Through music, memories return

Through music, memories return

If you have a loved one who is suffering from dementia, you should read this. My wife’s best friend has an aunt who has severe dementia and does not know her own name, but she can sit at the piano and play a classical composition flawlessly.

The suggestion is that dementia, except when the brain is physically injured by age or illness, does not erase the memory, but only makes it inaccessible. If we can ever find out how to reconnect the pathways in the brain, the memories should be able to be accessed again. It also suggests that music memory outlasts other forms of cognitive function, particularly music memories formed in one’s youth.

In 2014, a documentary called “Alive Inside” premiered at the Sundance Film Festival and won the audience award for best documentary. The film, which explores the idea that music can help reawaken memories and emotions in dementia patients, features the work of social worker Dan Cohen, MSW, whose nonprofit organization Music & Memory has improved the quality of life of thousands of patients through a very simple approach: giving them an iPod. In a recent question and answer session, Medscape spoke with Cohen about his rapidly growing initiative and about the therapeutic potential of personalized music in patients suffering from dementia.


What inspired you to start this nonprofit?

I’m a social worker but also have a long career with technology companies. In 2006 on the radio, I heard a journalist talk about how iPods were ubiquitous, and I thought, well, most young people have them, and many older adults do too. However, in a nursing home, it just didn’t seem likely that people had these devices that the rest of us had. I Googled “iPods in nursing homes,” and among 16,000 nursing homes, I could not find one that was using them. I called up a local facility and asked if we could try something. I knew the residents already had music, but I wanted to see if there was any added value to totally personalizing the music. They said yes, and it was an instant and definitive hit.


How can music help patients with dementia and other cognitive problems?

Music has multiple benefits. People with dementia who have lost their short-term memory often retain their long-term memory, especially for music. If you play music from someone’s youth that holds personal meaning, it will help them stay connected with themselves and be more alive, alert, communicative, social, attentive, and more engaged.

There is abundant research focus on music’s ability:

• to reduce blood pressure

• improve mood

• enhance sleep

• reduce agitation and anxiety.

Research has also shown that music:

• reduces behavioral and psychological symptoms of dementia

• helps reduce pain, helps to facilitate occupational therapy, physical therapy, and speech therapy.

Music, speech, and movement are all interconnected in the brain. People fail rehabilitation because they’re not getting up and walking. I remember this one gentleman who was not walking; he was given James Brown, and within a week he was walking 100 yards. There is no guarantee that music will generate hoped-for outcomes. Everyone is different. But the music that moves you now will probably move you the same regardless of cognitive impairment later in life. If you are unable to communicate what music you love, and no one else knows, you might end up listening to music you don’t like. That’s why people are beginning to integrate their list of favorites into their advance directives.


How has the program been received by doctors and other clinicians? 

It varies, but overall the reception has been great. “Alive Inside” portrays pretty striking results with music interventions in dementia, but is there supporting data out there too? Have people run studies? Currently five Music & Memory-related studies are underway at four University of Wisconsin campuses. If you go to the New York State Department of Health website to the Electronic Dementia Guide for Excellence (EDGE), they recommend that all 650 nursing homes in New York State use individualized music to reduce agitation. It’s been up for 10 years, and basically nobody has paid any attention to it. There is no money behind it and no requirement to do it. But the recommendation is based on the evidence-based research from Linda Gerdner, RN, PhD, who in the 1990s did what is considered excellent research. So the foundational research is there. Also, we have research studies going on in California, Texas, Ohio, and in different European countries.

Doctors often prescribe antipsychotics to dementia patients with agitation. We now know that you can often replace the antipsychotic medications with music, if you can figure out which music holds personal meaning for someone.

The federal government is encouraging doctors who are working with elders with neurocognitive dysfunction who don’t have a psychiatric diagnosis — including those with Tourette syndrome and Huntington disease — to avoid prescribing an antipsychotic drug, which significantly increases mortality rates. Not only that, these drugs can really diminish whatever cognition, function and personality they have left. We want to get them off of these drugs. And once we get them off of these drugs, we don’t want them just sitting around doing nothing all day either. So we use music as an accelerant to relationships.


Practically speaking, how do you develop playlists for individuals?

If we can, we work with individuals to compile their personalized playlist. But if they’re unable to recall what music they enjoyed or meant something to them, then we’ll work with the family. We’ll ask, “Did they play an instrument when they were young?” “Did they sing in a choir or a chorus?” “Did they like Broadway musicals or religious music?” We’ll ask if they have any old LPs sitting in a closet somewhere and what their wedding or high school prom song was. All of these kinds of questions help us figure this out.

Aged care homes typically assume older patients want to listen to a popular music genre from their youth, such as big band. But unless that music holds personal meaning, perhaps associated to their senior prom, wedding song, or hanging with friends, it will probably just register as background noise.

That’s why we say that everybody should have their elders create a playlist. We should have all of our playlists in place. Neuroscientists say that this stuff works. We should help others in the family get their playlist together so that when they enter the healthcare system at any point—they go to the hospital, they go to hospice, wherever they go—their music goes with them and will help transform their experience.


What’s next for Music & Memory?

I think it’s really incumbent upon the medical profession and everybody who serves elders to leverage what we now know works. And in many cases, music can have significant benefits, especially if we can figure out what music holds personal meaning for someone. If we figure this out, patients can have much greater chances of success.


Dr. James L. Holly is CEO of Southeast Texas Medical Associates, LLP (SETMA) in Beaumont.