ORIGINAL ARTICLE Combining drug and music therapy in patients with moderate Alzheimer’s disease: a randomized study Anna Rita Giovagnoli 1 & Valentina Manfredi 1 & Letizia Schifano 1 & Chiara Paterlini 1 & Annalisa Parente 1 & Fabrizio Tagliavini 1 Received: 21 November 2017 /Accepted: 8 March 2018 # Springer-Verlag Italia S.r.l., part of Springer Nature 2018 Abstract Alzheimer’ s disease (AD) can impair language, but active music therapy (AMT) and memantine (M) can improve communication. This study aimed to clarify whether adding AMT to M may improve language in comparison with drugs alone in patients with moderate AD on stable therapy with acetylcholinesterase inhibitors (AchEI). Forty-five AD patients treated with stable dose of AchEI were randomized to receive AMT plus M 20 mg/day or M 20 mg/day for 24 weeks. The Severe Impairment Battery-Language (SIB-l), SIB, Mini Mental State Examination, Neuropsychiatric Inventory (NPI), Lubben Social Network Scale, Activities of Daily Living, and Instrumental Activities of Daily Living scores at baseline and 12 and 24 weeks assessed language (primary variable) and overall cognitive, psycho-behavior, social, and functional aspects (secondary variables). The SIB-l showed a stabilization of the baseline condition in both groups, in the absence of between-group differences. The NPI depression and appetite scores significantly improved in the M-AMT group. Moreover, significantly less patients in the M-AMT group than those in the M group showed worsening of the NPI total score. Daily activities, social relationships, and overall cognitive performance did not deteriorate. In patients with moderate AD, AMT added to pharmacotherapy has no further benefits for language in comparison with pharmacotherapy alone. However, this integrated treatment can improve the psycho-behavioral profile. Keywords Alzheimer’ s disease . Memantine . Cholinesterase inhibitors . Language . Behavioral and psychological symptoms in dementia Introduction Impaired verbal communication is a distressing manifestation of Alzheimer’ s disease (AD) [1]. Frequent language defects include anomia, altered comprehension, paraphasia, empty speech, decreased verbal fluency, and digression from the top- ic [2], impacting mood and quality of life (QoL) of patients and caregivers [3]. Cholinesterase inhibitors (AchEI) and memantine (M) (an uncompetitive N-methyl-D-aspartate receptor antago- nist) are pharmacologic options [4]. M demonstrated safe- ty and efficacy in monotherapy [5] or in combination with AchEI [6, 7] and, in a meta-analysis collecting 1826 pa- tients with moderate or severe AD, it resulted more effec- tive than placebo on global health, cognition, function, and behavior [8]. In patients with mild to moderate AD, treatment with AchEI and M resulted in significant but clinically marginal improvement of cognition, behavior, or functionality [9], while M alone did not relate to any * Anna Rita Giovagnoli annarita.giovagnoli@istituto–besta.it Valentina Manfredi valemanfre@gmail.com Letizia Schifano letizia.schifano@email.it Chiara Paterlini cpaterlini.psicologia@gmail.com Annalisa Parente annalisa.parente@istituto-besta.it Fabrizio Tagliavini tagliavini@istituto-besta.it 1 Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy Neurological Sciences https://doi.org/10.1007/s10072-018-3316-3