Dance and Movement Therapeutic Methods in Management of Dementia: A Randomized, Controlled Study

To the Editor: Behavioral and cognitive problems in dementia can be addressed using various nonpharmacological interventions such as neuropsychological rehabilitation1 and Reality Orientation therapy,2 but alternative methods still need to be sought for. Creative activities, stimulation of sensomotor system,3 and music therapy4 have been found to be potentially beneficial. We previously demonstrated the applicability of dance and movement therapy (DMT)5 in dementia, and this letter evaluates whether it would improve patients' cognitive level or behavior. The DMT intervention consisted of nine sessions with 1-week intervals lasting for 30 to 45 minutes each (see5 for the description); the control group spent the same amount of time together in regular nursing home activities. The intervention study was conducted in compliance with Declaration of Helsinki ethical standards. The patients and their spouses signed an informed consent, and the municipal board of Health Centre of Nivala, acting as a disciplinary committee, approved the study. Assessments made 1 week before and immediately before the beginning of the DMT (double-baseline, the mean used in statistical comparisons), at Weeks 5 and 9 of the intervention, and at Week 13 (follow-up 4 weeks post-intervention) included the Mini-Mental State Examination (MMSE);6 the Word List savings score (percentage of the delayed recall compared with the third learning trial) and the Clock Drawing Test (maximum score 6) from the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery;7,8 the Cookie Theft picture description task from Boston Diagnostic Aphasia Test,9 along with other pictures used alternatively, scored for the number of Information Units; and the Nurses' Observation Scale for Geriatric Patients (NOSGER),10 for which, in each subscale, a higher score indicates greater impairment. Means and standard deviations are given; an independent-samples t-test, a multivariate analysis of variance (MANOVA) for repeated measures, and a paired-samples t-test from SPSS for Windows (Release 13.0.1. 2004. SPSS Inc., Chicago, IL) were used. Patients (n=29, 76% female) of a dementia nursing home were randomly recruited. Fourteen had Alzheimer's disease, eight had vascular dementia, and seven had undefined types of dementia. Patients were randomized into an intervention group (n=19, mean age 79.9±7.7) and a control group (n=10, mean age 84.5±3.4). The groups did not differ according to sex or age. All were receiving cholinesterase inhibitor treatment and antipsychotic medication, antidepressant medication, or both. Medications remained unchanged during the study. The groups did not differ according to the analyzed variables in the beginning. The MANOVA did not show a general effect, but in subsequent analyses, slight differences were detected. MMSE score improved slightly in the DMT group but not in the control group, so that the mean score in DMT group at follow-up (14.16±6.67) was higher than at the baseline (12.08±5.53, t=−3.084, P=.007). On the Clock Drawing Test, the two groups showed opposing trends (Figure 1), and the difference between them reached statistical significance at Week 9 (1.05±1.27 vs 0.30±0.48, t=2.290, P=.03) but no longer at follow-up (0.95±1.08 vs 0.50±0.53). There was no difference between the groups on the Word List Savings. The Picture Description Task improved from baseline to follow-up in the DMT group (14.32±13.62 and 19.76±8.02, respectively, t=−2.184, P=.044) but not in the control group (13.75±12.68 and 13.4±10.15, respectively). The Clock Drawing Test performance in the dance and movement therapy (DMT) group and in the control group (higher scores indicate better performance), mean and standard error of the mean at baseline, during the intervention at Week 5, at the end of the intervention at Week 9 (*statistically significant difference between the two groups), and at follow-up at Week 13. The groups did not differ according to total NOSGER score. On the instrumental activities of daily living (IADLs) subscale, the DMT group (20.5±3.3) scored lower than the control group at Week 9 (22.9±1.5, t=−2.70, P=.01), but the MANOVA over time showed no change. On the Self-Care subscale, there was a general time effect (F(2,26)=4.30, P=.02), and the control group scored higher at follow-up (15.70±2.41) than at baseline (12.75±2.38, t=−4.75, P=.001), indicating deterioration in this group. On the Social Competence subscale, the between-group effect was significant overall (F(1,27)=4.70, P=.04), but subsequent analyses revealed no further differences. In conclusion, the changes remained small but some intervention-related improvements were seen. The DMT intervention group improved in a task of visuospatial ability and planning (Clock Drawing Test), whereas the control group remained unchanged or deteriorated mildly. In memory (Word List delayed recall) no effect was found. The DMT may stimulate visual functions and planning more than memory, but the findings are inconclusive. A benefit was previously observed in the information content of speech output,5 and this was partly replicated. The behavioral symptoms remained relatively stable, but self-care ability and IADLs seemed to improve slightly. DMT therefore seems to offer one option in treating dementia, having effects on cognition and self-care abilities. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that none of the authors have any financial or any other kind of personal conflicts with this article. Funded by the European Union Research Funds and the Alzheimer Disease Foundation (Finland).