Slumped in her chair, Estelle seems more like a statue than a person – eyes closed and breath shallow, flickering between asleep and awake. Then an eruption of trumpets cuts through the air, transporting the room to the 1950s with the jazzy, upbeat harmonies of Sinatra’s “Same Old Saturday Night.” She is suddenly Estelle again, singing along with the song, even laughing at the line, “coffee at the coffee shop,” as if reliving a cherished memory. Estelle is one of the nonagenarian residents of a nursing home suffering from Alzheimer’s, a neurodegenerative disease affecting memory and cognitive ability. She has no idea where she is, whom she is talking to, or what occurred just five minutes ago. However, her response to listening to music from her generation shows the power music can have on the brain.
With a continuously aging population, it is becoming increasingly important to find innovative solutions to care for the elderly. As the US population grows, so too will the instance of those suffering from gradual neurodegenerative diseases. In fact, according to a new study found by the Centers for Disease Control and Prevention, the US burden of Alzheimer’s disease and related dementias is projected to double by 2050 [1]. Moreover, memory loss is not the only symptom of Alzheimer’s. As loved ones’ memory begins to fade, their physical capabilities also begin to deteriorate and, as a result, dependence on a caregiver or nursing facility increases. There are seven stages of Alzheimer’s disease: normal outward behavior, very mild changes, mild decline, moderate decline, moderately severe decline, severe decline, and very severe decline [7].
Each progressive stage of Alzheimer’s requires more care for the patient as they continue to lose sense of themselves and their surroundings. In the severe stages of Alzheimer’s disease, the patient begins to physically deteriorate as well. They may become bed-ridden and forget how to eat and drink. Mentally, they may experience delusions, forget their loved ones’ names, and lose a sense of self [7].
Currently, there is no cure for Alzheimer’s and dementia; the diseases are gradual and irreversible. Therapeutics exist, but they only slow down and temporarily improve symptoms. The question remains, however, whether medications aimed at slowing down the progression of an irreversible disease are really worth it. Patients suffering from Alzheimer’s and dementia typically exhibit polypharmacy, meaning they take five or more drugs which may lead to higher prevalence of comorbidities, increased dependency on caregivers, and higher risk of death [2]. Despite taking Alzheimer’s and dementia related medications, such as cholinesterase inhibitors, patients may not experience drastic improvements in memory as the diseases progress into later stages. Even in the short term, their memory may get better, but this is not a guarantee [3]. Rather than take medications that can increase instances of polypharmacy, side effects, and may even result in no improvement in conditions, natural therapeutics can potentially offer a better option to alleviate symptoms.
Music is stored in the part of the brain that is associated with long term memory, the limbic system, which is the last part of the brain to be affected by Alzheimer’s [4]. Familiar songs from a patient’s youth may trigger past memories and emotions. Even in later stages of dementia and Alzheimer’s, music can lead to a number of beneficial outcomes: higher occurrence of positive moods, better management of stress-induced agitation, increased interactions with others, improved cognitive function, and movement such as dancing and feeding [4]. Music therapy is purposeful therapy that involves therapists working with patients to invoke memories, emotions, feelings, and sensations [5]. At the Institute for Music and Neurologic Function, researchers are committed to understanding how music therapy affects those suffering from neurological impairments including those suffering from strokes, dementia and Parkinson's. One study from this institute found that music therapy intervention could lower depression and anxiety in patients suffering from both early and middle stage dementia, as well as improve behavior [6]. In the early stages of dementia, it is best for music therapists to identify and compile a list of the patients’ favorite songs then encourage them to dance and sing along to the music. In the middle stages of dementia, music can help improve balance or gait, enhance mood, and reduce late day confusion, also referred to as sundowning.
In the late stages of dementia, music therapy is utilized to help patients communicate feelings, stimulate memory, promote exercise, and can serve as a source of comfort [4]. In place of medication, music can act as a natural therapeutic used to soothe the suffering of patients and their families.
The ruthless, irreversible condition of Alzheimer’s and dementia cannot be cured as of today. However, non-pharmacological therapies can help improve the burden of these diseases and allow for a greater quality of life for those suffering from them. Memories can be stimulated, exercise can be promoted and communication can be facilitated between the patients and their loved ones or nurses. To further advocate for the benefits of music therapy, the American Music Therapy Association should collaborate with the New York State Department of Health to establish music therapy programs in all nursing homes that will enable these patients to reap the benefits of music on the brain.
References
1. Centers for Disease Control and Prevention. US burden of Alzheimer's disease, related dementias to double by 2060 | CDC Online Newsroom | CDC. (2018, September 20). Centers for Disease Control and Prevention. Retrieved March 15, 2022, from https://www.cdc.gov/media/releases/2018/p0920-alzheimers-burden-double-2060.html
2. Park, H.-Y., Park, J.-W., Song, H. J., Sohn, H. S., & Kwon, J.-W. (2017, January 5). The Association Between Polypharmacy and Dementia: A Nested Case-Control Study Based on a 12 Year Longitudinal Cohort Database in South Korea. NCBI. PubMed. 2022
3. Poinier, Anne C. Alzheimer's Disease: Should I Take Medicines? (2020, September 23). University of Michigan Health. https://www.uofmhealth.org/health-library/ty756 6#:~:text=treat%20Alzheimer%27s%20disease%3F-,Medicines%20can%27t%2 0cure%20Alzheimer%27s%20disease.,commonly%20used%20medicines%20for%20Alzheimer%27s.
4. Olympian Clinical Research. Music Provides Positive Outcomes in Those with Alzheimer's Disease. (n.d.). Senior Connection Center. https://seniorconnectioncenter.org/ music-provides-positive-outcomes/
5. Schaeffer, J. (n.d.). Music Therapy in Dementia Treatment — Recollection Through Sound. Today's Geriatric Medicine. https://www.todaysgeriatricmedicine.com/news/story1.shtml
6. Mount Vernon, NY - Past Projects. (n.d.). Institute for Music and Neurologic Function. https://www.imnf.org/past-projects
7. Gardner, A. (n.d.). Alzheimer’s Disease Stages. WebMD. Retrieved April 15, 2022, from https://www.webmd.com/alzheimers/guide/alzheimers-disease-stages