Written by Beatrice Lucchesi, Founder and President of Music for Dementia
The article 'Music and Dementia: An Overview' by Dr. Ronald Devere, MD, is a review of studies carried out between 1992 and 2017 on the relationship between music and cognitive impairment. I believe it offers a great introduction to the amazing power of music for people suffering from dementia. Below is a summary of the main points of the article with reflections on my own experiences while volunteering with Music for Dementia (MFD).
Understanding Procedural Memory
Dr. Devere draws a comparison between Clive, a man with herpes encephalitis which caused his memory loss, and patients affected by dementia. It is reported that just like people suffering from dementia “he always feels he just emerged from unconsciousness”. I think this is a very powerful statement that helps us put ourselves into the shoes of someone affected by severe memory loss. This can guide interactions with people suffering from dementia: they cannot remember what they did prior to your conversation or what will happen after, so any specific questions like “what did you have for breakfast today?” or “when will you see your family?” cause them a great deal of unease and embarrassment. From personal experience, I learned that it is much more effective to focus on the present or the distant past (if the dementia is not too advanced). Questions about current activities, such as “do you like this song I am playing right now?” are much better conversation starters that do not rely on memory.
Despite the memory loss, Clive was able to connect with his environment and loved ones through music. Although having no recollection of his background as a musician, “when seen at the keyboard… he was himself and wholly alive. His life revolved around filling the present – the now – and that only occurred when he was totally immersed in his music”. In fact, Dr. Devere makes a point that the response to music remains intact even through advanced dementia. This makes music a very powerful coping mechanism, despite the lack of a cure. Even after having volunteered for a long time as a musician in memory care units, I continue to be touched by the reactions of residents to music sessions. Even those that are previously disconnected or asleep, sing along and clap to the rhythm while I play music. Being able to make their “now” more pleasant for me is a huge reward.
I am proud that MFD was able to continue to offer live music throughout the pandemic via online volunteering. However, I noticed that in-person interaction is much more effective in stimulating a positive response from residents. The presence of other human beings offering live music seems to be energizing for the residents and they are always eager to listen to their “private concerts”. I also notice that the residents are much more likely to engage in conversation with volunteers after a music session they enjoy and seem to be much more talkative compared to the beginning of the sessions.
Music and Dementia: Looking at the Data
As reported by Dr. Devere, many studies claim that “music intervention has positive effects on behavior, agitation, mood, and cognition in dementia”. Some support that the calming effects of music lasted for up to eight weeks. Although it is hard to see the long-term effects of music as a volunteer, I can clearly see how each music session instantly improves their mood. Many residents swing or clap along, while others just close their eyes to listen and smile. To have a better idea of how helpful MFD’s music sessions are, we worked with a healthcare professional to develop a music sessions survey that tracks each resident’s mood and reactions before and after sessions. We started to administer the survey this semester with the help of nursing home staff. Regardless of the outcomes of the survey, my heart is filled with joy every time I see a resident enjoy themselves thanks to our sessions.
As stated in the article, “in AD, personally selected music has led to more specific memories, is recalled more quickly, and is rated higher in emotional content”. Once, I was informed that a resident kept singing the song I sang during volunteering “You Are My Sunshine” even after our session was over. Meaning that this specific song was more meaningful and elicited a stronger emotional response in the resident. Even during a recent in-person session, as soon as we started singing “You Are My Sunshine” in the middle of a circle of residents, they all instantly started to sing along. The right music stimulates more powerful positive responses and memory of lyrics that perhaps would not be remembered without a music cue. These residents with advanced dementia could recognize the song right away and remember all the lyrics, even though in conversation they would not be able to tell me one title of a song they liked.
Music Expertise, Aging Cognition, and Dementia Risk
There is evidence that musical training early in life is associated with “faster neural responses to speech in elderly individuals”. Further, a study found that after musical training participants had improved performance on specific cognitive tasks compared to the control group which received no musical training. Many residents with AD that MFD volunteers with cannot remember if they were a musician when they were younger or what instruments they used to play. However, it would be interesting to see if those that are more engaged in the music sessions and have better rhythmic abilities, such as clapping along on the beat, were once musicians.
Benefits of Music Therapy
Dr. Devere points out that there are five important areas to include in music session assessment scales: interest, response, initiation, involvement, and enjoyment. These are some areas that the survey MFD developed and is testing focuses on. I believe it is important to have a way of measuring our impact during music sessions and I am excited to see if the survey is effective and how it can be improved.
Ultimately, Dr. Devere concludes that although there are still a lot of questions unanswered regarding the effects of music on people suffering from dementia, music therapy, especially individualized sessions, has a positive effect on patients. This is in line with current literature and with the efforts of MFD in providing a personalized music program. “Sustaining “here and now” musical and interpersonal connectedness helps value the uniqueness of an individual and help maintain the quality of his/her life”. I completely agree. No matter the long-term effects of musical therapy, I have seen how beneficial sessions are for the residents in helping to improve mood and engagement in the moment. Making even one person smile and regain their individuality, even if just temporarily, for me makes it all worth it.