The past which is not recoverable in any other way is embedded, as if in amber, in the music, and people can regain a sense of identity.”

Oliver Sachs, MD 

Introduction

The response to music has been found to be preserved in persons living with dementia, even in the advanced stages. It can offer a way for them to connect with caregivers and the environment around them. Depending on the type of music that is played, it can be energizing or calming, provoke movement or kindle a memory buried just below the surface. When linked to the past it reinforces an individual’s unique history and stories and may spark a smile.  

How music affects the brain

Listening to or playing music activates a wide range of regions in the brain involving the senses, emotions, stored memories, and motor responses. Music can cause the release of chemicals in the brain such as dopamine and serotonin that are associated with pleasure and reward which can elevate mood and potentially decrease anxiety and depression.  

Certain types of music can lower the stress hormone cortisol and promote relaxation. Classical music with a slow beat has been shown to lower blood pressure and heart rate. Music can evoke a variety of emotional responses based on the rhythm, pitch, lyrics, and previous associations. Focusing attention on music can be comforting, offer distraction, and reduce stress. 

Alternatively, music can be stimulating, improving alertness and cognitive function. The experience of listening to music in a group offers a nonverbal way to connect and communicate. It can prompt a physical response to move with the beat and rhythm by clapping, tapping, and dancing.

How a person experiences music is uniquely individual. Finding the right music at the right time to stimulate, comfort or just enjoy can be therapeutic, usually free and easily accessible.   

Music and dementia 

Memories associated with music are emotional memories and “if you play someone’s favorite music, different parts of the brain light up.” Recent studies revealed that people with dementia respond best to the music they grew up with. It appears that music can have a positive impact on the quality of life for those coping with dementia, as well as their caregivers. 

An analysis of 12 studies concluded that individualized music intervention can reduce agitation in patients with dementia. Agitation can be expressed by restlessness, wandering, aggression, yelling out or refusing care and can lead to safety concerns, caregiver burden, and reduced quality of life. Using medications for these behaviors is not always effective and has the risk of significant side effects. 

A large ongoing study at Brown University School of Public Health used preferred music from an individual’s teenage and early twenties and found a positive effect on agitated behaviors and mood in nursing home patients with dementia. Music can be the medicine. Increasing attention is being paid to non-pharmacological complementary interventions such as music, pet therapy and art therapy.  

Music based interventions

Music Therapy is a formal intervention offered by a trained healthcare professional to improve health and well-being through individualized goals focused on physical, emotional, cognitive, and/or social needs. “The aim of music therapy in people with dementia is to address emotions, cognitive powers, thoughts, and memories — to stimulate them and bring them to the foreground. It aims to enrich and give freedom, stability, organization, and focus.” Programs can be offered across the lifespan, individually or in groups and in a variety of settings: clinics, schools, long term care facilities and private homes. 

In the day-to-day life of someone who has dementia and their caregiver, there are limitless ways to incorporate music. There may take some trial and error to find the right songs, genre, beat, and method. Do they prefer to listen to music with or without headphones? Would they be interested in playing along with the music using a tambourine, drumming instrument or handbells? Maybe singing familiar lyrics or dancing creates the best response.  

It is a straightforward exercise to develop an individualized playlist through an audio streaming provider. There could be playlists designed for specific outcomes: music that is calming or stimulating or includes songs that evoke memories. We need to learn more about the best timing, type of music and if the response to music varies with different forms and stages of dementia. 

Anecdote 

Mary had moderate dementia and attended an adult day center Monday through Friday. Each morning, she required a finger stick to check her blood glucose and then an insulin injection. She began to become anxious and resistant to being ambulated into the clinic. Noticing how much she enjoyed any musical activity, we started to sing “You Are My Sunshine” as she came into the clinic. 

Whoever was working, with the cue “Mary is here,” the singing would begin, and Mary would start to sing along. The distraction would relax her, and she would barely notice the needle pricks and leave with a smile. Instead of accelerating her fear of the clinic, singing turned her visits into something positive, simple, effective, and at no cost. 

Resources 

Music & Memory is a service of the Institute for music and neurological function, a leader in advancing the therapeutic power of music to awaken, stimulate, and heal. It has apps that help a caregiver create a playlist based on their loved one’s age, medical issues, interests and goals.

SingFit (for a fee) focuses on music that encourages singing. Hands in Harmony offers professional neurologic music therapy services. They will collaborate with clients and caregivers to develop treatment plans and even come to the home. 

Tuned-In Music Therapy offers mobile group and individual services with live music that is personalized and targeted to the unique needs and interests of the individual client. The website Songs and Smiles has a list of the top 40 sing along songs. This is just a sample of the creative options and resources available. 

Summary 

Those moments of remembrance, clarity, joy, and connection that can be accessed through music are a gift to people who have dementia and, just as importantly, to those who care for and about them. It is a resource that is easily available and offers little to no side effects. John Hopkins Center for Music and Medicine is working on developing music and rhythm-based therapies that improve patients' quality of life and address symptoms of not only dementia, but Parkinson's disease, stroke, autism and other conditions. 

Bonnie Evans, RN, MS, GNP-BC, GC-C, lives in Bristol and is a geriatric nurse practitioner, End of Life Doula, and certified grief counselor. She can be reached at bonnie@bonnieevansdoula.com.