By Luciano Marinelli
Dementia affects more than 50 million people, and this number is expected to triple by 2050 (World Health Organization, 2017), thus constituting a big challenge in healthcare and research. It involves significant cognitive deficits in memory and language as well as behavioural impairments such as depression. While most of the current treatments aim at improving cognitive dysfunction, these do not address the psychological and behavioural symptoms which largely affect the patients’ quality of life. Music therapy is thoroughly used in practice not only to address the behavioural symptoms, but also to improve cognition in dementia patients (Moreno-Morales et al., 2020). Due to the numerous beneficial effects of music on the brain, its use offers great potential for slowing down the progress of the disease and improve the quality of life of the affected patients.
Many studies have shown the beneficial effects of music on cognition. A study by Gallego MG et al. determined cognitive and behavioural improvement in 42 Alzheimer’s disease patients who have undergone music therapy for 6 weeks. Significant improvement was observed in memory, depression and anxiety in mild to moderate cases as well as language in mild cases (Gallego MG et al., 2016). In line with these results, music has been shown to enhance, among others, the activity of the hippocampus, which is one of the major affected areas in Alzheimer’s and is responsible for long-term memory, thus restoring, at least partially, its loss in AD patients (Burunat et al., 2014; Groussard et al., 2010). Music also increases dopaminergic neurotransmission in the nucleus accumbens, the main pleasure centre of the brain, thus enhances the rewarding properties of music (Mavridis, 2014). The beneficial effects of music on mood are particularly important because dementia is often accompanied with depression, which in turn further advances cognitive decline (Kitching, 2015). Therefore, this is another way music therapy can slow down cognitive dysfunction in dementia patients.
One of the main mechanisms through which music is thought to restore cognitive function is by increasing neuroplasticity, which is the ability of neurones to form new connections (Wan et al., 2010). While it was previously thought that neuroplasticity was limited to the developing brain, researchers have shown that this phenomenon continues also in the ageing brain despite the cognitive decline (Boyke et al., 2008), and music has been demonstrated to enhance this process (Wan et al., 2010). For this, researchers have investigated the brains of musicians and compared them to those of non-musicians and found that musicians had higher volume of gray matter in areas such as the cerebellum and motor cortex as well as auditory and visuospatial cortices (Rodrigues et al., 2010). These multiregional differences, which were also seen in elderly musicians (Wan et al., 2010), may represent structural adaptations in response to long-term skill acquisition (Gaser et al., 2003), highlighting the beneficial effects of music on neuroplasticity and its potential in counteracting the cognitive decline seen in dementia patients.
Another aspect of music that could be very promising for improving the quality of life of patients is how some music is associated with certain associated pleasant memories. Autobiographical information is evoked when we hear relevant music or engage in conversation about it, which is responsible for the feeling of nostalgia when listening to it (Jäncke et al., 2008). This is particularly relevant for dementia patients, as music could be used by patients to unlock memories and connect with their past and it could be a useful tool to actively engage them. Music, in fact, has also been shown to reduce anxiety and depression, concomitant with its positive impact on the limbic system. However, what type of music in particular is effective depends on the individual’s subjective taste and experiences, as some music can actually elicit bad memories. This is why it is important for caregivers and family members to learn about the individual’s musical preferences and personal history (Owens, 2014).
There are various case studies showcasing the positive impact of music on cognition. One such case involves Mrs A., which is an elderly widow with cognitive impairment and depression, whose husband has died a year earlier. After her husband’s death, she joined a centre-based community programme for older adults and because of the consistent connections she made with music, the program director offered music therapy group sessions at the centre, which she joined. She was initially reluctant to share her interest in music, and her relatives didn’t consider her to have good musical abilities. However, during each session she exhibited good musical skill and extensive knowledge about her preferred musicians. After several weeks, she would sing entire songs with full voice and enthusiasm, and she also managed to write a song for her husband. Through this song, she managed to express her love towards him and her belief that one day she will be reunited with him in heaven. Therefore, music therapy assisted Mrs A. in overcoming her depression and express herself with enthusiasm and passion, cultivating her musical skills and making her relationships with those she loved more valuable (Owens, 2014).
Despite the potential that music therapy offers for dementia patients, it has its own risks. Firstly, when performing music on the spot patients may experience anxiety and embarrassment and the music can also evoke long-buried, unconscious, unpleasant memories even of a traumatizing nature. Secondly, risks associated with the listening experience include overstimulation and confusion, particularly if the patient’s ability to make meaning of sensory input is affected (OUPblog, 2019). These aspects should be taken in consideration by the musical therapist so that they can tailor the session to their subjective needs.
In closing, can music therapy be the key to treat dementia? While it can’t be considered a definitive cure for dementia, it is a valuable addition to current treatments and has the potential to even improve their efficacy. It can be said that it offers a “win-win” situation to dementia patients, as in addition to enhancing their quality of life through active engagement and reducing depression, it can significantly slow down cognitive decline hence increase patients’ life expectancy. While more studies have to be done to further elicit music’s benefits on their cognition, the future of music therapy looks very promising.
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