Awakening from deep dementia: favourite music as the key to memory
It seems like a miracle: a late-stage Alzheimer’s patient, completely immersed in dementia and cut off from his environment and his own identity. But when he hears the sounds of familiar pieces of music selected for him from his former life, he wakes up from his apathy, starts to laugh, talk, move and becomes ‘alive’ again!
This phenomenon is so impressive and moving that the television station ARTE has taken up and filmed it in the documentary ‘Alive Inside – The Music of My Life’, which is well worth seeing. You can find the video in full length in the ARTE download area at https://www.arte.tv/de/videos/070804-000-A/die-musik-meines-lebens/ until 31 May 2021.
Personal music (a familiar and enjoyable song, individually chosen for each person) can be much more than just sounds, tones and melodies for people suffering from Alzheimer’s and dementia. For patients in the far advanced stages, these favourite songs from long ago can unlock precious memories and reconnect them with family and friends in the world around them.
Science is also addressing the topic of music and dementia. Recent studies have demonstrated measurable symptomatic improvements associated with personalised music therapy:
For example, in the most comprehensive study of its kind, researchers at the University of California were able to show that personalised music has a hugely beneficial effect on anxiety-related behaviours in dementia patients. Not only was significantly less medication used, but the frequency of depression and aggressive behaviour was also significantly reduced (1).
Furthermore, an intervention study in cooperation with Stony Brook University School of Medicine in New York found for the first time that listening to familiar music playlists improves swallowing disorders in people with advanced dementia. This could lead to better long-term nutritional outcomes in dementia patients, reducing complications from aspiration and the need for feeding tubes (2).
It is important to use music that is biographically significant in each case. This includes, for example, favourite songs from childhood and adolescence. While (non-personalised) live music, background or relaxation music brought less benefit to the quality of life of Alzheimer’s patients, personally familiar music programmes, on the other hand, have shown significant improvements in the symptomatology of patients with advanced dementia in recent studies.
But what does childhood favourite music actually do to the brain of an Alzheimer’s patient?
Researchers at the University of Utah investigated this question and for the first time provided objective evidence with imaging diagnostics: biographically meaningful music could be an alternative way to communicate with advanced Alzheimer’s patients (3). To this end, the research team searched for meaningful songs from the patients’ respective biographies and each participant was given a customised music collection with their favourite songs. Using an imaging method called functional magnetic resonance, or fMRI for short, the researchers examined the patients’ active brain regions while they listened to the personalised music (also played backwards) and compared the images with those recorded during quiet moments.
They found that the personalised soundtracks not only activated many regions of the brain, including the salience network, but also the visual network, the executive network and parts of the cerebellum (with its connections to the cerebral cortex), but also made them communicate with each other, thus creating a significantly higher functional connectivity of these regions.
A special focus in the study was on the so-called salience network: This area of the brain is responsible, for example, for the goose bumps one gets when listening to a particularly moving piece of music. The reason for this is that the brain’s salience network is closely connected to reward circuits. Surprisingly, the salience region is an island of memory that is spared this destruction for a long time. In this respect, the brain region is particularly interesting for late-stage therapy, even when linguistic and visual memory pathways have already been destroyed: it could be the key to efficient music-based treatments.
However, this study is just the beginning: the number of participants was quite small (17) for reliable conclusions. Also, only one imaging session took place for each patient in the study. So, it remains unclear whether the observed effects actually last and whether other areas of the memory are involved. But all in all, the study results of the last few years are more than promising and with the increasing dementia diagnoses in our society stretching financial and human resources to the limit, every opportunity should be taken to improve Alzheimer’s symptoms or at least make them more controllable so that the patients’ quality of life can be improved!
For further information on this exciting topic, please visit the Music Therapy section of ‚Knowledge stops Dementia’, so that you will continue to be well informed!
In this context, we would also like to refer you to our partner initiative of the Singing Hospitals. This project has set itself the task of using the healing power of singing for people and making it possible for them to experience it. Here you will find the contact details and further information about this valuable project.
Conclusion:
Recent studies have been able to show that personalised music therapy has a positive effect on the attention and reward centres in the salience region of the brain, even in cases of very advanced dementia. These brain areas remained functionally intact for a very long time during the course of the disease and are reactivated by familiar music to form new connections with neighbouring brain regions. In this way, memories of ‘before’ are reawakened via the bridge of music. Especially patients who have lost contact with their environment and with themselves, music can bring them back – at least for a short time – into their identity and into life, take away their fear, reduce their symptoms and thus significantly improve their quality of life.
Jace B. King, the lead author of the JPAD study, could not have put it better:
“Music is like an anchor that grounds the patient back in reality.”
References
- D Bakerjian, K Bettega, A M Cachu, L Azzis, S Taylor. The Impact of Music & Memory on Resident Level Outcomes in California Nursing Homes. Journal of the American Medical Directors Association (JAMDA), Volume 21, Issue 8, August 2020, Pages 1045-1050.
- D Cohen , S G Post, A Lo , R Lombardo , B Pfeffer. “Music & Memory” and improved swallowing in advanced dementia. Dementia (London) 2020 Feb;19(2):195-204
- J B King 1 , K G Jones, E Goldberg, M Rollins, K MacNamee, C Moffit, S R Naidu, M A Ferguson, E Garcia-Leavitt, J Amaro, K R Breitenbach, J M Watson, R K Gurgel, J S Anderson, N L Foster. Increased Functional Connectivity After Listening to Favored Music in Adults With Alzheimer Dementia. Prev Alzheimers Dis. 2019;6(1):56-62
