Hervé Platel – Professeur de Neuropsychologie herve.platel@unicaen.fr

Inserm U1077 – EPHE - Université de Caen « Neuropsychologie et imagerie de la mémoire humaine »

L’impact des pratiques psycho-sociales sur le vieillissement : l’exemple de la musique

Hervé Platel – Professeur de Neuropsychologie herve.platel@unicaen.fr

Inserm U1077 – EPHE - Université de Caen « Neuropsychologie et imagerie de la mémoire humaine »

L’impact des pratiques psycho-sociales sur le vieillissement : l’exemple de la musique

Cette intervention est faite en toute indépendance vis-à-vis de l’organisateur de la manifestation. Je n’ai pas de lien d’intérêts avec le sujet traité.

La musique à l’hôpital…est partout

¨  Neurologie – Aphasie, AVC, Alzheimer, Parkinson… ¨  Pédiatrie – accouchement, stimulation des enfants

prématurés ¨  Pédopsychiatrie – autisme, dyslexie, anorexie… ¨  Addictologie – sevrage des substances ¨  Oncologie – accompagnement des patients ¨  Soins palliatifs – diminution de la douleur,

accompagnement de fin de vie

Comment la musique pourrait soigner ?

1.  La musique ne fait rien – l’effet vient du thérapeute/intervenant

Comment la musique pourrait soigner ?

2.  L’activité musicale en tant que telle a un pouvoir curatif ¤  Contexte de la pratique musicale

¤  Contexte de l’écoute musicale

Modulations neurocognitives induites par la musique

¨  La pratique musicale est un modèle privilégié de l’étude de la plasticité cérébrale ¤  Plasticité fonctionnelle : modification du fonction-

nement du cerveau (réponse électrophysiologique ou métabolique)

¤  Plasticité structurale : modification dans la structure du cerveau (densité de neurones, épaisseur corticale, substance blanche)

Groussard et al. (2014) Brain and Cognition

Corrélation entre la densité de substance grise dans l’hippocampe et les années de pratiques musicales

Plasticité cérébrale dans les régions dévolues à la mémoire

Groussard et al., 2010, 2014

Effet de thérapies utilisant la musique chez des patients Aphasiques

Schlaug et al. 2009

La pratique musicale protège-t-elle des effets délétères du vieillissement ?

¤  Effet protecteur… n  Sujets âgés musiciens > Sujets âgés non musiciens (Hanna-Pladdy et

McKay 2011 ; Fauvel et al. 2014)

n  Jumeau musicien ≠ jumeau non musicien (Balbag et al. 2014 ; de Manzano & Ullen 2017)

¤  Retarde l’apparition de trb de la mémoire ?

Cerebral Cortex, 2017; 1–8

doi: 10.1093/cercor/bhx299Original Article

O R I G I NA L ART I C L E

Same Genes, Different Brains: NeuroanatomicalDifferences Between Monozygotic Twins Discordantfor Musical TrainingÖrjan de Manzano and Fredrik Ullén

Department of Neuroscience, Retzius väg 8, Karolinska Institutet, 17177 Stockholm, Sweden

Address correspondence to Örjan de Manzano, Department of Neuroscience, Retzius väg 8, Karolinska Institutet, 17177 Stockholm, Sweden.Email: orjan.demanzano@ki.se.

AbstractNumerous cross-sectional and observational longitudinal studies show associations between expertise and regional brainanatomy. However, since these designs confound training with genetic predisposition, the causal role of training remainsunclear. Here, we use a discordant monozygotic (identical) twin design to study expertise-dependent effects onneuroanatomy using musical training as model behavior, while essentially controlling for genetic factors and sharedenvironment of upbringing. From a larger cohort of monozygotic twins, we were able to recruit 18 individuals (9 pairs) thatwere highly discordant for piano practice. We used structural and diffusion magnetic resonance imaging to analyze theauditory-motor network and within-pair differences in cortical thickness, cerebellar regional volumes and white-mattermicrostructure/fractional anisotropy. The analyses revealed that the musically active twins had greater cortical thicknessin the auditory-motor network of the left hemisphere and more developed white matter microstructure in relevant tractsin both hemispheres and the corpus callosum. Furthermore, the volume of gray matter in the left cerebellar region ofinterest comprising lobules I–IV + V, was greater in the playing group. These findings provide the first clear support for thata significant portion of the differences in brain anatomy between experts and nonexperts depend on causal effects oftraining.

Key words: expertise, MRI, music, neuroanatomy, twins

IntroductionMany neuroimaging studies have documented that experts invarious domains differ from nonexperts in regional brain anat-omy (Ullén et al. 2016). Several of these studies have used musi-cians as a model group, finding larger volume and corticalthickness of auditory and motor regions, the cerebellum, as wellas white-matter structural differences, for example, of the corti-cospinal tract which carries motor responses from the cortex tothe spinal cord, and the corpus callosum which connects thecerebral hemispheres (Schlaug, Jäncke, Huang and Steinmetz

1995; Schlaug, Jäncke, Huang, Staiger, et al. 1995; Gaser andSchlaug 2003; Bengtsson et al. 2005; Bermudez et al. 2009).Animal studies suggest that these differences could arise fromvarious expertise-dependent adaptations, including increasedsynapse numbers, modified synapse morphology, and increasedaxonal myelination in task-relevant regions/tracts (reviewed inMarkham and Greenough 2004).

Thus, a common assumption is that similar outcomes reflectcausal effects of training on brain plasticity. However, meta-analyses indicate that practice only explains between 21% and

© The Author 2017. Published by Oxford University Press.This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.For commercial re-use, please contact journals.permissions@oup.com

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mean cortical thickness (across the network) in each hemi-sphere with the within-pair differences in self-reported musicpractice (one correlation with total hours of training and one

correlation with early practice, age 6–11). The correlation withearly practice was added because it is suggested that earlypractice plays a particular role for brain plasticity (Bengtssonet al. 2005). These supplementary analyses were carried out inSTATISTICA. Again, the results were considered significant ifP < 0.05, one-tailed. Finally, we calculated the within-pair corre-lation in mean cortical thickness in each hemisphere based onvalues extracted using FreeSurfer and the full DKT atlas.

FA AnalysisPreprocessing of Diffusion-Weighted Images

Diffusion data could not be obtained from one participant dueto technical difficulties during scanning. The FA analysis wasconsequently limited to 16 individuals (i.e., 8 complete pairs).The preprocessing pipeline can be found in the Supplementarymaterial. Fiber orientation distributions (FODs) were computedusing robust constrained spherical deconvolution using thegroup average response function at lmax = 6 (Tournier et al.2007) as implemented in MRtrix3 (Tournier et al. 2012). Agroup-specific unbiased FOD template was created (Raffelt et al.2011, 2012) and the FOD images from all participants were reg-istered to this template. Upsampled versions of the brain maskimages were also registered to the FOD template and a groupbrain mask was created based on the intersection of theseimages. A group mean FA image was also created.

Definition of ROIs and Probabilistic StreamlinesTractography in Template Space

In this analysis, we targeted the key white-matter tracts whichenable auditory-motor integration and motor execution andhave been identified in previous studies. Firstly, there are 2main pathways by which auditory/music related informationin the temporal lobe (from regions shown to differ betweenmusicians and nonmusicians, see Cortical thickness analysis)can reach the ventral premotor and inferior frontal cortex: Adorsal pathway, projecting from primarily the auditory regionsin the superior posterior temporal lobe and temporoparietaljunction via the arcuate fasciculus (AF) (Halwani et al. 2011),and a ventral path which relays information from more inferiortemporal regions to the inferior frontal cortex via the inferiorlongitudinal fasciculus (ILF) and the uncinate fasciculus (UF)(Dohn et al. 2015). Secondly, we wanted to identify the descend-ing motor pathway/corticospinal tract (CST), specifically fibersoriginating in the hand/finger region of M1 (Bengtsson et al.2005; Han et al. 2009). Thirdly, studies have shown portions ofthe corpus callosum (CC) to be larger or more developed inmusicians compared with nonmusicians, presumably as a con-sequence of extensive training of complex bimanual move-ments and interhemispheric communication (Schlaug, Jäncke,Huang, Staiger, et al. 1995; Schmithorst and Wilke 2002; Steeleet al. 2013).

The overall aim of the fiber tractography was to define thesetracts of interest and create spatial masks within which to cal-culate and compare FA between the playing and nonplayingtwins. In voxels which contain more than one fiber bundle, it isobviously a nontrivial matter to assign a particular FA value toeach fiber bundle. Groeschel and colleagues (Groeschel et al.2014), while comparing FA in a number of tracts in adolescentsborn preterm and controls, demonstrated different effects inregions with different underlying fiber architecture. In regionswith predominantly single fiber pathways, there were signifi-cant differences in FA between the groups; averaging data over

Figure 1. (A) ROIs used in the cortical thickness analysis, illustrated on the lefthemispheric surface of the fsaverage inflated brain. Heschl’s = Heschl’s gyrus;IFGpop = inferior frontal gyrus pars opercularis; IFGpor; inferior frontal gyruspars orbitalis; IFGptr = inferior frontal gyrus pars triangularis; ITG = inferiortemporal gyrus; M1 = primary motor cortex, hand/finger region; PMD = dorsalpremotor region; PMV = ventral premotor region; rACC = rostral anterior cingu-late cortex (on the medial surface); rMFG = rostral middle frontal gyrus; SPT =Sylvian parietal temporal area; STGp = superior temporal gyrus including pla-num temporale. (B) The tracts of interest (shown in the left hemisphere, andcorpus callosum), based on probabilistic fiber tracking and generation ofstreamlines in template space. AF = arcuate fasciculus; CC = corpus callosum;CST = corticospinal tract; ILF = inferior longitudinal fasciculus; UF = uncinatefasciculus. (C) Cerebellar ROIs, used in the VBM analysis. LH = left hemisphere;RH = right hemisphere.

4 | Cerebral Cortex

Downloaded from https://academic.oup.com/cercor/advance-article-abstract/doi/10.1093/cercor/bhx299/4608057by Universite De Caen Basse-Normandie useron 28 November 2017

Cerebral Cortex, 2017; 1–8

doi: 10.1093/cercor/bhx299Original Article

O R I G I NA L ART I C L E

Same Genes, Different Brains: NeuroanatomicalDifferences Between Monozygotic Twins Discordantfor Musical TrainingÖrjan de Manzano and Fredrik Ullén

Department of Neuroscience, Retzius väg 8, Karolinska Institutet, 17177 Stockholm, Sweden

Address correspondence to Örjan de Manzano, Department of Neuroscience, Retzius väg 8, Karolinska Institutet, 17177 Stockholm, Sweden.Email: orjan.demanzano@ki.se.

AbstractNumerous cross-sectional and observational longitudinal studies show associations between expertise and regional brainanatomy. However, since these designs confound training with genetic predisposition, the causal role of training remainsunclear. Here, we use a discordant monozygotic (identical) twin design to study expertise-dependent effects onneuroanatomy using musical training as model behavior, while essentially controlling for genetic factors and sharedenvironment of upbringing. From a larger cohort of monozygotic twins, we were able to recruit 18 individuals (9 pairs) thatwere highly discordant for piano practice. We used structural and diffusion magnetic resonance imaging to analyze theauditory-motor network and within-pair differences in cortical thickness, cerebellar regional volumes and white-mattermicrostructure/fractional anisotropy. The analyses revealed that the musically active twins had greater cortical thicknessin the auditory-motor network of the left hemisphere and more developed white matter microstructure in relevant tractsin both hemispheres and the corpus callosum. Furthermore, the volume of gray matter in the left cerebellar region ofinterest comprising lobules I–IV + V, was greater in the playing group. These findings provide the first clear support for thata significant portion of the differences in brain anatomy between experts and nonexperts depend on causal effects oftraining.

Key words: expertise, MRI, music, neuroanatomy, twins

IntroductionMany neuroimaging studies have documented that experts invarious domains differ from nonexperts in regional brain anat-omy (Ullén et al. 2016). Several of these studies have used musi-cians as a model group, finding larger volume and corticalthickness of auditory and motor regions, the cerebellum, as wellas white-matter structural differences, for example, of the corti-cospinal tract which carries motor responses from the cortex tothe spinal cord, and the corpus callosum which connects thecerebral hemispheres (Schlaug, Jäncke, Huang and Steinmetz

1995; Schlaug, Jäncke, Huang, Staiger, et al. 1995; Gaser andSchlaug 2003; Bengtsson et al. 2005; Bermudez et al. 2009).Animal studies suggest that these differences could arise fromvarious expertise-dependent adaptations, including increasedsynapse numbers, modified synapse morphology, and increasedaxonal myelination in task-relevant regions/tracts (reviewed inMarkham and Greenough 2004).

Thus, a common assumption is that similar outcomes reflectcausal effects of training on brain plasticity. However, meta-analyses indicate that practice only explains between 21% and

© The Author 2017. Published by Oxford University Press.This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.For commercial re-use, please contact journals.permissions@oup.com

Downloaded from https://academic.oup.com/cercor/advance-article-abstract/doi/10.1093/cercor/bhx299/4608057by Universite De Caen Basse-Normandie useron 28 November 2017

La pratique musicale protège-t-elle des effets délétères du vieillissement ?

¤  Effet protecteur… n  Sujets âgés musiciens > Sujets âgés non musiciens (Hanna-Pladdy et

McKay 2011 ; Fauvel et al. 2014)

n  Jumeau musicien ≠ jumeau non musicien (Balbag et al. 2014 ; de Manzano & Ullen 2017)

¤  Retarde l’apparition de trb de la mémoire ? ¤  Les musiciens ne sont pas à l’abri des maladies cérébrales

n  Cas cliniques de patients Alzheimer musiciens (Cowles et al., 2003 ; Cuddy & Duffin, 2005 ; Fornazzari et al., 2006)

Maladie d’Alzheimer et musicothérapie ?

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En mars 2008, la Haute Autorité de Santé propo-sait dans ses recommandations de bonnes pratiques concernant la prise en charge des maladies neuro-dégénératives que « La musicothérapie, l'aromathé-rapie, la stimulation multisensorielle… pourraient améliorer certains aspects du comportement ». Il est apparu à de nombreux acteurs du secteur, des cli-niciens aux chercheurs, que ces recommandations étaient bienvenues pour apporter enfin du crédit à des années de pratiques empiriques de terrain fai-sant l'observation de retours très positifs de la part des patients et des familles sur ces actions, mais que dans le même temps nous manquions cruellement de travaux scientifiques et de méthodes validées pour étayer l'intérêt de ces approches. Ainsi, le sentiment était mitigé, car sur le terrain on ne peut qu'être convaincu de l'intérêt et des effets positifs des pratiques d'art-thérapie dans l'accompagne-ment de la perte d'autonomie chez la personne âgée en situation de fragilité, mais la très grande diversité (pour ne pas dire l'hétérogénéité) des propositions, des contextes d'applications, et surtout des justifica-tions de ces pratiques a longtemps jeté un flou, voire une méfiance, compréhensible, pour ces approches de prise en charge. A-t-on progressé aujourd'hui ?

Art-thérapie et musicothérapie : de quoi parle-t-on ?La première difficulté, et pas des moindres, est déjà de circonscrire ce domaine d'intervention et de le replacer dans le contexte du vieillissement normal et

pathologique. Il est intéressant aujourd'hui de regar-der dans une encyclopédie collaborative comme Wikipédia la définition proposée et qui est censée faire consensus. À partir d'une première définition générale : « L'art-thérapie est une méthode visant à uti-liser le potentiel d'expression artistique et la créativité d'une personne à des fins psychothérapeutiques ou de développement personnel », sont proposées plusieurs autres définitions complémentaires du domaine  : « L'art-thérapie est une pratique de soin fondée sur l'utilisation thérapeutique du processus de création artistique », « l'art-thérapie propose beaucoup plus que cela par l'utilisation psychothérapeutique de la pratique artistique. L'art devient alors un moyen, la thérapie un but ». Sans surprise, toute la première partie de l'article de Wikipédia souligne déjà la mul-tiplicité des définitions et même des controverses soulevées par l'association des deux termes art et thérapie, ambiguïtés qui ont à voir notamment avec la question de savoir si c'est l'art (son exposition ou sa pratique) qui soigne, l'intervenant qui soigne (peu importe son média), ou les deux… ou aucun, car pour certains tenants de l'art-thérapie, il n'est pas question de « soin » au sens médical, mais bien d'un accompagnement.

Dans bien des contextes de soin, c'est justement le terme « thérapie » qui pose problème, notam-ment vis-à-vis des familles de patients pour qui il n'est pas toujours clair qu'une intervention ayant le vocable « thérapie » dans son titre n'ait pas comme objectif direct de soigner (et de gué-rir) mais plutôt « d'accompagner », de « prendre en charge », ce qui ne constitue pas un objectif secondaire mais bien premier dans le contexte

FICHE 60Les thérapeutiques non médicamenteuses : art-thérapie et musicothérapieHervé PlatelProfesseur de neuropsychologie, Inserm U 1007-EPHE, université de Caen.

!"#$%"&'(&#&)'#%*+)&,#"-#&)'#./&)"%0,1#.23#$/45*,)'%#6'#*2-"%7#8"/#&).&#&)*,#9:;#*,#.2#/2("%%'(&'3#$%""-#-"%#*2&'%2.5#4/,*2',,#/,'#"258#48#&)'./&)"%0,1<#'3*&"%0,1<#%'=*'6'%0,1<#>5,'=*'%#.23#&8$','&&'%#?9*@#A&#*,#2"&#.55"6'3#&"#$/45*,)#&)*,#$%""-#"25*2'#"%#*2#$%*2&@#!)*,#$%""-#("$8#*,#&)'#("$8%*+)&$%"$'%&8#"-#&)'#$/45*,)'%#.23#*,#("2-*3'2&*.5#/2&*5#-"%7.5#$/45*(.&*"2@

Ecoute musicale auprès de patients Alzheimer

¨  Maladie d’Alzheimer ¤  Réactivation de souvenirs - Eveil cognitif

Alive inside, M. Rossato-Bennett 2015

Musique, Mémoire et Maladie d’Alzheimer

¨  Ateliers d’apprentissages de chants nouveaux chez des patients institutionnalisés ¤  Unité Alzheimer « Les pervenches », à Biéville-

Beuville ; Centre de personnes âgées, CHU de Caen

¤  Responsable Dr Odile Letortu

Samson, Dellacherie & Platel, 2009 Groussard, Mauger & Platel, 2013

https://www.youtube.com/watch?v=z8vPk-DbADo

Groussard, Chan, Coppalle & Platel, 2019

Comment expliquer la résistance de la mémoire musicale chez les patients Alzheimer?

Journal of Alzheimer’s Disease 68 (2019) 857–883DOI 10.3233/JAD-180474IOS Press

857

Review

Preservation of Musical MemoryThroughout the Progressionof Alzheimer’s Disease? Towarda Reconciliation of Theoretical,Clinical, and Neuroimaging Evidence

Mathilde Groussarda,∗, Tyler G. Chanb, Renaud Coppallea and Herve PlatelaaNormandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, CHU de Caen, Cyceron, Caen, FrancebThe Grossman Institute for Neuroscience, Quantitative Biology, and Human Behavior,The University of Chicago, Chicago, IL, USA

Accepted 28 January 2019

Abstract. Through this review of 25 clinical and experimental works on long-term musical memories in Alzheimer’s disease(AD) patients, we attempt to clarify the conceptual understanding of musical memories, identify their evolution across thestages of the pathology, and propose possible explanations concerning the neural and cognitive mechanisms that underpinthe preservation and impairment of certain musical memories. After clarifying the different kind of musical memories, weinvestigated their alterations throughout AD’s progression from mild to severe stages. Both procedural and retrograde semanticmemory seem relatively spared in AD, while episodic memory appears to be impaired early. Moreover, partial preservation ofmusic encoding in AD can be revealed through paradigms that are especially designed for AD patients (relying on behavioralcues, using adapted settings, etc.). Although seldomly used, they would definitely help understanding the preserved capacitiesin every stage of AD. However, more research is needed to better understand this phenomenon and assess its specificity tomusic or other types of supports. These findings could lead to multiple applications in care settings and research designs,bringing more nuanced understanding of how long-term musical memory degrades throughout the course of AD, and shouldencourage us to prioritize patients’ preserved cognitive abilities in current AD recreational and care programs.

Keywords: Alzheimer’s disease, care, memory, music, neuroimaging, preservation

INTRODUCTION

The earliest recorded case study on musical mem-ory in Alzheimer’s disease patients (hereafter ADpatients) dates back to Beatty et al. [1]. The authors

∗Correspondence to: Mathilde Groussard, PhD, Inserm U1077,Centre Cyceron, Blvd Becquerel BP 5229, 14074 Caen cedex 5,France. Tel.: +33 0231 470125; E-mail: mathilde.groussard@unicaen.fr.

examined an AD patient who, despite neither beingable to dress herself nor perform the pursuit rotortask of motor skill, was able to play the piece “Twin-kle, Twinkle, Little Star” on the piano, and eventransfer that skill to the xylophone, an instrumentshe had no formal training with. Shortly after, Crys-tal et al. [2] evaluated an AD patient, 82-year-oldpianist, who was able to play the piano pieces hehad learned before the onset of his illness despite

ISSN 1387-2877/19/$35.00 © 2019 – IOS Press and the authors. All rights reserved

Musique

Groussard et al., Neuroimage, 2010b

Langage

Commun aux deux

Comment expliquer la résistance de la mémoire musicale chez les patients Alzheimer?

L

www.thelancet.com Vol 390 December 16, 2017 2673

The Lancet Commissions

Dementia prevention, intervention, and careGill Livingston, Andrew Sommerlad, Vasiliki Orgeta, Sergi G Costafreda, Jonathan Huntley, David Ames, Clive Ballard, Sube Banerjee, Alistair Burns, Jiska Cohen-Mansfield, Claudia Cooper, Nick Fox, Laura N Gitlin, Robert Howard, Helen C Kales, Eric B Larson, Karen Ritchie, Kenneth Rockwood, Elizabeth L Sampson, Quincy Samus, Lon S Schneider, Geir Selbæk, Linda Teri, Naaheed Mukadam

Executive summaryActing now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and in doing so, will transform the future for society.

Dementia is the greatest global challenge for health and social care in the 21st century. It occurs mainly in people older than 65 years, so increases in numbers and costs are driven, worldwide, by increased longevity resulting from the welcome reduction in people dying prematurely. The Lancet Commission on Dementia Prevention, Intervention, and Care met to consolidate the huge strides that have been made and the emerging knowledge as to what we should do to prevent and manage dementia.

Globally, about 47 million people were living with dementia in 2015, and this number is projected to triple

by 2050. Dementia affects the individuals with the condition, who gradually lose their abilities, as well as their relatives and other supporters, who have to cope with seeing a family member or friend become ill and decline, while responding to their needs, such as increasing dependency and changes in behaviour. Additionally, it affects the wider society because people with dementia also require health and social care. The 2015 global cost of dementia was estimated to be US$818 billion, and this figure will continue to increase as the number of people with dementia rises. Nearly 85% of costs are related to family and social, rather than medical, care. It might be that new medical care in the future, including public health measures, could replace and possibly reduce some of this cost.

Dementia is by no means an inevitable consequence of reaching retirement age, or even of entering the ninth

Lancet 2017; 390: 2673–734

Published Online July 20, 2017 http://dx.doi.org/10.1016/S0140-6736(17)31363-6

See Comment pages 2614 and e51

Division of Psychiatry, University College London, London, UK (Prof G Livingston MD, A Sommerlad MSc, V Orgeta PhD, S G Costafreda PhD, J Huntley PhD, C Cooper PhD, Prof R Howard MD, N Mukadam MSc); Camden and Islington NHS Foundation Trust, London, UK (Prof Gill Livingston, S G Costafreda, C Cooper, Prof R Howard); Department of Old Age Psychiatry, King’s College London, London, UK (J Huntley); National Ageing Research Institute, Parkville, VIC, Australia (Prof D Ames MD); Academic Unit for Psychiatry of Old Age, University of Melbourne, Kew, VIC, Australia (Prof D Ames); Medical School, University of Exeter, Exeter, UK (Prof C Ballard MD); Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, UK (Prof S Banerjee MD); Centre for Dementia Studies, University of Manchester, Manchester, UK (Prof A Burns MD); Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine (Prof J Cohen-Mansfield PhD), Heczeg Institute on Aging (Prof J Cohen-Mansfield), and Minerva Center for Interdisciplinary Study of End of Life (Prof J Cohen-Mansfield), Tel Aviv University, Tel Aviv, Israel; Dementia Research Centre, University College London, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK (Prof N Fox MD); Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA (L N Gitlin PhD); Department of Psychiatry, University of Michigan,

Key messages

1 The number of people with dementia is increasing globallyAlthough incidence in some countries has decreased.

2 Be ambitious about preventionWe recommend active treatment of hypertension in middle aged (45–65 years) and older people (aged older than 65 years) without dementia to reduce dementia incidence. Interventions for other risk factors including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes, and obesity might have the potential to delay or prevent a third of dementia cases.

3 Treat cognitive symptomsTo maximise cognition, people with Alzheimer’s disease or dementia with Lewy bodies should be offered cholinesterase inhibitors at all stages, or memantine for severe dementia. Cholinesterase inhibitors are not effective in mild cognitive impairment.

4 Individualise dementia careGood dementia care spans medical, social, and supportive care; it should be tailored to unique individual and cultural needs, preferences, and priorities and should incorporate support for family carers.

5 Care for family carersFamily carers are at high risk of depression. Effective interventions, including STrAtegies for RelaTives (START) or Resources for Enhancing Alzheimer’s Caregiver Health intervention (REACH), reduce the risk of depression, treat the symptoms, and should be made available.

6 Plan for the futurePeople with dementia and their families value discussions about the future and decisions about possible attorneys to make decisions. Clinicians should consider capacity to make different types of decisions at diagnosis.

7 Protect people with dementiaPeople with dementia and society require protection from possible risks of the condition, including self-neglect, vulnerability (including to exploitation), managing money, driving, or using weapons. Risk assessment and management at all stages of the disease is essential, but it should be balanced against the person’s right to autonomy.

8 Manage neuropsychiatric symptomsManagement of the neuropsychiatric symptoms of dementia including agitation, low mood, or psychosis is usually psychological, social, and environmental, with pharmacological management reserved for individuals with more severe symptoms.

9 Consider end of lifeA third of older people die with dementia, so it is essential that professionals working in end-of-life care consider whether a patient has dementia, because they might be unable to make decisions about their care and treatment or express their needs and wishes.

10 TechnologyTechnological interventions have the potential to improve care delivery but should not replace social contact.

Lutter contre la perte auditive est le facteur de prévention ayant le plus fort impact

Musique et soins : limites et perspectives

¨  Reproductibilité des résultats à améliorer : ¤  Travaux cliniques

n  Standardiser critères de jugements / renforcer les méta-analyses n  Augmenter la synergie entre travaux fondamentaux et validations cliniques

¨  Effectifs des groupes expérimentaux trop faibles ¤ Vers davantage d’études multi-centriques…

¨  Trop de travaux transversaux ¤  Favoriser les moyens pour + d’études longitudinales

¨  Relier davantage processus neurophysio et cognitifs ¤ Augmenter les index physio (cardio, végétatif, stress, immunité…) ¤ Augmenter collaborations modèles animaux et Homme

Merci pour votre attention