Since the fall of 2014, Marvin Lofquist has sung hundreds of songs in the Giving Voice Chorus with Elaine, his wife of 53 years. But if you ask him if he has a favorite song, his answer might surprise you. "My favorite song?" he asks with mock exasperation, and he and Elaine both burst into laughter. "I don't remember! Ask the person who doesn't have a memory problem."
Elaine, who, unlike Marvin, is not in the early stages of Alzheimer's disease, knows her answer immediately. Quietly, she starts singing the lyrics to "You'll Never Walk Alone," from the musical Carousel, which the chorus will perform at their upcoming concert in June: "Though your dreams be tossed and blown, walk on, walk on, with hope in your heart, and you'll never walk alone."
Her voice cracking with emotion, Elaine stops to collect herself. After a beat, she explains the song's significance. "When you walk this journey with Alzheimer's, singing in this choir reminds you that you're not walking it alone," she says. "Singing removes the isolation and brings joy. That's what Giving Voice does for me."
Across St. Paul and Minneapolis, the Giving Voice Chorus has offered Elaine and Marvin and hundreds of other people with dementia and their caregivers a newfound sense of purpose and belonging.
Inclusive Experience
The Giving Voice Chorus was founded in 2014 by Mary Lenard, a former executive director of the Alzheimer's Association of Minnesota-North Dakota, whose father died from Alzheimer's in 2009. With co-founder Marge Ostroushko, who has taken care of a parent with Alzheimer's, Lenard set out to create an environment where people with Alzheimer's and their caregivers felt supported and comfortable.
"People with dementia sometimes withdraw and often are not included in the community," she says. "Marge and I recognized that music and singing are ways for people with dementia to still be included and participate in life."
At its inception, the chorus was composed of 30 people, including volunteers from the community who assisted with small tasks during choir practice, such as helping singers find the printed music in their binders if they lost their place. Since then, Giving Voice has expanded to two additional choruses in the Minneapolis-St. Paul area, with more than 180 participants overall, and similar choruses in 11 other states, including Illinois, Iowa, New York, Texas, and Virginia.
"We don't do auditions, and we don't care what dementia diagnosis you have or the stage of your disease," says Lenard. "As long as you enjoy the experience, anyone can be part of the group. It's a place where everyone belongs."
"When we first started out, we were worried," Lenard recalls. "Marge and I didn't know if people [with dementia] were going to wander or get violent or frustrated." But the opposite has happened, Lenard says. "There's this positive change we see in people when they're singing songs they love. They're smiling, and there's this joy and laughter. It's really special."
Music and Mood
Evidence bears this out: In a small study published in Frontiers in Human Neuroscience in 2015, researchers at Western Michigan University measured levels of two hormones-oxytocin, the so-called love hormone that governs sexual reproduction and social bonding, and adrenocorticotropic hormone (ACTH), a stress hormone-in four members of a vocal jazz ensemble while they sang scripted songs and improvised. ACTH concentrations decreased in both situations, but more so when the vocalists sang scripted songs. Oxytocin levels increased during the improvised singing. Overall, both types of singing improved social interaction.
Music and Memory
In mild to moderate cases of Alzheimer's disease, short-term memory is affected the most, says Richard J. Caselli, MD, FAAN, neurologist and Alzheimer's specialist at Mayo Clinic in Scottsdale, AZ. The parts of the brain associated with musical memory-the anterior cingulate and the ventral pre-supplementary motor area-aren't affected until much later, according to a 2015 study in Brain.
For this reason, people with Alzheimer's "might have difficulty learning a new song or coming up with words on their own," Dr. Caselli says. "But if they hear a song they've known all their lives, they tend to remember the words and are able to sing along." That's been true for Marvin Lofquist. "I can't always sit down and write out the lyrics to a song," says Marvin, "but when I hear music, the words form in my mouth and I can just sing right along."
And because speech and long-term memory aren't usually affected until late in the disease, members of the Giving Voice Chorus tend to stay active until the last few months of life. When a member dies, the chorus sings "May Sunshine Light Your Way" during practice.
Singing with Giving Voice is more than just a fun hobby for Marvin. It helps him come to terms with Alzheimer's. "I have a terminal disease with a really ugly end," he says. "To me, it's very important to talk about it and have people around me who understand. If I'm down, they see that I'm having a tough day, and that lightens my burden. It doesn't take the burden away, but it has helped me learn to live with it."
Weekly Routine
Each Wednesday morning, choir members gather for 45 minutes of socializing before practice. Then they separate into sections and start a warm-up song, "Oh, What a Beautiful Morning," from Oklahoma! After a 90-minute rehearsal, the group sings a closing song—"Happy Trails," by Dale Evans—and concludes with another hour of socializing. Over the three-plus hours, the choir members' change in attitude is remarkable, says Lenard.
"When they first arrive, the people with Alzheimer's might be a little more vacant or confused," Lenard says. "But once they start singing, it's almost like they return to who they were. Afterward, they're much more verbal. They are usually able to hold a conversation and be more relaxed and focused. It's amazing to see."
At the end of every 10-week session, each Giving Voice Chorus in the Twin Cities holds a public concert. Last June, they all learned and performed an original song commissioned by the American Composers Forum, a St. Paul-based nonprofit that promotes contemporary classical music. Called "Ballad of the Dinghy," it brought the house to tears, says Elaine.
"The song is about being in a dinghy on the ocean by yourself. There's fog and the waves are choppy, but when the fog lifts, you notice other boats around you, and you're not alone," she says. "That expresses everything so well. It's what we feel at practice. We're not alone with this disease. There are other people, and we're surrounded."
Marvin chimes in: "If we haven't started tearing up before, we're really fighting it by that song!"
