It’s a well-known adage that music can ‘soothe the soul’ but in recent years, researchers have found that it has applications in the treatment of the symptoms of dementia and Alzheimer’s sufferers.
Studies are showing promising results in the use of music therapy as an effective treatment for people living with dementia.
How and why does it work?
One of the most tragic effects of dementia, of which Alzheimer’s is the most common type of dementia, is the loss of self as perceived by the sufferer, along with their friends and family who yearn to have the person they knew back once more, if only for the briefest of moments.
In the patient, the disease and loss of self can lead to feelings of frustration, fear and agitation or restlessness from feeling lost in the world, wandering and agitation from feeling they need to find their home or family members they recognise; and sadness from feeling isolated and depressed.
Intensive psychotropic medication used to manage behaviours frequently results in patients becoming a higher risk of falls, losing the ability to speak and walk; and loss of interest in eating and clients becoming bed bound and “out of it”. However, musical favourites of individual patients can assist in tapping into deep memories not lost to dementia and ‘reawaken’ patients.
Music aids them in feeling like the person they once were again, enabling them to converse, socialise and ‘stay’ in the present, alert and responsive for a limited time. Due to the way in which the different types of memory work and are stored in the brain and the manner that it is affected by dementia, music aptitude and appreciation are often last remaining faculties that the patient retains.
Declarative memory is explicit or conscious memory and are encoded by the hippocampus and then stored in the temporal cortex of the brain. Declarative memory is memory of facts and events and memories that can be consciously recalled or declared. The hippocampus is the part of the brain that is first affected in Alzheimer’s. The hippocampus turns short term memory which is retained for less than a minute into long term memory.
By contrast, Procedural Memory is implicit or unconscious memory forms part of our long term memory by the virtue of the fact that it is formed by habit and the repetition of “over learned behaviours” such as skills and tasks. For example, reading is something we learn as a child and because we read so often throughout our life, it is a habit or task that we can do without thinking and is therefore retained in our long term memory. People living with dementia can read as long as the font is large enough for their eyesight to be able to read.
The wonderful thing about procedural memory is that it does not require the hippocampus to store it and therefore it is spared by dementia.
How does this relate to music?
From our teenage years to age 24 often we are playing music repetitiously and attaching it to significant emotional events in our lives such as falling in love, breaking up, war music, or the war ending.
Because this special music was played repetitiously when young and throughout their life as one of their favourite songs – it becomes part of the procedural memory and continues to be stored in the brain even when the brain has been damaged by dementia. When they hear it, they recognise it and the emotions they were feeling at the time.
This is why a person who has sat lifeless, head down and not speaking for 3 years in a nursing home can then hear music specific to his youth, puts his head up and start singing, knowing every word, arms waving in the air. When asked how he felt by his daughter he answers “I feel love, I feel love”. Or a women in end stage dementia who just sits with her head down day after day but then hears music and taps her foot, but when the special music of her youth is played such as “big band music” she actually gets up and dances, smiling joyfully with her hands in the air.
Frustration and confusion are often the defining characteristics of dementia and all behaviour is caused by unmet needs – the two biggest causes of behaviours are boredom and loneliness.
If the client does not relate to music of the mid-teens to mid 20s, then try music of their childhood such as hymns and nursery rhymes and if that fails, go further back to the music that their parents would have been listening to when they were a small child.
One company that has been using music therapy successfully in Australia for more than 16 years is in-home care company, Daughterly Care, based in NSW. Since co-founding the company CEO, Kate Lambert, says she has seen the incredible affect that music can have people even with severe dementia.
“Early on we recognised that music therapy had a place in the treatment of people with Alzheimer’s and dementia. We saw how the music ‘awakened’ them and that they became more responsive – an effect that lasts even after the music has stopped. They regain a certain degree of cognitive function and, for a short time, are close to being the person they once were,” comments Kate.
The company now work closely with families to assess the musical tastes of each of its clients in order to get the best results for them.
“The effects are quite remarkable. Often, those with the disease lose the ability to share emotions in the later stages. Providing they are ambulatory, the music will lead some to dance and open a wave of emotions that previously remained unattainable to them,” says Kate.
The success of the program has been such that the company actively encourage carers who play a musical instrument to take them on their patient visits. Other carers engage patients by singing with them or playing songs that re-live favourite memories from the past.
“My advice to carers and family members not yet using personalised music is to work with the client to find out their musical history. What they liked during the various stages of their lives and include key moments like the songs they enjoyed when first falling in love, or first dance songs at weddings or favourite artists etc. Take this information and put together a soundtrack for them to use on an iPod. We’ve found that songs from the ages of 18-24 years work best, but each client is different depending on their history and how far along they are in their dementia,” says Kate.
Clients who are in end stage dementia often really enjoy lullabies and that makes perfect sense after all the first songs you ever heard were most likely your mother singing lullabies as you were cuddled safely, warmly in her arms. How wonderful to remember that loving warmth and hearing those songs again.
Whilst music assists people living with dementia to re-connect to their life and brings them definite joy, movement to their body and a smile to their face, it can never be a cure. It shows however the benefit of repetitiously learning new skills like using an iPad to email your grandchildren and children.
Do you know someone with dementia/Alzheimer’s who has benefited from music therapy? What happened? Or if not, will you try it? Tell us below.