What is dementia?
Dementia is characterized by a deterioration in the cognitive behavioural social and emotional functions of a person beyond what might be expected from the usual consequences of biological ageing. Dementia is currently the seventh leading cause of death among all diseases and one of the major causes of disability and dependency among older people globally. Dementia has physical, psychological, social and economic impacts, not only for people living with dementia, but also for their careers, families and society at large.
Approximately 55 million people worldwide suffer with dementia, and this is projected to triple by 2050. There are over 200 subtypes of dementia but the five most common are Alzheimer’s disease, vascular dementia, Lewy body Disease, frontotemporal dementia, and mixed dementia. Alzheimers’s accounts for approximately 75% of all dementias.
Why is music therapy perhaps better than medications and other forms of treatment?
Medications have limited effect on treatment of many of the disease’s features. Many authors emphasise positive effects of music on the brain, in this sense, several studies showed that people with dementia enjoyed music and the ability to respond to it is preserved even when verbal communication is no longer possible.
Research suggests that listening or singing to songs can provide emotional and behavioural benefits for people with Alzheimer’s and other types of dementia. Musical memories are often preserved in Alzheimer’s disease (which accounts for approximately at least 75% of dementia) because key brain areas linked to musical memory are relatively unaffected by the disease. Music and emotions are linked in a powerful way. Babies sway to music even before words and language have developed and this continues even towards the end of their lives where verbal ability may be lost.
Music can tap into powerful memories and emotions as demonstrated in the BBC 1 programme “Our Dementia Choir” when 91-year-old Eileen with advanced dementia made a startling change in verbalization and behaviour, her real personality shining through with the music she was listening and singing to. Music memory is a form of implicit memory, there’s evidence from scientific studies that listening to music lights up regions of the brain that others cannot. Multiple studies that included meta-analysis of systematic reviews and randomised trials published have shown It can reduce stress anxiety depression and agitation in dementia.
Music and memory are inextricably linked, and the recollection of music varies according to age. In order to create personalized music playlists tailored for people living with dementia, the study from the Journal of Multidisciplinary Healthcare Rao,C.B,et al (2021) 14: 2195-2204 aimed to determine the age at which healthy individuals could best recall music that was popular at the time. Surveys were designed asking participants to identify the number of songs they recalled from a random selection of 10 from the 100 most popular songs from each year, presented in random order of years, from 1945 to 2015. Of the 311 individuals born between 1929 and 2002, who responded to the survey, 157 met the inclusion criteria. Results showed that the median peak of recollection was between the ages of 13 and 19 across all age-cohorts, with participants recalling a maximum median number of 6-8 songs in all of the age-cohorts. There was no evidence of a difference in the peak age of recollection between those who recognized seven or more songs in at least 1 year and those who recognized fewer than seven songs in all years. The conclusion from this study was that the peak of recollection of popular music occurs in the teenage years, regardless of era of birth. Music from this “reminiscence bump” provides a rich source of retained music that should be tapped when creating playlists of meaningful music for people living with dementia.
My personal encounter
Recently, I volunteered at a dementia care home for a month, and although I was trying to interact with the patients as much as possible, I still felt like there was still a barrier whilst talking to the residents. Many residents could not remember me after a week, and so I had to reintroduce myself weekly, explaining how I was a volunteer and I wanted to get to know them. On reflection there were a variety of dementia patients at the residential home who varied in the degree of severity and how much they had progressed into the illness. Some were unable to talk and feed themselves whereas others could have an engaging conversation with me. A couple of weeks in, after leading a bingo session with them, I played the piano to a very traditional, quite simple but memorable song- I played this song twice in a row and the second time many more residents within the living room joined in with the lyrics. To me, it was astonishing, and although I already heard of music therapy helping these patients, it truly shocked me seeing it in real life practice. Some who had not spoken to me throughout the whole month had begun to sing lyrics to some of these songs, and even though they might not be the exact lyrics to the song, it was clear to see that many of the residents had improved their mental state of mind.
Ideally it is best to personalise the music for the individual,but this may not be possible in all care settings. General rule of the thumb is start with gentle quiet music and involve the person wherever possible. Simply having loud music in the background could be over stimulating,sometimes distressing and could have a negative impact. Music can awaken negative emotions and memories as well as positive ones. Watch out for how the person reacts. If there are any signs of distress, turn the music off. However, expressing sadness may be a normal reaction to a memory or an association to the music,so this should be kept in mind in selecting playlists. The evidence for receptive music therapy(just listening to music) against interactive music therapy (singing along,dancing etc) is debatable as some studies show interactive music therapy has better outcomes but other studies vice versa,the most recent study being from the Journal of the American Medical DA-“ Receptive Music Therapy Is More Effective than Interactive Music Therapy to Relieve Behavioural and Psychological Symptoms of Dementia :A Systematic Review and Meta-Analysis”. Irrespective of whether it is receptive or interactive, regular musical leisure activities can have long-term cognitive, emotional, and social benefits in mild/moderate dementia and could therefore be utilized in dementia care and rehabilitation.
NICE (National Institute of Clinical Excellence)recommends that people with dementia should be offered activities that should help wellbeing. Music therapy is an established psychological clinical intervention which is delivered by the healthcare profession society council(HPSC). Compared with usual care in most studies, both singing and music listening improved mood, orientation, and remote episodic memory and to a lesser extent, also attention ,executive function and general cognition. Singing also enhanced short-term and working memory and caregiver well-being, whereas music listening had a positive effect on QOL(Quality of Life).
Music engages an extensive network of auditory, cognitive, motor, and emotional processing regions in the brain. Coupled with the fact that the emotional and cognitive impact of music is often well preserved in ageing and dementia, music could be a powerful tool in the care and rehabilitation of many ageing-related neurological diseases and dementia. It is cost effective, requires little resources and training to implement and should be more widely implemented in care settings and in the wider community.
Neha Biju, Youth Medical Journal 2022
Music Therapy in the Treatment of Dementia: A Systematic Review and Meta-Analysis:Frontiers in Medicine (Lausanne). 2020; 7: 160.–Published online 2020 May 19. doi: 10.3389/fmed.2020.00160
Music-based therapeutic interventions for people with dementia – Cochrane Database Syst Rev,. 2018 Jul 23;7(7):CD003477. doi: 10.1002/14651858.CD003477.pub4.
Does music therapy enhance behavioral and cognitive function in elderly dementia patients? A systematic review and meta-analysis.– Ageing Res Rev,. 2017 May;35:1-11. doi: 10.1016/j.arr.2016.12.003. Epub 2016 Dec 23.
“Music-based interventions for people living with dementia, targeting behavioral and psychological symptoms: A scoping review.” . Sousa, L., et al. (2021).International Journal of Geriatric Psychiatry 14: 14.
Comparative Efficacy of Active Group Music Intervention versus Group Music Listening in Alzheimer’s Disease— Int J Environ Res Public Health. 2021 Aug; 18(15): 8067.Published online 2021 Jul 30. doi: 10.3390/ijerph18158067
Preferred Music Listening Intervention in Nursing Home Residents with Cognitive Impairment: A Randomized Intervention Study— J Alzheimers Dis. 2019;70(2):433-442. doi: 10.3233/JAD-190361
Cognitive, emotional, and social benefits of regular musical activities in early dementia: randomized controlled study. Gerontologist. 2014 Aug;54(4):634-50. doi: 10.1093/geront/gnt100. Epub 2013 Sep 5.
“A focus on the reminiscence bump to personalize music playlists for dementia.” Rao, C. B., et al. (2021).Journal of Multidisciplinary Healthcare 14: 2195-2204. Camerlynck, M. F., et al. (2021).
“Can music reminiscence approaches be used in moderate-severe dementia? A pilot of music mirrors.” Dementia 20(3): 1162-1171. Baker, F. A., et al. (2021).