Mu­sic lifts de­men­tia’s con­stant fog

Mu­sic ther­apy is show­ing prom­ise in help­ing de­men­tia pa­tients tune into re­al­ity, writes Jane Lyons

The Weekend Australian - Travel - - Health -

DOROTHY sits in her ward, gaz­ing at noth­ing in par­tic­u­lar. Lost in time and space, she asks very lit­tle from her small world. She seeks no com­fort or com­pan­ion­ship, no in­tel­lec­tual stim­u­la­tion. When she does speak, she seems to fol­low the rhythm and cadence of con­ver­sa­tion with in­grained habit, but her re­sponses are dis­jointed and de­void of in­tent.

Wher­ever Dorothy is, it is not here. And ‘‘ here’’ is Alzheimer’s.

A pro­gres­sive and de­gen­er­a­tive ill­ness, Alzheimer’s dis­ease at­tacks the brain, de­stroy­ing cells and cre­at­ing a build-up of plaques and ‘‘ neu­rofib­ril­lary tan­gles’’ that dam­age neu­ral con­nec­tions and dis­rupt the flow of mes­sages. As the brain cells die, in­for­ma­tion can no longer be re­called or as­sim­i­lated and a variety of func­tions such as me­mory and lan­guage, rea­son­ing, plan­ning and de­ci­sion-mak­ing, so­cial in­ter­ac­tion and emo­tional re­sponses are lost.

Ac­cord­ing to the Alzheimer’s As­so­ci­a­tion, once th­ese abil­i­ties are lost they can rarely be re­gained or re­learned.

How­ever, pre­lim­i­nary re­search by the Na­tional Age­ing Re­search In­sti­tute in Melbourne has dis­cov­ered that mu­sic not only soothes the sav­age beast, it also calls to those like Dorothy (not her real name) who are lost in the wilder­ness.

On her first visit to the in­sti­tute’s lab­o­ra­tory, Dorothy was pas­sively co-oper­a­tive as re­searcher Bruce Bar­ber, the study’s team leader, set up the equip­ment. They played her a swirling and pas­sion­ate or­ches­tral piece by Ed­ward El­gar, and when asked to de­scribe how the mu­sic made her feel, Dorothy re­sponded with ‘‘ lov­ing’’.

But it was the next piece, a 1937 Art Ta­tum ver­sion of Gone with the Wind , which had the most pro­found ef­fect. Im­me­di­ately, her left hand started to beat in time to the mu­sic and her face was sud­denly suf­fused with a joy­ous smile. When asked if she had danced in her youth, 82-year-old Dorothy be­gan to talk an­i­mat­edly about the three girl­friends she used to go danc­ing with each Satur­day. She was able to re­call the two dif­fer­ent venues they danced in, and the names of the bands that played.

‘‘ For a pe­riod of no more than five min­utes, Dorothy talked an­i­mat­edly and spon­ta­neously with us about th­ese and other as­pects of her life as if there was no im­pair­ment,’’ Bar­ber says. ‘‘ She ap­peared, for the first time since we had met her, to be alert, at­ten­tive, re­spon­sive and very much in the present. The ini­tial ef­fect seemed to di­min­ish quite rapidly, but for the re­main­ing 30 min­utes we were to­gether, Dorothy main­tained the ca­pac­ity to re­spond co­her­ently and in con­text.’’

Mu­sic ther­a­pists have long re­ported symp­to­matic im­prove­ments in Alzheimer’s pa­tients, in­clud­ing in­creased so­cial in­ter­ac­tion, re­duced de­pres­sion, lower lev­els of ag­i­ta­tion and greater fo­cus, and im­proved cog­ni­tion, lan­guage abil­i­ties and emo­tional skills. A new study in the jour­nal Brain has also just re­ported po­ten­tial ben­e­fits for stroke pa­tients (see The Pulse, op­po­site page).

But with most re­ports lack­ing an ex­plo­ration of the phys­i­o­log­i­cal whys and where­fores, Bar­ber — a mu­si­cian and for­mer mu­sic ed­u­ca­tor who has com­pleted a doc­tor­ate look­ing at the elec­tro-phys­i­o­log­i­cal pro­cesses that mu­sic stim­u­lates in the brain — de­cided it was time to in­ves­ti­gate fur­ther.

The aims of his re­search were to find out if there are ob­jec­tive mea­sures to show the ex­tent of any ben­e­fits from mu­sic ther­apy, which could then be used to help de­sign mu­sic in­ter­ven­tion pro­to­cols.

In his first study Bar­ber en­listed the help of 11 Alzheimer’s suf­fer­ers whose im­pair­ment ranged from mod­er­ate to se­vere, and 17 con­trol sub­jects. Once con­nected to an EEG ma­chine, which records brain elec­tri­cal ac­tiv­ity from the sur­face of the scalp, the par­tic­i­pants were read sto­ries and played both familiar and unfamiliar mu­sic.

Bar­ber then mea­sured the fre­quency gen­er­ated at each elec­trode point and the de­gree to which the 171 elec­trode pairs worked to­gether. This is known as EEG co­her­ence, an in­dex of co-op­er­a­tion be­tween var­i­ous func­tional re­gions of the neo­cor­tex.

Not only did Dorothy and all the other Alzheimer’s suf­fer­ers re­spond to the mu­sic, their brains did, too — and in a most sur­pris­ing way.

Mu­sic is known to stim­u­late the lim­bic re­gion of the brain, which has a role in reg­u­lat­ing au­to­nomic pro­cesses and ba­sic emo­tions such as fight and flight. Higher func­tions such as sen­sory per­cep­tion, mo­tor com­mands, spa­tial rea­son­ing, ab­stract thought and lan­guage are the re­spon­si­bil­ity of the neo­cor­tex, the grey wrinkly mat­ter that cov­ers the brain and de­gen­er­ates as Alzheimer’s pro­gresses.

Bar­ber was ex­cited to dis­cover that mu­sic en­gaged the brain ex­ten­sively, with wide­spread in­ter­ac­tions be­tween most re­gions of the cor­tex and across both hemi­spheres. Th­ese in­ter­ac­tions were also greater than those mea­sured af­ter lis­ten­ing to the story.

‘‘ It’s say­ing that the whole brain in Alzheimer’s pa­tients still func­tions in re­sponse to mu­sic, even in mod­er­ate to se­vere lev­els of the dis­ease,’’ Bar­ber says.

The re­sults, he says, also in­di­cate that the pa­tients are not just re­act­ing hap­haz­ardly or au­to­mat­i­cally to mu­sic. Such mu­sic-in­duced, in­tra- and in­ter-hemi­spheric ac­tiv­ity is like the ‘‘ nor­mal’’ process by which the re­gions that con­trol move­ment, emo­tions, me­mory, vi­su­al­i­sa­tion, lan­guage and au­di­tory pro­cesses work to­gether in an in­te­grated fash­ion.

‘‘ When it comes to ask­ing why peo­ple who are se­verely cog­ni­tively im­paired re­spond to mu­sic, the ob­vi­ous thing is that there is a highly in­te­grated and com­plex process that prob­a­bly hinges on emo­tional func­tion, num­ber one, that ac­ti­vates me­mory pro­cesses, that ac­ti­vates mo­tor pro­cesses, it ac­ti­vates cog­ni­tive pro­cess­ing in some way,’’ Bar­ber says.

Be­liev­ing that mu­sic may tem­po­rar­ily re­ac­ti­vate es­tab­lished neu­ral path­ways, Bar­ber de­cided to con­duct a lon­gi­tu­di­nal study that would mea­sure the im­pact of a daily mu­sic-ther­apy reg­i­men over six months.

Fif­teen Alzheimer’s suf­fer­ers were en­listed at the time of their di­ag­no­sis. One group was given cho­linesterase in­hibitors, a com­monly pre­scribed drug, while the other took the med­i­ca­tion and fol­lowed a daily reg­i­men of mu­sic. Fif­teen min­utes was the min­i­mum, but most would lis­ten for an hour.

Us­ing the Hi­er­ar­chic De­men­tia Scale, a cog­ni­tive func­tion test that in­volves a se­ries of ques­tions and ac­tiv­i­ties, Bar­ber mea­sured both groups be­fore they started their reg­i­men, then at three and six months.

The mu­sic group scored an av­er­age 185.1 at the on­set, ris­ing to 190.8 at the three-month mark and drop­ping back slightly to 190 at six months. The other group be­gan with an av­er­age of 183.5, dropped to 180.67 and then rose slightly to 182.75.

But with just 15 peo­ple in­volved in the study, Bar­ber knew more rig­or­ous re­search was re­quired. He re­ceived fund­ing from a private phil­an­thropic trust to con­tinue the re­search in a two-year, ran­domised con­trolled study, which is now about half-way through its two-year du­ra­tion.

So far about 60 pa­tients have been re­cruited, all of whom have de­men­tia. Bar­ber hopes to en­rol a to­tal of 200. While it’s too early to give any de­fin­i­tive re­sults, he says ‘‘ an in­ter­est­ing trend is go­ing on’’.

‘‘ The ob­jec­tive of this study is to de­ter­mine whether the fre­quently re­ported ef­fects of mu­sic ther­apy stand up in the con­text of a ran­domised con­trolled trial,’’ he says.

‘‘ With a lot of com­ple­men­tary ther­a­pies there are all sort of claims. Mu­sic ther­apy has got up to 400 (re­search) re­ports talk­ing about the ben­e­fits of mu­sic ther­apy specif­i­cally for the symp­toms of de­men­tia.

‘‘ The prob­lem is they don’t meet the level of re­search rigour re­quired to con­sti­tute ev­i­dence, as ev­i­dence is de­fined in health care now.’’

Bar­ber is anx­ious to stress ther­apy is not a po­ten­tial cure.

‘‘ I would ar­gue that it may be shown to help peo­ple with pro­gres­sive patholo­gies such as Alzheimer’s dis­ease to main­tain cog­ni­tive and func­tional sta­tus at their high­est po­ten­tial,’’ he says. ‘‘ This would help to de­lay and ame­lio­rate the se­vere qual­ity of life deficits caused by de­men­tia.’’

that mu­sic

Henry Bro­daty, pro­fes­sor of psy­chogeri­atrics at the Univer­sity of NSW and the di­rec­tor of aged-care psy­chi­a­try at Syd­ney’s Prince of Wales Hospi­tal, agrees that mu­sic can of­ten go where words and me­mory have failed.

‘‘ Mu­sic me­mory seems to be more re­sis­tant to de­cay than ver­bal me­mory. We can see peo­ple with quite se­vere de­men­tia who are mu­si­cians who can still play in­stru­ments,’’ pro­fes­sor Bro­daty says.

He has also used mu­sic to treat his Alzheimer’s pa­tients, bring­ing in mu­sic ther­a­pists once a week to the aged care unit at Prince of Wales Hospi­tal.

But while Bro­daty wel­comes re­search such as Bar­ber’s, he cau­tions against plac­ing too much hope in mu­sic ther­apy’s long-term ef­fects.

‘‘ Clin­i­cally we cer­tainly see that peo­ple re­spond to mu­sic when they may not be reach­able in other ways. Whether it has any last­ing ef­fect be­yond the du­ra­tion of the mu­sic, I don’t think that has ever been shown.’’

He also thinks Bar­ber should in­tro­duce more mea­sures to his study be­fore mak­ing any judg­ments on whether mu­sic im­proves Alzheimer’s pa­tients’ qual­ity of life.

‘‘ The Hi­er­ar­chic de­men­tia scale just mea­sures func­tion. You also need to look at cog­ni­tion and you also need to mea­sure be­hav­iour and look at qual­ity of life,’’ Bro­daty says. ‘‘ You can’t say whether it will im­prove qual­ity of life just be­cause we can show some­thing clin­i­cally. To make those fur­ther claims needs a lot more re­search.’’

Pic­ture: Michael Pot­ter

Ther­apy: Bruce Bar­ber and Loretta Quinn be­lieve Alzheimer’s pa­tients ben­e­fit from mu­sic

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