臺灣博碩士論文加值系統

本研究旨在透過網路統合分析方法，評估各類音樂治療介入對改善老人失智症認知功能及心理症狀的效果，探索失智症的有效治療方法是一個實徵的議題，因為生理老化的認知能力下降是一種在世界各地日益普遍的疾病。我們從主要國際學術資料庫中嚴選音樂治療介入失智症患者認知功能及心理健康的隨機對照試驗。這些試驗涉及多種音樂治療，包括主動音樂治療、聽音樂、節奏音樂治療、唱歌及個別化音樂介入等。本研究共納入了28項隨機對照試驗，涵蓋了2882名參與者，旨在分析音樂治療介入對失智症患者的認知功能提升、憂鬱症狀改善以及焦慮和躁動減輕的影響。結果發現節奏音樂治療（RMT）（SMD：0.76；95% CI：0.32至1.21）與主動音樂治療結合唱歌（AMT + Sing）（SMD：0.79；95% CI：0.09至1.49）對失智症患者認知功能有顯著正面影響；主動音樂治療結合唱歌（AMT + Sing）對改善失智症患者憂鬱症狀特別顯著（SMD: -0.89; 95% CI：-1.48至-0.30）；改善失智症患者焦慮的結果發現聽音樂（LtM)（SMD：-1.45；95% CI：-2.67至-0.22）和主動音樂治療（AMT）（SMD：-1.29；95% CI：-2.34至-0.23）均顯著有效；而各項音樂治療對改善失智症患者躁動是不顯著的。這些研究與標準護理相比，顯示退出率並無顯著增加，表明音樂治療在臨床環境中具有可行性和可接受性。本研究發現了文獻中的一個空白，事實上是第一個探討不同類型音樂對失智症患者認知功能和心理健康改善效果的研究。這些發現為失智症患者的照顧提供了新的見解，並為未來的研究與臨床實踐指明了新的方向。

The aim of this study is to evaluate the effects of various music therapy interventions on cognitive and psychological symptoms in dementia patients using network meta-analysis. Given the increasing prevalence of cognitive decline worldwide, identifying effective treatments for dementia is crucial. We conducted a rigorous screening of randomized controlled trials (RCTs) on music therapy for cognitive function and psychological symptoms in dementia from major electronic databases. The interventions encompassed active music therapy, music listening, rhythmic music therapy, singing, and personalized music interventions. This study included 28 RCTs with a total of 2882 participants. We analyzed the effects of music therapy on cognitive function, depression, anxiety, and agitation in dementia patients. The results indicated that rhythmic music therapy (RMT) (SMD: 0.76; 95% CI: 0.32 to 1.21) and active music therapy combined with singing (AMT + Sing) (SMD: 0.79; 95% CI: 0.09 to 1.49) significantly improved cognitive function. AMT + Sing was particularly effective in reducing depressive symptoms (SMD: -0.89; 95% CI: -1.48 to -0.30). Listening to music (LtM) (SMD: -1.45; 95% CI: -2.67 to -0.22) and AMT (SMD: -1.29; 95% CI: -2.34 to -0.23) were both significantly effective in reducing anxiety. However, music therapy did not significantly improve agitation. Compared to standard care, these studies showed no higher dropout rates, indicating the feasibility and acceptability of music therapy in clinical settings. This research addresses a gap in the literature and is the first to investigate the effectiveness of various types of music in enhancing cognitive function and psychological health in dementia patients. These findings offer new insights and guidance for future music therapy research and clinical practice.

摘要 i
Abstract ii
縮寫對照 iii
目錄 v
表目錄 vii
圖目錄 viii

1. Introduction 1
2. Methods 5
2.1 Database Search and Study Identification 5
2.2 Inclusion and Exclusion Criteria 6
2.3 Network Meta-Analysis Model Construction 7
2.4 Risk of Bias Assessment 7
2.5 Primary Outcomes 8
2.6 Secondary Outcome: Dropout Rate Differences 8
2.7 Data Extraction, Processing, and Transformation 9
2.8 Statistical Analysis 9
2.9 Sensitivity Analysis Methods 10
3. Results 12
3.1 Study Identification and Network Model Construction 12
3.2 Methodological Quality of the Included Studies 19
3.3 Primary Outcome 20
3.3.1 RMT and AMT + Sing Effectively Improve Cognitive Function 20
3.3.2 Most effective in improving depression in dementia patients is AMT + Sing 21
3.3.3 LtM and AMT Effectively Improve Anxiety in Dementia Patients 22
3.3.4 LtM Shows Potential for Improving Agitation in Dementia Patients 23
3.4 Secondary Outcomes: Dropout Rates Among Studies 26
3.5 Inconsistency Test 28
3.6 Sensitivity Analysis 28
3.7 Publication Bias 29
4. Discussion 30
4.1 Main Findings and Clinical Implications 30
4.2 Significance of Results in the Context of Current Research 33
4.3 Possible Explanations for the Observed Result 34
4.3.1 Music Therapy Enhances Dementia Cognitive Function via Neuroplasticity 34
4.3.2 Social Mechanisms of Music Therapy in Dementia Patients Care 38
4.4 Study Limitations 41
5. Conclusion 42
Supplementary Materials 43
References 68
Appendix 84

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