For those living with Alzheimer’s disease, the melodies of Big Band music or the sound of a loved one singing a favorite song is more than a string of notes—it’s a connection to their past.
“Familiar music creates a sense of nostalgia,” explains Concetta Tomaino, DA, MT-BC, LCAT, executive director and co-founder of the Institute for Music and Neurologic Function. “It brings back memories and reminds them of familiar people and places.”
More than 5 million Americans have been diagnosed with Alzheimer’s disease, and up to 5% have early-onset Alzheimer’s, with many in their 40s and 50s. The disease, which is the sixth leading cause of death in the US, cannot be prevented or cured and the progression can’t be slowed. Music can have a tremendous positive impact by boosting mood, reducing agitation, improving cognitive function and motor movements, and facilitating positive social interactions, according to the Alzheimer’s Foundation of America.
Singing or listening to familiar music—think doo-wop songs from the 1950s or classic country crooners instead of Top 40 radio—seems to have the most significant impact.
“Often [people with Alzheimer’s disease] recognize music even though their brains have begun to deteriorate and lost some of their other connections,” notes Alicia Ann Clair, PhD, music therapist and professor emeritus in the division of music education at the University of Kansas. “It provides a way for them to emotionally connect when they can no longer speak.”
A Healing Tune
Music therapy is more than simply listening to music, playing instruments or singing.
Therapists, accredited through the Certification Board for Music Therapists, take an evidence-based approach to music interventions, meaning it is grounded in scientific research, as they work in nursing homes, hospitals, rehabilitation facilities, senior centers or private practice.
“It’s a treatment prescription designed to achieve specific outcomes,” explains Tomaino.
Even though music therapy has been around since the 1960s, Tomaino believes that people are just starting to hear about it, in part because of a growing interest in alterna-
Jane M. Flinn, PhD, director of the undergraduate program in neuroscience at George Mason University, notes that non-medical interventions are especially important for those living with Alzheimer’s disease. “The drugs for Alzheimer’s disease don’t work that well,” she says.
Music therapy, in contrast, has shown significant benefits.
Korean researchers evaluated patients with mild cognitive impairments, including Alzheimer’s disease, and found that music therapy improved cognitive function and reduced depressive mood. And a 2015 study published in the Australian Journal of Music Therapy found that six months of singing sessions in a music therapy group facilitated communication and reduced social isolation among those with dementia.
Music therapy also appears to improve brain function. Research in the journal Dementia and Geriatric Cognitive Disorders Extra used functional magnetic resonance imaging to study the impact of singing training on Alzheimer’s patients. At the end of the six-month study, functional MRIs (which show brain activity) indicated improved cognitive processing.
The reason music has such a profound impact on the brain, according to Flinn, is because the hippocampus, the area of the brain responsible for forming new memories, shrinks in Alzheimer’s patients but the disease does not impact the areas of the brain that process music and sound. In fact, the ability to listen to music, sing and play an instrument remains intact until late into the disease process.
“Listening to music and singing engages the entire brain, firing the neurons and improving connections, strengthening the brain,” Flinn says.
Principles into Practice
In her work as a music therapist, Clair has witnessed the profound impact music can have on the health and wellbeing of Alzheimer’s patients as well as their loved ones and caregivers.
Working with a woman who longed for emotional connection with her husband, Clair suggested dancing together. The husband didn’t recognize his wife or know her name—he often wandered away when she visited him in the hospital. When the music started and she invited him to dance, however, he pulled her close and kept time to the music; he even
kissed her on the cheek.
“It was such a touching, enlivening experience,” Clair recalls.
During a stint at a VA medical center, Clair realized that Alzheimer’s patients got agitated when shifts changed, hanging around the nurses’ station and getting into scuffles with each other.
She created a drum circle that started 10 minutes before the shift change; it reduced agitation and created a sense of calm, making the environment safer for everyone.
“It’s a nonverbal, interactive, engaged process that soothed the patients and helped them get through rough patches,” Clair explains.
Since there are fewer than 7,000 music therapists in the United States, Clair believes “there will never be enough music therapists to meet the demand.” But there are things caregivers can do to help loved ones with Alzheimer’s disease experience the benefits of music.
Tomaino suggests putting together a playlist of music that will resonate with the patient. It could include sentimental songs like a wedding song or songs that invoke nostalgia like theme songs from their favorite movies or a high school fight song. The goal, she explains, is to share music that evokes strong feelings of connection.
“It’s a terribly sad disease for the person who has it and their families because you can’t reason with them or comfort them,” says Clair. “Music provides a way to facilitate engagement and provide cognitive stimulation. It’s also a really effective way to connect emotionally.”
Seniors Find a Comforting
Companion in Music
by Violet Snow
“We all need meaning and purpose, and at the end of life, we need to feel like our life meant something, that it was worthwhile. If you can tell your story in a way that other people enjoy and will listen to, it’s an amazing boost for your sense of worth.”
Geriatric physician Lewis Mehl-Madrona, MD, PhD, author of Remapping Your Mind: The Neuroscience of Self-Transformation through Story (Bear), was describing the power of programs that bring together elders and musicians to collaborate on writing songs that express the essence of each elder’s life experience. A study by New York University, published in the American Journal of Occupational Therapy, showed that a greater sense of purpose resulted for seniors interacting with college students while they composed their writings, compared with participants in non-collaborative workshops. Bringing the generations together is also key to the success of Lifesongs, a Santa Fe organization that pioneered the collaborative songwriting method in 2007.
Such therapy benefits young and old, explains Acushla Bastible, co-director of Lifesongs. “Our approach is based on the idea that we need each other to grow and learn, and we need it across the generations. Many of our voices and stories are not expressed. When we do express end-of-life stories in public, it heals all of us. We all are going to have that experience.”
At Lifesongs, singer-songwriters and elders collaborate on their compositions over several months. Then professional singers and youth choirs are taught the songs, which are performed in a public concert, the young singing the seniors’ songs back to them. “When a young person sings an elder’s song and takes it into their body, that changes something
in them,” says Bastible. “When we hear it, it changes us. It opens up a door to reflection and emotion that is often closed.”
The singer-songwriters report profound learning experiences as well. Inspired by the example of Lifesongs, Colette Ruoff of Rosendale, New York, founded SageArts in 2014, bringing in Bastible and co-director Molly Sturges to train a group of local musicians to work with elders.
Elizabeth Clark-Jerez, a member of the band Mamalama, met once or twice a week over three months with 84-year-old Janet Fulmer. “I did a lot of listening to her stories,” says Clark-Jerez. “I asked about different phases of her life, her Hungarian background, growing up in that particular Hungarian-American culture, on to motherhood, marriage and now being a grandmother.”
As they spoke, a theme kept emerging, expressed in the Hungarian words Te yole vadge—“You are good.” The words became the backbone of the song they wrote together, based musically on Hungarian folk songs from Fulmer’s childhood.
“I had been feeling not so good about myself,” Fulmer recalls. “When I finished working with Elizabeth, I wasn’t judging myself in the same way anymore. This was simply my story. I came out really liking me. It was an enormous gift.”
Soon after their work together, Fulmer moved out of the area, giving her collaborator a painting of a Tara, or female Buddha. “It sits over my piano,” says Clark-Jerez. “I look up at it when I’m writing songs and think of all it represents—wisdom from this grandmother. I learned a lot from her stories, and that reminder not to be so hard on myself—that’s something I could practice for the next 50 years.”
Lifesongs programs are ongoing in nursing homes and hospices in the Santa Fe area. After getting SageArts musicians up to speed with individual elders in the Hudson Valley, Ruoff is launching a project at a low-income senior housing project in Kingston, New York. She is not a musician but a business consultant whose fundraising skills will help enable SageArts programs to grow, while paying the musicians. The project is a labor of love for Ruoff, who reaps daily satisfaction from the work.
“Our elders have been through so many trials and tribulations,” she says. “They’ve learned what it is to be a human being. They have something to share—a reminder to us of what’s truly important about the way we live. By marginalizing their voices, we marginalize ourselves. By including them, we can see these incredible jewels they are carrying—wisdom that we can tap into.”