音樂治療對於改善失智症病人憂鬱症狀之成效:系統性文獻回顧與統合分析

背景:失智症是老年人常見疾病之一，而臨床上失智症病人常合併出現憂鬱症狀，是需要積極處置的，音樂治療就是可以運用的治療方式之一。但目前的研究結果顯示，針對音樂治療改善失智症者憂鬱症狀，沒有一致性的結論。目的:本研究透過系統性文獻回顧暨統合分析方式，探討音樂治療對於改善失智症憂鬱症狀之成效。方法:透過PubMed、Ovid、EBSCO、Embase、Cochrane Library等電子資料庫，使用Dementia、Alzheimer's disease、Major neurocognitive disorder、Music Therapy、Depression等中、英文關鍵字，搜尋相關文獻，納入文獻標準是：以研究設計為隨機或非隨機控制性實驗、類實驗性設計為主；研究對象符合DSM-IV診斷為失智症或DSM-5診斷為認知類障礙症之病人；介入措施為音樂治療且以憂鬱量表作為成效指標之文章。此外，經臨床證據等級及修改版的Jadad品質量表，評價文獻品質後，共納入11篇文獻，進行系統性文獻回顧與統合分析。結果:音樂治療對於中、重度失智症憂鬱症狀，未具有顯著差異性。在團體類型音樂治療，對於輕中度失智症憂鬱症狀，則具有顯著之差異性，但在5-16週短期音樂治療，不論是團體或個別類型音樂治療方式，對於輕中度失智症憂鬱症狀其成效出現不一致；因而在11篇13筆文獻資料下，進行統合分析發現，音樂治療介入後，僅對輕中度失智症病人，其憂鬱症狀具有成效，而在不論是團體類型音樂治療方式，或是重度失智症病人，對於改善憂鬱症狀具有不顯著之成效。結論與建議:經系統性文獻回顧與統合分析後，發現音樂治療對於輕中度失智症病人，改善其憂鬱症狀具有成效，音樂治療是一種非侵入性、低成本的輔助療法，建議臨床照護者可運用在有憂鬱症狀之輕中度失智症病人。可以加強學校教育與護理在職教育，能夠提供學習音樂治療的相關知識，如音樂治療理論、臨床實務操作等知識訓練，如此才能設計嚴謹的護理研究計畫和措施，驗證音樂治療對失智症憂鬱症狀之成效異性。

關鍵字

音樂治療；失智症；憂鬱症；系統性文獻回顧；統合分析

並列摘要

Background: Dementia is one of the common diseases of the elderly, and clinically, the patients with dementia are often complicated with the symptoms of depression, which requires the active treatment. The music therapy is one of the available treatment methods. However, the current research results show that there is no consistent conclusion for the music therapy to improve the depression symptoms of the dementia patients. Objective: This study uses a systematic review and meta-analysis to explore the effectiveness of the music therapy in improving the depressive symptoms of dementia. Methodology: Through PubMed, Ovid, EBSCO, Embase, Cochrane Library and other electronic databases, using the Chinese and English keywords such as Dementia, Alzheimer's Disease, Major Neurocognitive Disorder, Music Therapy, Depression, etc., I search for the relevant literature. The criteria for the inclusion in the literature is: The research design is a randomized or non-random controlled experiment and a quasi-experimental design. The research subjects meet the DSM-IV diagnosed as dementia or DSM-5 diagnosed as neurocognitive disorder patients. The intervention measures are the music therapy and the articles where the depression scale is used as an indicator of effectiveness. In addition, after evaluating the quality of the literature through the clinical evidence level and the revised version of the Jadad Quality Scale, a total of 11 articles were included for the systematic review and meta-analysis. Results: The music therapy did not have significant differences in the depression symptoms of moderate and severe dementia. In the group type music therapy, there are significant differences in the depressive symptoms of mild to moderate dementia. However, the short-term music therapy in 5-16 weeks, regardless of whether it is a group or individual type of the music therapy, has the inconsistent effects on the depressive symptoms of mild to moderate dementia. Therefore, a meta-analysis based on 11 articles and 13 documents found that the intervention of the music therapy are only effective for the depression symptoms of the mild to moderate dementia patients. Regardless of the group music therapy methods, or the patients with severe dementia, there are insignificant effects in improving the depression symptoms. Conclusions and recommendations: After a systematic review and meta-analysis, it is found that the music therapy is effective for the patients with mild to moderate dementia in improving their depression symptoms. The music therapy is a non-invasive, low-cost adjuvant therapy, and it is recommended that the clinical caregivers can use it in the patients with mild to moderate dementia who have the depression symptoms. We can strengthen the school education and on-the-job nursing education, and can provide the relevant knowledge for learning the music therapy, such as the music therapy theory, clinical practice operation and other knowledge training, so that the rigorous nursing research plans and measures can be designed to verify the dissimilarity in the effectiveness of the music therapy on the depressive symptoms of dementia.