Clinical Improvisatory Music for Alzheimer’s Disease Anxiety and Caregivers (CIMAC): Preliminary Behavioral and Network Modulation Findings from Ongoing Trials
Catherine Vidano1, Jordan Behn1, Clara Takarabe2, Borna Bonakdarpour1
1Mesulam Center for Cognitive Neurology and Alzheimer Disease, 2Northwestern University Neurology
Objective:

This study explores Clinically Designed Improvisatory Music (CDIM) feasibility in reducing anxiety in individuals with Alzheimer’s Disease (AD-A) and caregiver burden and modulating four brain networks crucial for emotional processing.

Background:
Anxiety affects approximately 40% of individuals with AD, diminishing quality of life and increasing caregiver stress. Anxiety medications can have negative side effects, prompting exploration of non-pharmacological interventions like music.  CDIM has previously shown efficacy at decreasing anxiety in healthy individuals
Design/Methods:

Fifteen individuals with AD-A and 12 caregivers participated in a delayed enrollment study with two pre- and one post-CDIM evaluation. CDIM involved eight 30-minute sessions of slow, meandering melodic improvisations delivered in 2-minute segments by a certified clinical music practitioner. Anxiety and caregiver burden were assessed using the Rating Anxiety in Dementia (RAID) and Zarit Burden Interview (ZBI), respectively. Vital signs (BP, RR, HR) were recorded. Functional MRI data were analyzed for connectivity changes in 4 brain networks: Default Mode Network (DMN), Salience Network (SN), Reward Network (RN), and Auditory Limbic Network (ALN) using the CONN toolbox.

Results:
Pre- and post-CDIM comparisons using Mann-Whitney U test revealed significant RAID and ZBI reductions. Both groups had significant reduction in SBP (a trend in AD-A), HR and RR (only caregivers). AD-A fMRI results revealed increased connectivity in SN, ALN, RN.  Negative correlation between RN connectivity and RAID trended towards significance. Caregivers showed increased connectivity in SN, posterior DMN and ALN, which negatively and significantly correlated with ZBI.
Conclusions:

Our findings indicate CDIM appears feasible for reducing anxiety and caregiver burden, with symptomatic, physiological, and neural effects. In the AD-A group, autonomic dysfunction or cholinesterase inhibitors may interfere with physiological evaluations. We believe CDIM transitions the autonomic and emotional networks to a calmer state through entrainment. fMRI findings suggest CDIM may modulate abnormal network connectivity, reducing anxiety. Recruitment and fMRI data collection are ongoing.

10.1212/WNL.0000000000217338
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