Music lifts dementia’s constant fog
Music therapy is showing promise in helping dementia patients tune into reality, writes Jane Lyons
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.’’
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.’’
Therapy: Bruce Barber and Loretta Quinn believe Alzheimer’s patients benefit from music