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By Gina Shaw

How Music Affects Memory in Those with Dementia


Most people aren't connected to music the way Tony Bennett is, but virtually everyone has songs they love. And music can reengage a person with dementia.

“When my father was in hospice in the last weeks of his life, he had been unable to speak for a while and wasn't responding to us,” says Daniel Potts, MD, FAAN, a neurologist at VA Tuscaloosa Health Care and author of A Pocket Guide for the Alzheimer's Caregiver. “We're a singing family, so we called everybody who used to sing with us. Most of them came, and we just sat around his bedside and sang…and he sang with us. We'll never forget that.”

Over the past two decades, a substantial body of research has demonstrated that music in all its forms arouses, stimulates, and organizes many areas of the brain. “Songs of personal meaning stimulate memories, even for people who have trouble accessing their memories, because of the various ways networks that form information in the brain get recruited,” says Concetta Tomaino, DA, executive director and co-founder of the Institute for Music and Neurologic Function in New York City. “Imaging studies have shown that there is an area of convergence in the medial prefrontal cortex [a region that holds onto and retrieves memories] that lights up in the brain when we hear music that's important to us.

“Music that's personal has many elements that help us recall information. It affects us emotionally, it connects us to people and places, and we tend to relive it and listen to it many times throughout our lives, which strengthens those connections even more,” Dr. Tomaino says.

In a study published in Brain in 2015, European researchers examined a group of people with Alzheimer's disease by using brain imaging technologies and compared them with young, healthy participants. The scientists found that the areas of the brain that encode musical memory show very little damage in Alzheimer's.

And researchers at the University of Utah, who published their results in the Journal of Prevention of Alzheimer's Disease in 2019, found that playing personally meaningful music for people with Alzheimer's disease stimulated those areas of the brain and improved mood. “We had patients and their families identify music they liked. Then we used an MP3 player to develop a playlist and asked them to listen to it over several weeks,” says Norman L. Foster, MD, FAAN, professor of neurology at the University of Utah and one of the lead authors of the study. They then used functional MRIs to see which regions of the brain were activated when patients listened to their favorite music.

They found that several key regions of the brain—including the visual network, the salience network (regions that decide which stimuli deserve our attention), the executive network (which performs high-level cognitive tasks such as reasoning and problem-solving), and the cerebellar and corticocerebellar network pairs (for visual attention and working memory)—showed significantly higher-level functional connections. “Language and visual memory pathways are damaged early as the disease progresses, but personalized music programs can activate the brain, especially for patients who are losing contact with their environment,” Dr. Foster says.

That kind of reconnection produces tangible results. Music & Memory, a nonprofit organization in Mineola, NY, helps nursing homes and family caregivers create and manage playlists. A study published in the Journal of the American Medical Directors Association in March 2020 found that the Music & Memory program significantly reduced the need for anti-anxiety, antipsychotic, and antidepressant medications in nursing home residents. It also led to significant declines in aggressive behavior, depressive symptoms, pain, and falls.

To make the most of the power of music for someone with dementia, consider these four expert-recommended strategies.

Make it personal. Find out what music is meaningful to the person, says Dr. Potts. Songs from the “reminiscence bump”—between the ages of 10 and 30, when emotion tends to be heightened—have extra staying power. “Those songs really stoke the autobiographical memory,” Dr. Potts says. (This is why general “music therapy” groups in long-term care facilities may not be as helpful; if people listened to different types of music when they were younger, they might not respond to the same music.)

Participate. “In our support groups, we find that it isn't just putting on music that people like; it's also engaging with them—singing along, keeping the beat with them,” says Jonathan Graff-Radford, MD, division chair of behavioral neurology at Mayo Clinic in Rochester, MN. “See which songs trigger more engagement—people may clap their hands, sing, or tap their feet—and then play those songs more frequently and eliminate ones that don't seem to do the trick.”

Add it to the routine. “Don't just play the music once in a while; make it a regular part of their days,” Dr. Graff-Radford says. “But avoid overdoing it, keep the volume at an appropriate level, and take a break if they seem to be overstimulated.”

Use it strategically. “Music can be very helpful when the person gets difficult or is agitated,” says Dr. Tomaino. “Don't fight with the person; instead, find a piece of music and see if you can engage the person.” Dr. Tomaino remembers a couple who loved big-band and swing music and used to go out dancing. After the wife was diagnosed with Alzheimer's disease, she became obstinate when it was time for bathing and personal care. To budge her from the chair, her husband would put on a Duke Ellington album and extend a hand as if asking her to dance. She recognized that and would take his hand, and he'd gently dance her over to the bathroom. “It's the context, the feelings, the personal connections embodied in music that stay with us forever.”

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