In this series we publish blog posts written by our undergraduate students for the PB101 Foundations of Psychological Science course. Here, Yasmin Hussain explores the therapeutic potential of music in treating cognitive impairments in dementia patients. 

When you think of treating an illness, you probably think of taking medicine or undergoing surgery. But would you believe me if I told you the sound of music could in fact be the answer to treating some of the symptoms that dementia patients experience?

The term dementia is currently known to be the loss of cognitive thinking, remembering, and reasoning, which significantly affects one’s behaviour, consequently disrupting everyday activities. From the deterioration of memory, to trouble articulating their thoughts through language, this syndrome is associated with a progressing decline of brain functioning. The confusion stems from the name itself, as dementia is not a single or specific disease, but an umbrella term that describes a myriad of symptoms, generally cognitive, that impairs an individual’s ability to perform simplistic tasks and live independently. More specifically, Alzheimer’s disease is the most common type of dementia which accounts for ‘60-80%’ of dementia cases (Alzheimer’s Disease and Dementia, 2021), and is also known as a progressive disease that exacerbates gradually over time. As more areas of the brain become damaged, more symptoms arise and worsen. The greatest contributor to dementia is increasing age, with most people being diagnosed with Alzheimer’s aged 65 and over (WHO, 2020).

The projection of Alzheimer’s in the US is to be 13.8 million by 2050 (Nair et al., 2013). The prevalence of dementia is rising; therefore, the management of symptoms must be further researched. Using music has been shown to help ‘assist in the management of agitated behaviours’ and has positive effects on the human central nervous system (Nair et al., 2013).

Is there a cure for dementia?

Currently, there is not. However, there are numerous clinical interventions that have developed over the years, to help treat the symptoms of dementia. Using drugs like memantine/cholinesterase inhibitors or partaking in non-pharmacological therapies has been shown to effectively treat the cognitive, emotional and behavioural symptoms. Examples of such interventions include art and music therapy.

Music can be like a time machine

Have you ever listened to a song that reminds you of your childhood? Whether it was that one High School Musical song or that ABBA song. “Our sensory experiences as human beings are connected with
our memories. For people with dementia or other cognitive impairments, often those association remain even if other elements of their memory are impaired and impacted.” (Freeborn, 2022).

For dementia patients who are undergoing music therapy, listening to old songs from their youth helps with treating memory loss. The patients can link their old experiences to a song and relive them, retrieving their old memories, which is challenging in the absence of music. This is called episodic memories (Juslin, 2019). Bringing about positive emotional responses will alleviate feelings of anxiety by triggering parts of the brain’s reward systems; the mesolimbic dopamine pathway, producing neurotransmitters like serotonin and dopamine, in turn ameliorating their emotional state.

However, we must consider the triggering of unwanted memories, causing heightened anxiety. Music may cause ‘harm as much as it helps, creating false memories, confusion and distress.’ (Swayne, 2014). The effect of songs is not constant, some days it may bring happiness whilst on other days, sadness. This is something to be aware of when considering whether this is the right treatment method.

Music can stimulate cognitive abilities, for example our attention, memory, cognition, communication. Improvisation training (producing their own music) allows for developments in self-regulation and memory, activating areas of the brain that would usually be inaccessible [like the prefrontal cortex, which is key in playing a central role in our cognitive control functions (Mckenzie et al., 2022)]. As well as improving one’s ‘sleep quality and depressive symptoms’, which was indicated by a 78 year old Chinese female with dementia who underwent eight weeks of music therapy delivered by her husband who was her caregiver (Lai & Lai, 2017).

How is the therapy is conducted?

Whether the patient is in a hospice or at home, the music therapist would play their favourite pieces of music through headphones to avoid distractions. Overstimulation may form as a result of the volume being too high, where the patient becomes agitated. Thus, it is essential to control the surroundings to a quiet setting. Finding their favourite music pieces from the past is pivotal to the exercise, so family and friends should be consulted. It is striking how some may be able to recognise their own wedding song, but not know who their partner is. Music unlocks a whole new level of their memory, which is fascinating to witness.

The evidence is there

A recent development in music therapy has shown significant improvement in the comorbidity of depression and dementia. The aim was to investigate the effectiveness of group music therapy for improving depression and prolonging the deterioration of cognitive function in dementia patients (Chu et al., 2014). The sample consisted of 104 people who were randomly assigned to the experimental or control group. The experimental group attended 12 sessions of group music therapy for six weeks and the control group just attended usual care. Data was obtained one week before treatment, the sixth session of the treatment, the 12th session of the treatment, and one month after final treatment. The results indicated that group music therapy reduced depression in dementia patients, these improvements occurred straight after the treatment. Cognitive function improved slightly after all the sessions, in particular short term recall function.

In another study patients had their saliva collected to quantify the level of cortisol, and completed a questionnaire to measure anxiety and depression, after undergoing a 60-minute music therapy session. Results also reinforces the notion that music can lower levels of stress after a short protocol of music therapy (de la Rubia Ortí et al., 2018).

Music therapy is a non-invasive and inexpensive treatment that appears to reduce depression in people with dementia. It has brought many benefits to the cognitive function, quality of life and emotional wellbeing of patients. Allowing the patients to reminisce of the joyful memories in their life and regain a sense of identity, in which many of them lose after being diagnosed. For caregivers it can allow them to connect with their patients, enabling them to find shared experiences with musical memories. Not only does it relieve stress in the patients but in the caregivers too. Of course, more clinical trials need to take place including larger sample sizes, longer testing periods, so we are able to understand the full benefits of this therapy. But the question is, will non-pharmacological therapies be the future?

• This post was originally written as part of PB101: Foundations of Psychological Science, which is a core course on the BSc Psychological and Behavioural Science. It has been published with the permission of the author.
• The opinions in this post are of the author, not of the Department of Psychological and Behavioural Science or LSE.
• Cover image by Tima Miroshnichenko from Pexels.

References

• Alzheimer’s Association (2016). What Is Dementia? Alzheimer’s Disease and Dementia. Annual Review of Public Health, 13(1), pp. 431–449.
• Barradas, G. T., Juslin, P. N., & i Badia, S. B. (2021). Emotional Reactions to Music in Dementia Patients and Healthy Controls: Differential Responding Depends on the Mechanism. Music & Science, 4. Link.
• Chu H, Yang CY, Lin Y, Ou KL, Lee TY, O’Brien AP, Chou KR. (2014). The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study. Biological Research for Nursing, 16(2), pp. 209-217. Link.
• Darling (2013). Music and Dementia. Psychology Today. Link.
• De la Rubia Ortí, J. E., García-Pardo, M. P., Iranzo, C. C., Madrigal, J. J. C., Castillo, S. S., Rochina, M. J., & Gascó, V. J. P. (2018). Does Music Therapy Improve Anxiety and Depression in Alzheimer’s Patients? Journal of Alternative and Complementary Medicine (New York, N.Y.), 24(1), pp. 33–36. Link.
• Freeborn, J. (2022). Music therapy improves well-being in people with dementia and caregivers. Medicalnewstoday.com; Medical News Today. ‌Link.
• Juslin, P.N. (2019) Musical emotions explained: Unlocking the secrets to musical affect. Oxford University Press.
• Lai, D. L., & Lai, C. K. (2017). A case study on a home-based caregiver-delivered music-with-movement intervention for people with early dementia. SAGE Open Medical Case Reports, 5. Link.
• Lam, H.L., Li, W.T.V., Laher, I. and Wong, R.Y. (2020). Effects of Music Therapy on Patients with Dementia—A Systematic Review. Geriatrics, 5(4), p.62. Link.
• Larson, E.B., Kukull, W.A. and Katzman, R.L. (1992). Cognitive Impairment: Dementia and Alzheimer’s Disease. Annu Rev Public Health, 13, pp. 431-449. Link.
• Matthews, S. (2015). Dementia and the Power of Music Therapy. Bioethics, 29(8), pp. 573–579. Link.
• Mckenzie, A., Shakila Meshkat, Leanna M.W. Lui, Ho, R., Di, J. D., Ceban, F., Cao, B., & McIntyre, R. S. (2022). The effects of psychostimulants on cognitive functions in individuals with attention-deficit hyperactivity disorder: A systematic review. Journal of Psychiatric Research, 149, 252–259. Link.
• Nair, B. (Kichu), Browne, W., Marley, J., & Heim, C. (2013). Music and dementia. Degenerative Neurological and Neuromuscular Disease, 47. Link.