Melodies and Memory Loss

Alzheimer’s, Frontotemporal, Vascular, HIV-Induced-Dementia. No matter the cause, all are equally terrifying.

For the uninformed, dementia refers to a set of diseases which impair the ability to think, access your memories, and make decisions. It can make you look at your loved ones and friends and not remember their names. It can make you walk into your home and forget where your bedroom is.

“We are our memories,” Dodge said. “That’s all we are. That’s what makes us the person we are. The sum of all our memories from the day we were born.”

- Brian Faulkner

While dementia comes from many sources and underlying conditions, it is largely driven by Alzheimer's disease in the elderly. In Alzheimer's disease, brain cells and their interconnections die off en masse, which slowly destroy memory and the ability for the brain to do most basic functions. It quite literally causes holes to form in your brain where functioning neuronal tissue used to be. If we are but the sum of our memories, then dementia is a new death every day, as those who suffer from its effects lose parts of themselves each and every day.

https://www.drugwatch.com/health/alzheimers-disease/

Since its discovery more than a hundred years ago, there’s been no cure found, meaning it’s ultimately one-hundred percent fatal. However, the time from detection to mortality is often quite long, with people living after diagnosis often for years if not decades.

While doctors and researchers work tirelessly to find some cure which can reverse or prevent the effects of Alzheimer's and other forms of dementia, the long-lived nature of the disease requires significant work to be done in caretaking. To treat the disease, often a combination of conventional talk-therapy and medications are used to improve outlook on the disease, come to accept the eventuality of death, and delay the worsening of symptoms. Likewise, memory care facilities exist to keep those with severe cases, such as issues with remembering where one is and who they are. However, amongst the pharmaceuticals and doctor’s office visits, music has started to take a centerplace in some dementia treatment regimens.

Music therapy can take many forms, depending on the needs and preferences of the individual. Some common techniques used in music therapy for dementia include singing, listening to music, and moving to music. Listening to music can provide relaxation and stimulation, and can also be used to help with pain management (Synder & Chlan, 1999). This may make sense from a common basis, as many people use music in their everyday life to relax, explore emotions, and focus, but the science backing up music therapy is serious.

While memory loss in and of itself is horrible, the comorbidities of dementia are far reaching. One major set of comorbidities is anxiety, depression, and other mood instability (Fauth & Gibbons, 2013). The use of music has been shown to reduce levels of cortisol in the human body (Khalfa et al., 2003), which helps lessen anxiety and the physical symptoms associated with it. In the elderly, this has been studied using a protocol which introduced preferred music at regular intervals into the lives of dementia patients. The protocol involves working with families of patients to determine what music was uniquely “preferred” by each participant, even if they no longer remember their preferred artists themselves. The music was then listened to for 30 minutes twice a week for six weeks, at regular times for the patient. It was found that listening to preferred music significantly reduced anxiety symptoms over the course of treatment (Sung et al., 2010), leading to considerably better quality of life for dementia patients.

https://eldercarealliance.org/blog/can-music-benefit-seniors-assisted-living/

Another common comorbidity of dementia can be aggression or agitation, both verbal and physical. Because dementia causes people to feel very uncertain in their environment or surroundings, and often not recognize who or where they are, they are likely to become defensive. This can manifest in actual hitting or kicking if they feel seriously threatened, or lashing out at family members or caregivers. Music therapy has been shown to decrease this, especially in the case of group therapy. Group music therapy is often used in adult day centers, memory care facilities, and continuing care facilities in order to connect with others and participate in social activities, while also serving as a way to calm and comfort patients. Researchers in Taiwan have formalized this, finding that music therapy in a group setting reduced agitation in elderly patients with dementia. Between two groups of dementia patients, one who got weekly music therapy and one who did not, the group who did have music showed significant alleviation of aggression and agitation as compared to the group who was not given any music therapy (Lin et al., 2010). While the study was done on group therapy, this likely extends into individual treatment, though the group modality definitely helps increase socialization and comfort.

https://www.prweb.com/releases/vnamusictherapy/2016/prweb13194554.htm

One of the most exciting types of music therapy being researched in dementia patients is Neurologic Music Therapy (NMT), a protocol that uses music as a mechanism for developing therapeutic exercises. NMT combines listening to music with playing music, walking and dancing to music, and singing with specific therapeutic goals in the space of motor control, cognition, and speech.

https://www.mewsicmoves.com/neurologic-music-therapy

Researchers in Massachusetts found that NMT not only increased participant willingness to attend or adhere to music therapy treatment sessions versus controls, but also a greater increase in positive cognitive functioning outcomes such as environment recognition and decision making. Additionally, they found that NMT had lower incidence of comorbidity symptoms, such as anxiety and depression (Álvarez, 2022).

While music therapy looks to be a promising way to make dementia patients happier and healthier for longer, research into it is fairly limited and needs to be further explored. Many current studies only evaluate a very limited number of dementia patients, as many memory care facilities are limited to a few dozen patients who qualify for the study, making it more difficult to draw broad conclusions. Likewise, much of the research is being done in facilities where music therapy interventions are able to be practiced, and less in the community where early dementia patients may be still out and living either on their own or with family.

Music is an incredibly powerful tool in increasing the joy and well-being of dementia patients, and is incredibly core to the human experience. While treatments continue to be developed, and hopefully a cure for diseases like Alzheimer's is finally found, novel treatments and regimens help people suffering from dementia live out their final days with respect, dignity, and joy.

References

Sung, H.-C., Chang, A. M., & Lee, W.-L. (2010). A Preferred Music Listening Intervention to Reduce Anxiety in Older Adults with Dementia in Nursing Homes. Journal of Clinical Nursing, 19(7–8), 1056–1064. https://doi.org/10.1111/j.1365-2702.2009.03016.x

Prieto Álvarez, L. (2022). Neurologic Music Therapy with a Habilitative Approach for Older Adults with Dementia: A Feasibility Study. Music Therapy Perspectives, 40(1), 76–83. https://doi.org/10.1093/mtp/miab021

Lin, Y., Chu, H., Yang, C.-Y., Chen, C.-H., Chen, S.-G., Chang, H.-J., Hsieh, C.-J., & Chou, K.-R. (2010). Effectiveness of Group Music Intervention Against Agitated Behavior in Elderly Persons with Dementia. International Journal of Geriatric Psychiatry, 26(7), 670–678. https://doi.org/10.1002/gps.2580

Fauth, E. B., & Gibbons, A. (2013). Which Behavioral and Psychological Symptoms of Dementia are the Most Problematic? Variability by Prevalence, Intensity, Distress Ratings, and Associations with Caregiver Depressive Symptoms. International Journal of Geriatric Psychiatry, 29(3), 263–271. https://doi.org/10.1002/gps.4002

Khalfa, S., Bella, S. D., Roy, M., Peretz, I., & Lupien, S. J. (2003). Effects of relaxing music on salivary cortisol level after psychological stress. Annals of the New York Academy of Sciences, 999, 374–376. https://doi.org/10.1196/annals.1284.045