The video clip is here:
This is exciting because it’s spreading an important idea: there are easy and affordable ways to help reach people with dementia. Music, specifically, can have an incredible impact on people, even those who seem beyond reach.
Music and dementia
Think of a familiar song. It can be your favorite song or one you heard on your way into work this morning; any song will do. Start to hum or sing it in your head…how does your body react?
Me, I start tapping my toes lightly, inside my shoe. And a lot of the lyrics come back to me, words I didn’t think I remembered. My mind starts to drift to times I heard the song.
People with dementia, even advanced dementia, may have similar responses.
Oliver Sacks, MD (Author | Neurologist) speculates in the PBS video Music and the Brain: Scientist Oliver Sacks on Musical Cognition (May 21, 2009):
There’s no one musical center–there are 15 or 20 different systems in the brain. But, in general, many of the musical parts of the brain, if I could put it this way, are close to the memory parts and close to the emotional parts.
And so music tends to embed itself in memory and to evoke emotions with an immediacy beyond, I think, of any other stimulus with the possible exceptions of smells.
In particular, when people really have chills and thrills and their hair stands on end with music, enraptured, then you can find the particular systems of the brain. Rewards systems are activated, the same systems which are activated when one falls in love, or is overwhelmed with beauty generally.
This is why Henry, in the video at the top of this post, begins to light up and sway and sing when he hears his favorite songs playing. Something about music stays with us. Even when dementia begins to affect language or coordination, music seems somehow more durable.
Music stays with us
What is it about music that is so resilient in our brains? It seems to be no singular element (although rhythm has specifically proven to have interesting impacts on us), but rather the many areas in the brain that are connected to processing music.
Music predates recorded history, but its roots may lie in early human communication and rituals for healing. In traditional African cultures and rain forest cultures in other parts of the world, for example, music is connected with many of life’s vital patterns and occasions. In Western culture, however, as music became increasingly accepted as an art form, its therapeutic properties were mostly forgotten—rediscovered only when music therapy became an organized ﬁeld in the early 1950s.
Music is a complex stimulus, involving everything from pitch to rhythm, melody to volume. Consequently, it is not processed in a single area of the brain. We can see this in what is called “amusia,” in which a single musical skill is lost when a speciﬁc area of the brain is damaged—for example, loss of pitch perception resulting from lesions to the right temporal lobe. But while a component of music, such as pitch, may be processed in a speciﬁc region of the brain, the overall experience of music is a gestalt of perceptual and psychological processes occurring in synchrony and involving a spectrum of neurologic activity and brain regions.
How can this help you?
Play music for your friends or family with dementia. Try to find music that impacted their lives.
So for someone born in the 30′s who has advanced dementia I might try music from The Andrew Sisters, Nat “King” Cole, Frank Sinatra, and Oklahoma! to start. I’d try to time it so that it was a “good time” of day (perhaps in the morning). See how she reacts: are there artists that she prefers? Does she seem to like faster tempos? Does she sing along?
Or say your husband, born in 1945, is just beginning to experience dementia. You can talk to him about what he likes and get a feel for the kind of memories he associates with different songs. If he finds Burt Bacharach songs soothing, make a mental note: you may want to have them on-hand for when he has a difficult day. Or if Beach Boys songs remind him of carefree days on the beach with his friends, great!
Put on an album one day and see what happens.
Experiment a bit with music’s impact on your loved one…or even yourself. Are there certain songs that calm you down? It might not be a bad idea to keep them on your iPod or in your car. This affects everyone, not just people with dementia!
So here’s something that you can try yourself and feel good about.
There aren’t many negative side-effects to listening to music. It is unlikely to interact with current medications. You can do it anywhere (headphones or the stereo). And it’s cheap!
Start to pay attention to reactions to music. You might end up with a new tool in your toolkit of actions to take when something unexpected happens…or you might just end up enjoying the time spent together.
Additional Reading and References
On music therapy and Parkinson’s
Rhythm is, in fact, the primary property of music and is critical to human life in other ways. Plato deﬁned rhythm as “the order in movement,” and the temporal structure of music (its movement) has suggestive parallels in human motor development. At ﬁve months of age, when a fetus’s neural circuits and auditory memory are forming, it experiences rhythm through the mother’s heartbeat and respiration. Immediately after birth, basic motor patterns begin to develop. While eating, crawling, and walking, each child ﬁnds a cadence, particular motor rhythms that will remain fairly consistent throughout life. Our natural and spontaneous body movements may be outward representations of inner timing mechanisms. Leon Glass, Ph.D., at McGill University, and other scientists are investigating the complex mathematics of physiological rhythms and how they interact to maintain our health. We know that an alteration in internal rhythm—cardiac arrhythmia, for example— can be the harbinger of ill health or death.
Some internal rhythms can come to match external rhythms. In effect, a rhythm in the external world is heard and internalized, evoking an answering rhythm within us. When we understand how and when external auditory rhythms, or cues, inﬂuence various internal timing mechanisms, rhythm can become a powerful therapeutic tool.
The effect of external rhythmic cues on motor function, as we saw with Sam, is a prime example of how this inﬂuence occurs. Brain-imaging studies show that an area in the prefrontal motor cortex will start to become active at precise intervals in anticipation of a sequence of motor activity, such as ﬁnger tapping at one-second intervals. The resiliency of this motor-timing mechanism is strikingly apparent in people whose motor control, or motor initiation, has been lost as a result of a stroke or Parkinson’s disease, but whose brains still respond to a rhythmic stimulus.
In neuromuscular diseases affecting the ability to initiate and control movement, external rhythm seems to supply the timing information that makes movement possible.
On music’s effects on the brain
Although much is being discovered about music’s effects on the brain’s functioning, we have no cohesive, detailed theory of how this takes place. For example, what speciﬁc element of music aids in the recovery of language in a person with aphasia? Is it the articulation and rhythmic cueing of familiar speech patterns? Or does singing the lyrics stimulate and improve word retrieval for normal speech? How, speciﬁcally, does music affect retrieval of memories? When stimulated by music, what role do lower brain areas (the cerebellum, reticular formation, and others) have in the upward activation of higher cortical mechanisms?
The great Russian neuropsychologist Alexander Luria observed that what we know of brain function is based on what has been lost and what remains following a traumatic brain injury. Music therapists who do neurologic rehabilitation know that it is almost impossible to lose all aspects of music perception. Knowing how the brain processes the elements of music—rhythm, pitch, harmony, timbre, tempo, contour, loudness, spatial location, and melody— as well as associations and memories, and where overlapping or parallel regions share this processing, could support increased use of these components of music early in treatment, the better to take advantage of brain functions that have been preserved.
With the advent of new imaging techniques, we know that the brain is a dynamic, ever-changing system of interconnecting neurons that work in concert to produce our complex, dynamic responses to the world around us. The discovery that new networks and connections may be formed in the brain every time we learn a new skill has implications not only for early childhood development, but also for potential recovery of function after injury.
On music’s ability to heal
Although personally music has been very important to me from before I can remember, as a physician it only hit me really in the 1960s, and that was when I found myself at a hospital in the Bronx seeing the frozen post-encephalitic patients whom I later wrote about in Awakenings.
These were people with very profound Parkinsonsism, so profound that sometimes they would stay absolutely motionless for hours on end and could not initiate any movement or speech or indeed thought, although one learned that later, but so much so, “What’s going on with these people?” “Are they there?” “Is there anyone at home?”
And it was originally the nurses and people who knew of these patients well who said they could be transformed by music. If there’s music, these people could dance, they could sing, they could talk, they can do things, they can think, they can become almost normal while music is there.
And then I saw this for myself, and I was stupefied. I don’t know what term to use. And 40 years later I find it astounding, and it needs to be seen, as someone for whom music, someone for whom movement is unimaginable is suddenly able to move. But it strictly goes with the music, and when the music stops, they stop.
So music therapy for these Parkinsonsian patients was my first experience as a physician, and I wondered what sort of music was involved or if any music could do so. It didn’t have to be familiar music or loved music. It doesn’t sometimes have to be a conscious attention to the music. But obviously the rhythm and the beat and pulse of music was very important. And this would spontaneously and almost automatically I think allow people to move.
So the good music had a strong rhythm, not overwhelming but a strong rhythm. But obviously I think if people like the music, so much the better.
Oliver Sacks, M.D. is a physician, a best-selling author, and professor of neurology and psychiatry at the Columbia University Medical Center. In 2007, he was named the first Columbia University Artist, in recognition of his contributions to the arts.
He is best known for his collections of neurological case histories, including The Man who Mistook his Wife for a Hat (1985), Musicophilia: Tales of Music and the Brain (2007) and The Mind’s Eye (2010). Awakenings (1973), his book about a group of patients who had survived the great encephalitis lethargica epidemic of the early twentieth century, inspired the 1990 Academy Award-nominated feature film starring Robert De Niro and Robin Williams. The New York Times has referred to him as “the poet laureate of medicine.”
Dr. Sacks is a frequent contributor to the New Yorker and the New York Review of Books, and a fellow of the American Academy of Arts and Letters as well as the American Academy of Arts and Sciences.
Concetta Tomaino, D.A., MT-BC, LCAT,is vice president of music therapy at Beth Abraham Family Health Services in the Bronx, New York. She is the executive director and co-founder of the Institute for Music and Neurological Function at the Beth Abraham Family of Health Services. She is a past president of the American Association for Music Therapy.
Many of her publications can be found through this link: IMNF Staff Publications
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