Agitation in dementia and music therapy: A theoretical study of the legitimacy of reductionist music-based interventions

Introduction There is an urgent need for non-pharmacological approaches to address agitation (restlessness and/or aggression) among persons with dementia. Music-based interventions could be one solution. Agitation in dementia is often conceptualised as a manifestation of a distinct neurological dysfunction, which can be targeted by a specific medication or a uniform psychosocial intervention. However, this reductionist perspective fails to account for the heterogeneity and the multifactorial nature of agitation in dementia.Method The article is based on extensive reading bridging findings from the research on music-based interventions, psychogeriatrics and neuroscience. We use a combination of dialectical and epistemological argumentation to discuss the legitimacy of different types of music-based approaches to mitigate agitation.Results We identify three different types of music-based approaches: 1) a radical reductionist approach, which aims to treat agitation through assumed universal effects of particular music; 2) a moderate reductionist approach, with the use of music therapy in a standardised way; and 3) a contextual approach, where the impact of music therapy on agitation is understood as a side-effect of psychosocial needs being met.Discussion We argue that a radical and a moderate reductionist approach is insufficient in capturing both the multifaceted nature of agitation and the complexity of the impact of music-based interventions. Those approaches might therefore hinder the methodological flexibility and context sensitivity of music therapy. Music therapists should therefore avoid seeking uniform interventions and instead maintain a contextual approach to agitation in dementia.