Lead:
Cognitive decline is prevalent in older adults with type 2 diabetes mellitus (T2DM). Music interventions have emerged as a non-pharmacological treatment to improve cognitive function. Although music rewards have been shown to improve cognitive function, there are no studies that focus on how specific factors of music rewards, such as music seeking or emotion regulation, affect cognitive function. A recent study explored the effect of musical reward factors on cognitive function in older adults with T2DM [1].
Cognitive impairment is prevalent in patients with diabetes
High blood sugar can cause inflammation and increase the risk of damage to blood vessels in the brain, which increases the risk of cognitive decline. In one study, 63.8 percent of older adults with diabetes had cognitive impairment, compared with only 10.8 percent of non-diabetic older adults [2]. Cognitive impairment in patients with T2DM can negatively affect self-management behaviors, including poor medication management and self-monitoring of blood glucose. In addition, cognitive impairment is a prodromal stage of dementia, with approximately 18.4 percent of patients with cognitive impairment developing dementia each year [3]. In order to reduce the risk of diabetic complications, early prevention and management of cognitive health in older patients with T2DM are necessary.
Music Improves Cognitive Function: The Effects of Music on the Brain
Studies demonstrate the beneficial effects of music interventions on individuals with declining cognitive function, including enhancement of subjective memory function, as well as enhancements in various objective cognitive domains, such as executive function and language fluency. Listening to music can promote the release of dopamine, increasing activity in the brain's pleasurable and rewarding areas. When people listen to pleasant music, they experience the release of dopamine – which, as neuroimaging technology shows, helps improve cognitive function and enhance memory formation. However, the effects of dopamine on cognitive function only showed positive effects in individuals who were already cognitively declining.
People experience musical rewards through a variety of musical activities, such as listening to music, dancing, or sharing musical tastes with others. Music rewards are complex and multifactorial and depend on individual experiences. As a result, there are significant individual differences in sensitivity to musical pleasure.
Individual differences in the music reward experience can be divided into the following five factors [4]:
1) Music seeking: refers to the way in which an individual seeks music-related information or pursues musical activities;
2) Emotional arousal: refers to the emotional impact of music;
3) Emotion regulation: refers to how music regulates and releases emotions;
4) Sensory-motor: refers to body movements caused by music, including dancing, simple movements such as percussion or humming;
5) Social rewards: Sharing music-related activities with others, such as concerts and the pleasure of music preferences.
The variability of these factors is related to brain structure and connectivity and can further affect cognitive function. Several studies have shown that people with higher musical reward responses can achieve better memory performance. Listening to music that you enjoy or listen to that evokes rewarding experiences, especially music that helps with emotional regulation, may help reduce stress, alleviate psychological symptoms such as depression and anxiety, and play a positive role in improving cognitive function.
Research Methods:
Data were derived from a randomized controlled trial of Memory, Attention and Problem Solving Skills in Patients with Diabetes Mellitus (MAPSS-DM) in which 185 older adults with T2DM and subjective cognitive decline were selected for a cross-sectional secondary analysis.
Individual differences in music reward experiences were assessed using the Barcelona Music Reward Questionnaire (BMRQ). The BMRQ is a 20-item scale with 5 dimensions: music seeking, emotional arousal, emotional regulation, sensory-motor, and social reward. The higher the score, the higher the reward experience through music-related activities. The individual factor scores were calculated through a program provided by Mas-Herrero et al., and the effects of each musical reward factor were analyzed [4].
Objective Cognitive Function Assessment: Using the BrainCheck tool, each cognitive domain is assessed through neurocognitive testing, including attention, executive function, processing speed, and memory. The overall cognitive function score ranged from 0~200 points.
Subjective Cognitive Function Assessment: Cognitive deficits in mental acuity, attention, verbal and non-verbal memory, and verbal fluency over the past 7 days were assessed using the Patient-Reported Outcome Measurement Information System version 2.0 (PROMIS-v2.0)-Cognitive Function Survey. There are 32 items in PROMIS, and the higher the score, the better the subjective cognitive function.
Kruskal Wallis (H) test and bivariate correlation test were used to evaluate the effect of demographic variables on cognitive function. Pearson correlation analysis was used to study the relationship between music reward factors and subjective and objective cognitive function.
Findings:
Of the 185 participants, 73.0% (n=135) were female, 26.5% (n=49) were male, the mean age of the participants was 60±6.10 years, the median duration of diabetes was 5.5 years (IQR=5), and the mean HbA1c was 8.60%.
All 185 participants had subjective cognitive function scores, with an average score of 43.94±7.15, which was lower than that of the general population, and only 87 participants had objective cognitive function scores, and the average objective cognitive function scores were 89.09±30.01, which was within the normal range.
In the correlation analysis, emotion regulation was the only musical reward factor that was significantly related to subjective cognitive function (correlation coefficient r=0.19, P<0.05). In the subjective cognitive function model, emotion regulation had a significant effect on subjective cognitive function while controlling for other musical reward factors (β=0.315, 95%CI: 0.087~0.290; P<0.001). This suggests that participants who receive emotional regulation rewards through music are more likely to have better subjective cognitive performance.
Table 1. Regression model results for objective cognitive function (n=87) and subjective cognitive function (n=185).
brief summary
The results showed that the musical reward factor of emotion regulation was significantly positively correlated with subjective cognitive function. However, all musical reward factors were not related to objective cognitive functioning. Among the five musical reward factors, emotion regulation was the only significant factor affecting subjective cognitive function, emphasizing the potential importance of music in regulating emotions. The findings provide valuable insights into the potential therapeutic application of music in promoting cognitive health in older adults with T2DM. However, its limitations should also be acknowledged, and the results of the study should be interpreted with caution. In the future, rigorous studies with larger sample sizes should be conducted to further use neuroimaging techniques to understand the relationship between music reward, dopamine release and cognitive function in elderly patients with T2DM, and to find evidence that an effective music intervention method can manage psychological symptoms and enhance cognitive function in elderly patients with T2DM for clinical application.
Bibliography:
1. Kim J, Cuevas H. Geriatr Nurs. 2023 Dec 25;55:327-332.
2. Varghese SM, et al. Front Public Health. 2022; 10: 822062.
3. Thaipisuttikul P, et al. Alzheimer's Dementia (N Y). 2022; 8(1):E12272.
4. Mas-Herrero E, et al. Music Percept. 2013; 31 (2):118-138.