It might be easy to think that music therapy for Alzheimer’s dementia is well-intentioned and kindhearted, certainly, but ultimately not all that helpful against such a destructive disease. But there’s an enormous amount of anecdotal evidence that music therapy can significantly help many people with Alzheimer’s, with research beginning to confirm these observations and analyzing how and why music therapy works.
Therapists are learning more about how to use music to access parts of the mind that remain largely unaffected, even as Alzheimer’s disease devastates other areas of the brain, with a few small studies confirming this effect through the use of magnetic resonance imaging (MRI) and other imaging methods.
While enrolling people with dementia into clinical trials has proved challenging, research, such as a review published in March 2019 in Frontiers in Neuroscience, has found that music therapy can lead to improvements in behavioral, cognitive, and social functioning — helping allay anxiety and depression and reducing the use of anti-anxiety and antipsychotic medication in nursing homes and assisted living facilities, per a study published in January 2018 in the Journal of Alternative and Complementary Medicine.
Phrased less clinically, it’s clear that for many people with Alzheimer’s dementia, the right kind of music therapy can provide comfort, joy, and connection during a frightening and lonely time.
So many of us "respond to music in some way, shape, or form, whether it’s a physical response, an emotional response, a social response, or a cognitive response,” says Joy Allen, chair of the music therapy department at the Berklee School of Music in Boston. “We know that in dementia, the brain is damaged, but the part that responds to music is one of the last that seems to go.”
What Music Therapy for Alzheimer’s Can Do
Music therapy isn’t listening to or making music for entertainment; it is a healthcare discipline. The American Music Therapy Association describes it as “the clinical and evidence-based use of musical interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.”
Music therapy for Alzheimer’s dementia can take many forms. “We do find that singing is definitely a big thing,” Allen says. “With singing there’s the predictability of rhythm that is soothing. But also, if you think about it, you have to breathe when you’re singing, and that has a relaxing quality to it, too.”
Singing can also offer social connection, which helps explain the rise of “dementia choirs” around the country made up of people with early to middle-stage Alzheimer’s, and sometimes their caregivers too, as profiled in a 2019 article in the Journal of Intergenerational Relationships. Says Allen, “With dementia choirs, it’s no longer, ‘Do you know my name?’ or ‘Tell me what day it is.’ It’s ‘Hey, we can enjoy each other’s presence and companionship.’”
As everyone sings together it becomes clear that a person with Alzheimer’s is still a person, and not just their disease. Allen adds that even people with dementia who have trouble finding the right words in conversation may have an easier time recalling lyrics to a familiar song.
As dementia advances, music’s calming quality can decrease agitation during anxiety-producing events of daily life and make transitions less fraught for both those with Alzheimer’s and their caregivers. “So if you need a person to walk, by singing something familiar like ‘When the Saint Go Marching In,’ the focus is on the reward of the song instead of the discomfort of what they’re doing,” says Allen.
Drumming circles with percussive instruments such as egg shakers are another type of group activity that may help people with dementia. “You don’t have to know anything fancy or complicated. You just have to know a heartbeat — it’s that simple motor response,” Allen says. “And that goes back to the principle of entrainment, where your body and your brain and your central nervous system are automatically activating to create purposeful movement.” That active rhythm provides predictability (“It’s a time sequence; you know what’s going to happen,” Allen explains), which can decrease tension and agitation.
A music therapist also has methods for making listening to music beneficial. “The person can be sitting in their chair, and you can be moving with them in rhythm, which is going to help activate a connection,” Allen says. “But the key is, you have to use that music effectively. You don’t want it in the background all the time, because then the person tunes it out. You want to use it in ways that are purposeful and meaningful, making sure that the music is also culturally relevant to the person. It’s going back and seeing the different roles music has played throughout their lives, because that’s what they connect to.”
How Personalized Music Reawakens the Brain
The goal of finding personally meaningful music has led to a new type of therapy that is uniquely suited to the digital age — the Music & Memory program, run by a nonprofit founded in 2006 by a social worker named Dan Cohen.
Music & Memory hinges on the unique power of songs that are specific to each patient’s personal preferences and history. Giving someone with dementia the opportunity to listen to “their” songs through headphones connected to iPods or other portable listening devices can arouse strong positive emotions and stimulate the brain.
A documentary called Alive Inside, which won the 2014 Audience Award at the Sundance Film Festival in Utah, follows residents of long-term care facilities as they experience Music & Memory for the first time. The camera records anxious, withdrawn, and even seemingly unreachable men and women as they “wake up” — raising slumped heads, tapping feet, pushing walkers to the side and dancing, or even in one remarkable case sharing detailed childhood memories with an interviewer — while listening joyfully to the songs they loved when they were young.
Galvanized by the film and looking to see if research could support the movie’s storytelling, a number of scientists have been finding evidence to corroborate the effects of Music & Memory.
While studies have been limited by size and other variables, there have been a number of encouraging findings. One study, published in September 2017 in the American Journal of Geriatric Psychiatry, found that nursing homes that used Music & Memory saw significant improvements in behavioral symptoms of dementia as well as a notable decline in the amount of anti-anxiety and antipsychotic medications they gave patients.
Alive Inside has been instrumental in spreading the word about Music & Memory. For instance, after seeing the film at Sundance, a private donor in Utah initiated ambitious follow-up efforts through a multidisciplinary team of researchers at University of Utah Health and a consortium of business and community leaders throughout the state. As a result, the Music and Memory program was rolled out to every nursing home and long-term dementia-care facility in Utah.
The program is currently used in all 50 states and internationally, with the Music & Memory organization also offering instruction for home caregivers.
“It’s really quite remarkable,” says Norman Foster, MD, a geriatric neurologist and director of the Center for Alzheimer’s Care and Imaging Research at University of Utah Health. Dr. Foster is senior author of a small study published in 2019 in The Journal of Prevention of Alzheimer’s Disease that used functional MRI to scan the brains of subjects with Alzheimer’s as they listened to personally meaningful music. The scans revealed that the experience caused different regions of the brain to communicate, including the visual network, salience network, executive network, and cerebellar and corticocerebellar network.
“My hope and my goal was to encourage research,” says Music & Memory founder Dan Cohen. Today, Cohen is working to launch an initiative called Right to Music, aimed at promoting personalized music as a go-to therapy for people with dementia, too many of whom are on antipsychotic drugs that “kind of scramble your brain,” as he puts it.
“I spoke to a conference of a thousand pharmacists, who oversee drug regimens in nursing homes and assisted living, and they know that our elders over 85 are overmedicated,” Cohen says. “They know we need to de-prescribe and they’re looking for tools to do it, and personalized music is one of them.”