People with dementia often lose their ability to verbally communicate with loved ones in the later stages of the disease. But a study by Northwestern Medicine, in collaboration with the Institute for Therapy Through the Arts (ITA), shows how this gap can be bridged with a new musical intervention.
In the intervention — developed at ITA and called “Musical Bridges to Memory” — a live ensemble plays music from a patient’s youth, such as songs from the musicals “Oklahoma” or “The Sound of Music.” This creates an emotional connection between a patient and their caregiver by allowing them to interact with the music together by singing, dancing and playing simple instruments, the study authors said.
The program also increased patients’ social engagement and reduced neuropsychiatric symptoms such as agitation, anxiety and depression in both patients and caregivers.
More than 6 million people in the US have Alzheimer’s disease.
The study is unusual because it targeted dementia patients and their caregivers, said lead study author Dr. Borna Bonakdarpour. Most previous studies using music for dementia patients have focused on patients alone.
“Patients were able to connect with their partners through music, a connection that was not available to them verbally,” said Bonakdarpour, an associate professor of neurology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine neurologist. “Family and friends of people with dementia are also affected by it. It’s painful for them when they can’t connect with a loved one. When language is no longer possible, music gives them a bridge to each other. “
The study was published on August 25 in Alzheimer’s disease and associated disorders.
Musical memory, processing not as affected by Alzheimer’s
Memories of music often remain in the brain even when language and other memories disappear in dementia, Bonakdarpour said. This is because regions of the brain that are involved in memory and musical processing (eg the cerebellum) are not as affected by Alzheimer’s or dementia until much later in the course of the disease. Thus, patients may retain the ability to dance and sing long after their ability to speak has diminished.
How the study worked
In the study, individuals with dementia—residents of Silverado Memory Care (in a suburb of Chicago)—and their care partners were videotaped talking and interacting for 10 minutes before and 10 minutes after the intervention. Before playing the music, each patient/caregiver pair had training on how to interact more effectively during the music.
During the 45-minute musical intervention, an ensemble of chamber musicians and a singer performed songs that attracted patients from a young age. Patients and their caregivers received simple instruments such as tambourines and shakers to accompany the music. Specially trained music therapists interacted with the patients during the performances, forcing them to beat the drums, sing and dance.
A group chat followed the music. Patients were more socially engaged, as evidenced by more eye contact, less distraction, less agitation, and an elevated mood. In comparison, the control group, which did not receive the intervention and was exposed to usual daily care and programs, showed no such changes within the same time frame.
The program included 12 sessions over three months.
“Everyone can relate to their lover”
Before the intervention, some individuals would not communicate much with their partners. However, during the intervention they started playing, singing and dancing together, which was a significant change for the family. These changes were also generalized in their behavior outside the sessions.
“As the program progressed, caregivers invited multiple family members,” said Jeffrey Wolfe, a neurological music therapist at ITA and director of the Musical Bridges to Memory program. “It became a normalizing experience for the whole family. Everyone could relate to their loved one, regardless of their degree of insanity.”
The next step in the research is to conduct the study in a larger group of patients. ITA and Northwestern have been funded by a three-year grant through the National Endowment for the Arts to expand this study.
Other Northwestern authors in the study include first author Rhiana Schafer. Co-first author Aimee Karstens, formerly at Northwestern, is now at Mayo Clinic, Rochester.