Approximately 50 million people worldwide are living with Alzheimer’s Disease and other forms of dementia according to The Alzheimer’s Association. Dementia is not a specific disease, but rather, it characterizes a group of symptoms associated with a decline in cognitive functions — including memory and thinking abilities — as well as behavioral alterations — including agitation and depression. The population affected by dementia is primarily over the age of 65. Alzheimer’s, the most common cause of dementia, is a progressive disease that leads to the degeneration of nerve cells in parts of the brain that control thought, memory and language.
Among the top 10 causes of death in the United States, Alzheimer’s is the only disease for which no cure or prevention strategies have been found yet. Drug and non-pharmacological approaches are administered to alleviate and slow down the symptoms of the disease. However, these options have limited impact on improvement and the prescribed medications are often accompanied with harmful side effects.
Among the non-pharmacological treatments available, the implementation of music has been found to provide emotional and behavioral benefits — such as reducing irritability, apathy and mood swings — for people with Alzheimer’s disease and other types of dementia.
“There are certain areas of the brain that are still relatively intact even as a progressive disease like Alzheimer’s takes effect,” said Dr. Suzanne Hanser, the department chair of music therapy at Berklee College of Music in Boston and former program director of San Francisco’s Alzheimer’s Association. “In particular, the limbic system. And specifically, the hippocampus, which retains long-term memory and has retained emotional impact. Music triggers these long-term memories. So we see people who have not spoken in years begin to sing songs that they knew in their early teens and early adulthood.”
Musical perception, musical emotion and musical memory can survive long after other forms of memory and cognitive function have disappeared in individuals living with dementia. In fact, individuals with dementia retain both general musical skills and rhythmic skills long after losing their verbal skills.
“One thing about Alzheimer’s disease is that it’s a lot more heterogeneous than we usually talk about it and the manifestations can be quite variable. For the most part, PET scans of Alzheimer’s patients show that the frontal lobe, which is the hub for music, is relatively spared, but the scans show that it is only the hub. In fact, music memory is distributed throughout the brain, so it hits some parts of Alzheimer’s that are still preserved, ” said Dr. Susan Wehry, the Chief of Geriatrics at the University of New England College of Osteopathic Medicine and the Director of AgingME, Maine’s Geriatric Workforce Enhancement Program (GWEP).
Through music association, the brain creates pathways that attach music to memories and emotions. Musical memories are often preserved in Alzheimer’s disease because the key brain areas linked to musical memory remain relatively undamaged by this disease. Even in the last stage of the disease, patients remain responsive to music when other stimuli can no longer produce a reaction.
“In amnesia, whether or not it’s with Alzheimer’s, you lose your life, you’ve lost your past, you’ve lost your story, you’ve lost your identity to a considerable extent, and you can at least get some feel of it and regain it for a little while with familiar music,” said the late Oliver Sacks, neurologist and author of Musicophilia: Tales of Music and the Brain.
A study by Jörn-Henrik Jacobsen, researcher at the Max Planck Institute in Leipzig and the University of Amsterdam, found that music therapy was effective in reducing depressive and overall behavioral symptoms in their dementia participants. His study found a greater preservation of brain areas involved in the processing of music. This study also found that musical memory seems to be independent of other memory systems, and in Alzheimer’s, musical memory may be partially preserved.
Additionally, results from this study showed that music interventions can have other positive physiological effects on Alzheimer’s Disease. For example, music can help improve sleep by increasing melatonin levels and balancing hormones even without using hormone replacement therapy, which can have harmful side effects.
“To be most effective, music therapy procedures must be tailored to the individual needs of each person with dementia,” Hanser said. “Each music therapy strategy must also reflect the person’s history, preference and ability to engage with a certain type of musical experience. These are some of the factors that make it extremely challenging to conduct randomized controlled trials.”
Although many studies have shown music’s potential in improving behavioral and emotional symptoms, these studies suggest that there is still insufficient evidence proving the effectiveness of music therapy for Alzheimer’s and dementia. Further research and clinical trials are required to better understand the precise effects of music and Alzheimer’s disease.
“My experiences with Alzheimer’s patients have collectively shown that music definitely helps with agitation. In units where patients have adopted music therapy, there are much lower rates of agitation, lower rates of aggressive resident to resident incidents,” Wehry said.
The experiences Alzheimer’s patients have with music are unique to each person and responses vary on a case-by-case basis. Over the past decade, there has been a mindset shift on how music is approached with Alzheimer’s patients. Instead of perceiving music as an “intervention” or “treatment,” it is primarily now used to provide a source of relief.
“In our society, the diagnoses of dementia are snowballing and are taxing resources to the max,” said Dr. Jeffrey Anderson, an associate professor in Radiology at The University of Utah. “No one says playing music will be a cure for Alzheimer’s disease, but it might make the symptoms more manageable, decrease the cost of care, and improve a patient’s quality of life.”