furthermore, there are also 9 questions about the caregivers re-
garding their age, gender, marital status, educational status, working status,
family type, income status, the presence of chronic diseases, and their relation-
ship with the patient.
Standardized Mini-Mental Test (SMMT): The SMMT was developed by Fol-
stein et al. [33]. It is a short, standard and useful test that can be used particu-
larly for the assessment of mental functions of dementia patients. The Turkish
validity and reliability study of this test was conducted by Güngen et al. [34].
There are 11 items in the test, which are grouped under 5 main titles such as
orientation, registration memory, attention and calculation, recall, and lan-

24 Complement Med Res 2019;26:22–30 Gok Ugur/Orak/Yaman Aktas/Enginyurt/

DOI: 10.1159/000490348 Saglambilen
guage. The maximum score that can be obtained from the test is 30. The maxi-
mum score of 30 can be attained as follows: 10 points from the time and space
orientation, 6 points from memory, 5 points from attention, 8 points from lan-
guage, and 1 point from visual-spatial functions. Scores ranging from 24 to 30
represent a normal mental status, scores ranging from 18 to 23 represent a mild
level of dementia, scores ranging from 10 to 17 represent a moderate level of
dementia, and scores of less than 10 represent a severe level of dementia [34].
Activities of Daily Living Scale (ADLS): The ADLS was developed by Katz et
al. [35]. It is a scale used to provide the basic necessities for sustaining life. This
scale is used to assess the ability of an individual to perform daily activities and
is composed of 6 questions that are related to these activities, such as bathing,
dressing, toileting, moving, continence, and eating. According to the assess-
ment of the ADLS, 1 point is given when patients perform their activities inde-
pendently, 2 points are given when patients receive support, and 3 points are
given when patients cannot perform their daily activities. Accordingly, a score
of 0–6 is defined as ‘independent’, a score of 7–12 is defined as ‘semi-depend-
ent’, and a score of 13–18 is defined as ‘dependent’ [35].
Caregiver Burden Scale (CBS): The CBS was developed by Zarit et al. [36]
and was translated into Turkish by Inci [37]. This scale is used to evaluate the
care burden (i.e., the impact of caregiving) on caregivers; it is composed of 22
items that help to determine the care burden. The scores on this scale vary be-
tween 0 and 4 (never, rarely, sometimes, frequently, and always). The minimum
score on the scale is 0, and the maximum score of the scale is 88. Higher scores
represent more problems during the health care of dementia patients. The in-
ternal consistency of the scale was 0.91, the test-retest reliability was 0.86, and
the consistency between interviewers was 0.63 [36]. The internal consistency
coefficient of the Turkish version of the scale was 0.95, and its test-retest im-
mutability factor was 0.90 [37].
Physiological Parameters Form: This form included physiological parame-
ters including SBP, DBP, HR, and RR.
Outcome Measures
The caregiver burden was the primary outcome and was assessed using the
CBS in this study. Physiological parameters including SBP, DBP, HR, and RR
were used as secondary outcomes.
Data Collection
After allocation of the groups, data collection regarding the Patient and Care-
giver Information Form, SMMT, ADLS, CBS, and physiological parameters of
the participants (SBP, DBP, HR, RR) took place at baseline (week 0). Changes in
the caregiver burden scores and physiological parameters were observed in the
12th week using face-to-face interviews obtained through home visits.
Caregiver burden was assessed by a lecturer who was one of the researchers
in the study and a specialist in psychiatric nursing. Physiological parameters
were evaluated in the morning between 9 and 10 a.m. by a doctor whose exper-
tise is home care and by 2 nurses who were specialists in surgical and home care
nursing. Blood pressure measurements were performed by the same researchers
using an aneroid-type sphygmomanometer (ERKA D-83646; Bad Tölz, Ger-
many) at the brachial artery. In all subjects, both the SBP and DBP were meas-
ured in the supine position: The SBP and DBP were taken from the left arm,
which was flexed at the elbow and supported at the level of the heart. The re-
searcher’s hand was held for 1 min at the radial artery of the patient, and the
pulse was measured with the palpation technique. Afterwards, movements of
the diaphragm were followed without providing any explanation to the patient
and respiration was assessed and recorded for 1 min. Subsequently, palpation
was applied for 2 min to measure both the HR and RR in patients with
dementia.
Intervention
Control Group
MT was not provided to control group patients in the study. However, clas-
sical Turkish music on CD was also provided to patients in the control group
after the post-test.
Effects of Music Therapy on Dementia Patients
and Their Caregivers
Music Group
Patients received 3 sessions of MT per week (Monday, Wednesday, Friday;
30 min each) in the mornings for 12 weeks (fig. 1). In the literature, it has been
reported that 30 min of MT has positive effects on both psychological and phys-
iological parameters in patients [38–40]. Therefore, we decided to provide MT
to dementia patients for 30 min. It has been shown that at least 3 months of MT
is effective in mental illnesses [41]. Therefore, patients received MT for
12 weeks. The patients listened to instrumental classical Turkish music, includ-
ing Rast, Buselik and Isfahan maqams. Classical Turkish music is a slow and
relaxing type of instrumental music; it has the most recreative effect on both an
individual’s psychological state (anxiety, social adaptation, behavioral prob-
lems, etc.) and physiological parameters [42–45]. Therefore, these music com-
positions were selected. It has been reported that they have more positive effects
when individuals listen to these maqams in the morning [45, 46]. Therefore,
MT was performed in the morning after the patients had woken up. Music
players, flash drives that consisted of all songs and MT programs were provided
to each of the patients in the music group. MT was brought to the dementia
patients and led by a music therapist. The music therapist is a lecturer in the
music department at the Faculty of Music and Performing Art. Primarily, the
music therapist taught the caregivers how to use the music player and explained
the MT program to them. The MT program was as follows: 30 min of MT in the
morning 3 times per week (Monday, Wednesday, and Friday) for 12 weeks. MT
was individually provided to each patient at home. A music player was placed in
the patient’s room where she/he spent time at home. The caregivers did not lis-
ten to these music compositions; only the patients listened to the MT programs
in their own rooms. During the first session, the MT was implemented accom-
panied by the music therapists, in order to show the caregivers how to use the
music player. The second session was also attended by the music therapist and
caregivers, and the music therapist observed the MT and supported the caregiv-
ers. Furthermore, a contact phone number of the music therapist was given to
the caregivers. The caregivers reached out to the music therapists via phone
calls whenever they encountered problems related to using the music player.
The caregivers’ adherence to the program was checked by the music therapist
with home visits once a week and by calling the caregivers on each session day
(Monday, Wednesday, Friday).
Statistical Analysis
The Statistical Package for Social Sciences (SPSS, Chicago, IL, USA) for Win-
dows 20.0 was used to evaluate the data. The Kolmogorov-Smirnov test was per-
formed to determine whether the data were normally distributed. Parametric
tests were used because the data were screened and confirmed to have a normal
distribution. Baseline characteristics were compared between the groups to ex-
amine the success of randomization, using chi-square tests and t-tests for inde-
pendent samples. Changes in caregiver burden and physiological parameters
were compared between the groups at baseline (week 0) and week 12, using a t-
test for independent samples. Changes in caregiver burden were compared
within groups using the CBS at baseline (week 0) and week 12, using a paired-
sample t-test. The statistical significance was accepted at p < 0.05 in the study.
Results
Demographic Characteristics of Dementia Patients and Their
Caregivers
The mean ages of the dementia patients were 82.43 ± 6.80 and
83.40 ± 7.60 years in the music group and the control group, re-
spectively. Of the participants in the music group, 86.7% had an-
other disease besides dementia, and 50% were in the severe stage of
dementia. Of the participants in the control group, 80% had an-
other disease besides dementia, and 40% were in the severe stage of
dementia. No significant differences were found between the two
groups regarding demographic characteristics (p > 0.05) (table 1).
Complement Med Res 2019;26:22–30 25
DOI: 10.1159/000490348
 Table 1. Demographic characteristics of the dementia patients

Characteristic Music group (n = 30) Control group (n = 30) Test p

N % N %

Age, mean ± SD (range) 82.43 ± 6.80 (68‒98) 83.40 ± 7.60 (65‒100) t = −0.519 0.606
Gender
Female 23 76.7 24 80.0 χ2 = 0.098 0.754
Male 7 23.3 6 20.0
Marital status
Married 11 36.7 11 36.7 χ2 = 0.000 1.000
Single 19 63.3 19 63.3
Educational status
Illiterate 20 66.7 20 66.7 χ2 = 4.286 0.509
Literate 5 16.7 2 6.7
Primary school 3 10.0 6 20.0
Secondary school 1 3.3 1 3.3
High school ‒ ‒ 1 3.3
University 1 3.3 ‒ ‒
Presence of other disease besides dementia
Absent 4 13.3 6 20.0 χ2 = 0.480 0.488
Presence 26 86.7 24 80.0
Stage of dementia
Normal 1 3.3 3 10.0 χ2 = 3.762 0.288
Mild 2 6.7 6 20.0
Moderate 12 40.0 9 30.0
Severe 15 50.0 12 40.0
Duration of disease, mean ± SD 6.10 ± 3.19 (1‒12) 4.63 ± 2.86 (1‒12) t = 1.876 0.066
(range)
SMMT, mean ± SD (range) 9.93 ± 7.98 (0‒26) 12.23 ± 8.76 (0‒28) t = ‒1.063 0.292
ADLS, mean ± SD (range) 16.00 ± 2.45 (10‒18) 14.93 ± 3.66 (6‒18) t = 1.327 0.190

SD = Standard deviation; SMMT = Standardized Mini-Mental Test; ADLS = Activities of Daily Living Scale.

The mean ages of the caregivers were 50.43 ± 11 and 54.60 ±
13.79 years in the music group and the control group, respectively.
Of the caregivers in the music group, 70% had a chronic disease,
and 43.3% were the daughters of the patients. Of the caregivers in
the control group, 60% had chronic disease, and 40% were the
daughters of the patients (table 2).
respectively). However, the mean scores of the post-test HR and
RR in the music group were not significantly different from those
in the control group (t = –1.850, p = 0.069; t = –1.013, p = 0.315,
respectively) (table 4).
Discussion

The Burden of the Caregivers and Physiological Parameters of
the Dementia Patients
There was no difference between the two groups with regard to
the pre-test CBS scores (t = –0.725, p = 0.471). However, the differ-
ence between the post-test CBS scores of the two groups was found
to be statistically significant (t = –4.478, p = 0.001). It was also de-
termined that the mean scores of the pre- and post-test CBS were
significant within both the music and the control group (t = 9.035,
p = 0.001; t = –5.699, p = 0.001) (table 3).
There were no differences in the pre-values of SBP, DBP, HR,
and RR between the music and control groups (t = –0.652, p =
0.720; t = –0.179, p = 0.085; t = –0.836, p = 0.407; t = 0.486, p =
0.629, respectively). The mean scores of the post-test SBP and DBP
in the music group were found to be significantly lower than those
in the control group (t = –4.603, p = 0.001; t = –2.656, p = 0.010,
This study was conducted to explore the effect of therapy with
classical Turkish music on the caregiver burden and physiological
parameters of patients with dementia. In this study, there was a sig-
nificant difference between the means of the post-test CBS scores
of the music and control group patients. In a review of the litera-
ture by Raglio et al. [22], most studies reported that MT demon-
strated a significant reduction in anxiety and agitated behaviors
and an improvement in both positive social behaviors and depres-
sive disorders in patients with dementia. Kramer [47] has also
found that dementia patients feel calmer during the day after MT.
This calming effect allows caregivers to feel more comfortable and
enables them to better communicate with the patients. Patients
with Alzheimer’s disease were found to benefit from MT for reduc-
ing anxiety levels [48, 49]. In several other studies examining the
effect of MT on anxiety and agitated behaviors in patients with de-

26 Complement Med Res 2019;26:22–30 Gok Ugur/Orak/Yaman Aktas/Enginyurt/

DOI: 10.1159/000490348 Saglambilen
 Table 2. Demographic characteristics of the caregivers

Characteristic Music group (n = 30) Control group (n = 30) Test p

N % N %

Age, mean ± SD (range) 50.43 ± 11.17 (34‒87) 54.60 ± 13.79 (25‒88) t = −1.286 0.204
Gender
Female 28 93.3 26 86.7 χ2 = 0.741 0.389
Male 2 6.7 4 13.3
Marital status
Married 24 80.0 24 80.0 χ2 = 0.000 1.000
Single 6 20.0 6 20.0
Educational status
Literate 2 6.7 8 26.7 χ2 = 5.882 0.208
Primary school 11 36.7 12 40.0
Secondary school 5 16.7 2 6.7
High school 8 26.7 6 20.0
University 4 13.3 2 6.7
Working status
Working 5 16.7 5 16.7 χ2 = 0.000 1.000
Not working 25 83.3 25 83.3
Family type
Nuclear family 27 90.0 24 80.0 χ2 = 1.176 0.278
Extended family 3 10.0 6 20.0
Income status
Less income than expenses 8 26.7 10 33.3 χ2 = 1.222 0.543
Equal income and expenses 19 63.3 19 63.3
More income than expenses 3 10.0 1 3.3
Presence of chronic disease
Absent 9 30.0 12 40.0 χ2 = 0.659 0.417
Present 21 70.0 18 60.0
Degree of closeness
Spouse 2 6.7 6 20.0 χ2 = 6.112 0.191
Daughter 13 43.3 6 20.0
Son 1 3.3 2 6.7
Daughter-in-law 8 26.7 12 40.0
Caregiver 6 20.0 4 13.3

Table 3. Comparison of the mean CBS scores between and within groups

Caregiver Burden Scale Music group (n = 30), mean ± SD Control group (n = 30), mean ± SD Test and p-value

Pre-test 52.83 ± 15.82 55.77 ± 15.50 t1 = −0.725

p = 0.471
Post-test 43.27 ± 13.83 59.37 ± 14.02 t1 = −4.478
p = 0.001
Test and p-value t2 = 9.035 t2 = ‒5.699
p = 0.001 p = 0.001

CBS = Caregiver Burden Scale; SD = standard deviation.

p < 0.05, t1 = t-test for independent samples, t2 = t-test for paired samples.

mentia, the authors found a significant reduction in both anxiety
and agitated behaviors after MT [49–53]. Regarding the mecha-
nisms of action, music, by masking environmental noises, directs
one’s attention to a more pleasant emotional state, thereby trigger-
ing feelings of connection with both physical and mental relaxation
[26]. It is thought that, in our study, the exposure of dementia pa-
tients to classical Turkish music caused a positive effect on the pa-
tients’ mental states and decreased the caregivers’ care burden.
There was a significant difference between the two groups re-
garding the post-test SBP and DBP scores in this study. It was
shown that both the post-test SBP and DBP scores in the music
group were significantly lower than those in the control group. MT
has been shown to improve physical signs, decrease stress hor-
mones and stabilize vital signs [54, 55]. Takahashi and Matsushita
[31] conducted a study with moderate to severe dementia patients.
The study results showed that SBP levels were significantly lower in

Effects of Music Therapy on Dementia Patients Complement Med Res 2019;26:22–30 27

and Their Caregivers DOI: 10.1159/000490348
 Table 4. Comparison of the mean scores of the physiological parameters between groups

Music group (n = 30), mean ± SD Control group (n = 30), mean ± SD Test and p-value

SBP, mmHg pre-test 121.33 ± 16.13 122.67 ± 12.30 t = −0.652

p = 0.720
post-test 109.67 ± 13.77 124.33 ± 10.73 t = −4.603
p = 0.001
DBP, mmHg pre-test 76.00 ± 6.75 76.33 ± 7.65 t = −0.179
p = 0.085
post-test 71.67 ± 6.99 76.67 ± 7.58 t = −2.656
p = 0.010
HR, bpm pre-test 75.60 ± 7.21 77.73 ± 11.97 t = −0.836
p = 0.407
post-test 74.13 ± 5.99 78.47 ± 11.35 t = −1.850
p = 0.069
RR, rpm pre-test 22.47 ± 6.49 21.67 ± 6.26 t = 0.486
p = 0.629
post-test 20.80 ± 3.47 21.73 ± 3.67 t = −1.013
p = 0.315

SD = Standard deviation; SBP = systolic blood pressure; DBP = diastolic blood pressure; HR = heart rate; RR = respiration rate;
bpm = beats per minute; rpm = breaths per minute.
p < 0.05, t = t-test for independent samples.

participants who received MT compared with those who did not
receive MT. Stefano et al. [56] have shown that music listeners ex-
hibit changes in relevant plasma signaling molecules consistent
with physiological changes associated with the reported actions of
music, i.e. lower blood pressure. The current study finding is in
agreement with a study conducted by Okada et al. [57] that investi-
gated the effects of MT and found a significant improvement in
parasympathetic activities in elderly patients with dementia, but
not in the control group. Similar to our results, it is stated that lis-
tening to classical Turkish music for a long period of time de-
creases the SBP [44]. In another study, the SBP was attenuated in
response to the music exposure when hypertensive patients lis-
tened to music as a group once a week for 60 min over a 12-week
period [58]. But this finding is contrary to a previous study which
reported that MT did not reduce the blood pressure of neurology
patients [40]. It can be said that, in our study, the exposure of the
patients to music therapy 3 times a week for 12 weeks was effective
in regulating the patients’ blood pressures.
There was no statistically significant difference between patients
in the music and the control group in terms of post-test HR scores
in this study. The findings of this study were similar to those of
other studies conducted with different populations by Korhan et al.
[59], Yaman Aktaş and Karabulut [60], and Lee et al. [61], in which
no significant changes in the HR were observed in patients who
received MT. In contrast, Raglio et al. [30] evaluated the effects of
MT and found an increase in HR variability in patients receiving
MT, suggesting a possible improvement in cardiovascular func-
tion. However, unlike clinical studies, the current study was con-
ducted with dementia patients who received in-home health care,
and HR measurements were not performed immediately after the
MT.
According to our findings, no significant difference between the
two groups regarding the post-test RR scores was found in the
study. 3 randomized controlled trials in a systematic review, in-
volving hospital patients, showed a reduction in the RR of the
music group when compared with the control group [62]. Lee et al.
[39] and Phipps et al. [40] have shown that the RR scores in the
music group were significantly lower than those in the control
group. In our study, MT was given to patients in their homes and
respiration was evaluated as pre-test in week 0 and as post-test in
week 12. In the studies found in the literature that have concluded
that MT influences the RR, it can be seen that respiratory measure-
ments were conducted right after the MT intervention; however, in
this study, the patients’ RR was not assessed right after the MT. It is
thought that the results of the study are associated with this fact.
Limitations
The present study has a number of limitations. First of all, MT
was given to dementia patients in their homes. The music therapist
conducted the first and second MT sessions himself. In addition,
he made home visits once a week and controlled the MT interven-
tion by calling the caregivers in each session. The facts that the
study was conducted in a home environment and that music thera-
pists were not present with each patient in each session are the
limitations of the study. Secondly, the patients’ vital findings were
measured only as pre-test (week 0) and post-test (week 12). The
fact that the vital findings were not measured after each MT inter-
vention or within specific intervals was another limitation of the
study. Thirdly, this study was conducted in only one province of
Turkey and with only dementia patients who were registered with
in-home health care services. Therefore, our findings cannot be
generalized to all dementia patients and caregivers. New studies
with more samples are needed to find out the effect of classical
Turkish music on dementia patients.

28 Complement Med Res 2019;26:22–30 Gok Ugur/Orak/Yaman Aktas/Enginyurt/

DOI: 10.1159/000490348 Saglambilen
 Conclusions Acknowledgements

We would like to thank the patients with dementia and their home caregiv-
In this study, it was found that exposure of dementia patients to
ers who accepted to participate in this study.
classical Turkish music at home decreased the burden of care for
the caregivers and regulated the blood pressure of the patients. In
addition, it was found that MT did not have an influence on the
patients’ HR and RR. In line with these results, MT is recom- Disclosure Statement
mended for decreasing the care burden of home-care dementia pa-
There are no conflicts of interest. This study was supported by the project
tients, and especially the burden of caregivers and in regulating the
AR-1416 by Ordu University, Scientific Research Projects Coordination Unit.
patients’ blood pressure. Low expenditure, lack of side effects, and
practical usage of MT makes it a reasonable alternative, especially
in in-home care.

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