I’ve Got the Music in Me

by Mind Over Matter V 13:

Music Triggers Memory in those with Alzheimer’s Disease

Music has been a cultural universal throughout human history. Listening to music can move us deeply, evoking a spectrum of emotions and bringing back memories, often pleasant ones. One does not need to be particularly “musical” to enjoy and respond to music. Rather, music appeals to people of all ages and can even have positive impacts on individuals with dementia, who may not respond to much else. 

MUSICAL MEMORY IN PEOPLE WITH ALZHEIMER’S DISEASE

Musical memory (i.e., the ability to recognize music from one’s past) is preserved in the early stages of Alzheimer’s disease (AD) and is sometimes retained in the later stages as well, despite severe impairments in cognitive function. 

An early case study provided evidence of musical memory in a severe instance of AD. In 2005, Dr. Lola Cuddy and Dr. Jacalyn Duffin shared noteworthy findings from testing that they conducted with an 84-year-old woman whose family claimed showed signs of musical memory, despite significant cognitive impairment. 

At the time of the study, the woman’s score on the Mini-Mental Status Examination (MMSE) was eight (out of a possible 30), and she was experiencing severe problems with memory, language, and cognition. The researchers found that the woman sang along with songs she recognized, sometimes continuing to sing after the music had stopped, yet she was nonresponsive to unfamiliar songs. 

Moreover, she was able to recognize when the melody of familiar songs had been distorted – she would frown, or laugh, or say “Oh, dear!” when she heard any incorrect notes. Her scores on the music tests matched those of healthy age-matched controls. These findings were published in Medical Hypotheses.

Since then, research has confirmed that the 2005 case study findings were not an anomaly: many individuals with AD display similar preservation of musical memory. For example, Dr. Cuddy conducted another study with different colleagues, this one involving 50 younger adults, 100 older adults, and 50 older adults with a diagnosis of AD. 

In this study (published in Music Perception in 2012), the participants were subdivided into three groups based on AD severity and were asked to complete six tests involving different aspects of melody and language processing. Key findings of the research include the following: 

·       Long-term familiarity for melody and lyrics was found across all levels of AD. 

·       Participants with mild AD retained the ability to sing a melody when prompted by lyrics alone, without melodic cues (i.e., their performance was comparable to the healthy older adults). However, the median performance on this test was significantly lower for moderate and severe AD participants compared to the healthy older adults. Interestingly, though, variability across individuals within the moderate and severe AD groups was quite high. Although these groups, on average, performed poorly compared to their healthy peers, several of the participants with moderate AD, and one with severe AD, performed near the top of the healthy range.

·       When it came to detecting melodic distortions (i.e., incorrect notes), participants with mild, and some with moderate, AD performed within the same range as the healthy older adults.

·       In contrast to the above findings, which showed preservation of musical memory in those with AD, the researchers found that the ability to detect grammatical distortions in lyrics of familiar songs (i.e., inclusion of grammatically incorrect words) was negatively impacted, even in the mild stage of AD.

“Our findings suggest that musical semantic memory may be an aspect of cognitive function that is uniquely spared in some individuals with Alzheimer’s disease,” said Dr. Cuddy, Professor Emerita in the Department of Psychology at Queen's University in Kingston, Ontario.

“IT APPEARS TO BE QUITE COMMON FOR PEOPLE WITH MILD ALZHEIMER’S DISEASE TO RETAIN THE ABILITY TO RECOGNIZE FAMILIAR SONGS AND REMEMBER MELODIES AND LYRICS, AND THESE ABILITIES CONTINUE TO BE PRESERVED FOR MANY THROUGH THE MODERATE STAGE (AS WELL AS FOR SOME IN THE SEVERE STAGE) OF THE DISEASE.”

THE MANY BENEFITS OF LISTENING TO MUSIC

It is fortunate that musical memory is retained by people with AD. It means that a simple and enjoyable activity like listening to music can provide a range of potential benefits for these individuals, at a time when other activities become difficult or impossible. 

Listening to music can be especially helpful in improving mood and behaviour among people with AD. In particular, music has been shown to help alleviate anxiety and reduce agitation. It may help improve quality of life and boost some aspects of cognitive function as well.

One particularly valuable way that listening to music can help people with AD is by evoking autobiographical memories and positive feelings of nostalgia. 

WHAT ARE AUTOBIOGRAPHICAL MEMORIES AND WHY ARE THEY IMPORTANT?

Autobiographical memories are recollections about the self from the past. These types of memories serve many important functions, including helping to preserve self-identity, self-knowledge, and self-esteem. 

Listening to music is one way to evoke autobiographical memories spontaneously and effortlessly. (Other things that can evoke autobiographical memories include odours, photographs, and movies.)

Nostalgia is a particular response to meaningful autobiographical memories – specifically, a sentimental longing or predominantly positive affection for the past. However, not all recollections of memories about oneself from the past will provoke nostalgia. Sometimes, autobiographical memories generate negative feelings or no feelings at all rather than positive, nostalgic ones. 

AUTOBIOGRAPHICAL MEMORY IS IMPAIRED IN ALZHEIMER’S DISEASE, BUT MUSIC CAN HELP

Alzheimer’s disease has devasting consequences on a person’s autobiographical memory. People with AD are known to have fewer and less detailed autobiographical memories than healthy older adults, and as a result, they struggle with their sense of self. 

So, anything that has the potential to help individuals with dementia experience more, or richer, autobiographical memories is of great interest to researchers. Music is one such tool; it is very efficient at evoking autobiographical memories, even in people with AD.

Numerous studies have revealed strong evidence that listening to music evokes autobiographical memories in people with AD more effectively than when they are asked to recall memories in silence. Some research has shown that when the music is self-chosen, it can be more effective than if the music is selected by the researcher. 

MEMORIES EVOKED WHILE LISTENING TO SELF-CHOSEN MUSIC ARE RECALLED MORE QUICKLY, ARE MORE SPECIFIC AND GRAMMATICALLY COMPLEX, AND HAVE HIGHER EMOTIONAL CONTENT, COMPARED TO RESEARCHER-CHOSEN MUSIC OR SILENCE.

Dr. Cuddy and colleagues conducted another informative study in which they used familiar instrumental tunes to gauge whether music alone (i.e., songs without lyrics) would be successful at evoking music-evoked autobiographical memories (MEAMs). Participants listened to excerpts from 12 instrumental tunes that were known to be familiar to them, and then described the first memory from their past that spontaneously arose while listening to the music or shortly after the music stopped playing. Participants could also indicate if no memory had surfaced. 

Most AD participants not only recalled memories, but also on average responded similarly to healthy controls on several measures, including length of the described memories (i.e., number of words), and self-rated vividness and positivity of the memories. These findings were published in 2017 in Cogent Psychology. 

“This research builds upon earlier findings that music is an effective cue for retrieval of autobiographical memories in people with AD. While not every participant with Alzheimer’s in this study was able to recall memories in response to the music, most did,” said Dr. Cuddy. “And the tune itself appears to be a powerful memory cue all on its own, even in the absence of song lyrics.” 

CREATING A PLAYLIST FOR SOMEONE WITH DEMENTIA

Listening to music is such a simple, enjoyable, inexpensive, and low-risk activity that incorporating it into the daily routine of a person with dementia is an ideal goal. Many long-term care homes and day centres offer music programs, sometimes run by professional music therapists. 

In addition to any guided group music sessions, individuals with dementia can enjoy listening to music on their own (perhaps 
with some help selecting music and setting up/using the technology to play the music). 

When choosing music to include on a playlist for someone with dementia, keep the following tips in mind:

·       If possible, involve the person with dementia in the process of selecting the music. 

·       Begin by identifying a favourite genre(s) – e.g., does the person love rock ‘n roll, country, classical, or some other type of music? 

·       Listen to samples of different songs with the goal of identifying a compilation of 25 to 50 songs that resonate with the person. 

·       Focus on particular songs from the favourite genre(s), specifically from the years when the person was between the ages of 10 and 30 years old. (That is a key period in our lives when autobiographical memory formation is at a peak, a phenomenon referred to as the “reminiscence bump.” Research has shown that songs from this time period are more likely to trigger memories.)

·       If the person is in a later stage of dementia and is unable to guide you in selecting music, ask family members or friends about her or his favourite songs or music genre(s). If you are unable to obtain that information, try an assortment of music that was popular during the person’s younger years (i.e., during the reminiscence bump). Then, play some songs from the chosen era/genre and observe how the person reacts – often you will be able to tell which songs resonate with the person, even if that person can no longer express herself or himself verbally.

Listening to music can be beneficial for everyone, not just individuals with Alzheimer’s disease. Research has shown the benefits of listening to music include reducing anxiety, blood pressure, and pain; improving sleep quality and mood; and boosting mental alertness and memory.