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Musical Memories and Alzheimer’s Disease

Music therapy can improve the quality of life for patients with Alzheimer’s disease by reducing agitation and depression while also improving mood and social interaction. Music serves as a powerful tool for improving communication and emotional well-being. It is particularly effective in facilitating a connection with their past and sense of identity.
music

By: Juan Manuel Orjuela, MD

Neuropsychiatrist

Alzheimer’s Disease (AD) is a progressive, degenerative brain disorder that affects memory, thought, and behavior. It is the most common cause of dementia in older adults, and it currently affects about 55 million people worldwide.1 As the disease progresses, individuals with Alzheimer’s Disease often experience a decline in their ability to communicate, perform daily activities, and care for themselves. However, music can activate areas of the brain that are still relatively intact, allowing people with Alzheimer’s Disease to connect with positive memories and emotions. In addition, listening to music can provide a pleasant and relaxing distraction from the symptoms of the disease, improve mood, and reduce anxiety.

Recently, images of older adults with cognitive impairment coming to life as they listen to songs that evoke autobiographical memories have become very famous. One such case is Marta González, a Spanish dancer and ballet teacher, whose success began in the 1960s in New York City. She developed Alzheimer’s Disease and, a few months before her death, the Spanish platform “Música Para Despertar” (Music to Awaken) recorded the moment in which she, while confined to a wheelchair and clearly deteriorated, replicated the Tchaikovsky Swan Lake choreography masterfully.

ALIVE INSIDE Clip of Henry

[Alive Inside]. (2018, July 17). ALIVE INSIDE Clip of Henry 

Another viral case involved Henry, an older adult with cognitive impairment who was featured in the documentary, “Alive Inside”. Though he was typically apathetic during his institutionalization, he experienced a wonderful awakening when he heard jazz songs he used to listen to in his youth. He opened his eyes, returned to life, and enjoyed a meaningful but transient moment. In this documentary, Oliver Sacks, the famous neurologist, and author of the best seller “Musicophilia: Tales of Music and the Brain”, comments on Henry’s musical awakening.

Homenaje a una bailarina con alzheimer del 'Lago de los Cisnes'

[AGENCIA EFE]. (2020, November 10). Homenaje a una bailarina con alzheimer del ‘Lago de los Cisnes’

In recent years, advancements in neuroscience have revealed the brain modules responsible for musical processing. Just as specific regions are dedicated to processing tones, rhythms, melodies, and musical emotions, the brain also has sections devoted to storing musical memories. The first approach was made in the 1930s by Canadian neurosurgeon Wilder Penfield (Fig.1). He performed brain stimulation procedures on conscious patients, using electrodes to activate various regions of the cerebral cortex while patients reported their thoughts. When Penfield stimulated lateral regions of the right temporal cortex, which are adjacent to the secondary auditory areas, this frequently resulted in patients hearing fragments of songs (often childhood songs), even in the absence of an external music source.2
Figure 1. Wilder Penfield (1871 - 1976). Adapted from reference 2.
In recent neuroscience research, there has been a focus on the right superior temporal sulcus and the anterior cingulate (Fig. 2), These structures are essential for storing musical memories.3,4 which could explain why people with Alzheimer’s disease can recall musical memories even in advanced stages, as these regions are often unaffected by the disease.
Figure 2. Musical memory region of interest and Alzheimer’s disease biomarkers. Adapted from reference 4.

In early stages of the disease, music therapy can help improve memory and concentration. In more advance stages, music can be used to reduce stress and anxiety5, promote relaxation, and encourage communication with the patient.

Music therapy can be implemented in different ways, depending on the patient’s degree of involvement. In some cases, a therapist or musician can play live music, which allows for direct interaction with the patient. In other cases, the therapist can use a recording and guide the patient through listening, singing, or movement exercises.

Studies have shown that music therapy can improve the quality of life for people with Alzheimer’s disease by reducing agitation and depression while also improving mood and social interaction (Fig. 3). Furthermore, music serves as a powerful tool for improving communication and emotional well-being among Alzheimer’s patients, caregivers and family members. It is particularly effective in facilitating a connection with their past and sense of identity.6

Figure 3. Music therapy with Alzheimer’s disease patients.

In conclusion, music is a powerful bridge, allowing people to connect with their memories and emotions despite the challenges posed by Alzheimer’s disease. The remarkable preservation of regions dedicated to storing musical memories defies the relentless progression of this neurodegenerative condition. Therefore, music therapy can promote emotional support and general well-being in Alzheimer’s disease patients by allowing them to maintain meaningful emotional connections with themselves and others.

  1. Alzheimer’s Disease International.  Dementia Statistics.  https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/

  2. Alison Winter. (2012). Wilder Penfield and the Recording of Personal Experience. Memory Fragments of a Modern History. (pp.75-102) University of Chicago Press.

  3. Peretz, I., Gosselin, N., Belin, P., Zatorre, R. J., Plailly, J., & Tillmann, B. (2009). Music lexical networks: the cortical organization of music recognition. Annals of the New York Academy of Sciences, 1169, 256–265. https://doi.org/10.1111/j.1749-6632.2009.04557.x

  4. Jacobsen, J. H., Stelzer, J., Fritz, T. H., Chételat, G., La Joie, R., & Turner, R. (2015). Why musical memory can be preserved in advanced Alzheimer’s disease. Brain : a journal of neurology, 138(Pt 8), 2438–2450. https://doi.org/10.1093/brain/awv135

  5. 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), 33–36. https://doi.org/10.1089/acm.2016.0346

  6. Leggieri, M., Thaut, M. H., Fornazzari, L., Schweizer, T. A., Barfett, J., Munoz, D. G., & Fischer, C. E. (2019). Music Intervention Approaches for Alzheimer’s Disease: A Review of the Literature. Frontiers in neuroscience, 13, 132. https://doi.org/10.3389/fnins.2019.00132

  7. [AGENCIA EFE]. (2020, November 10). Homenaje a una bailarina con alzheimer del ‘Lago de los Cisnes’ [Video]. Youtube. https://www.youtube.com/watch?v=mZ8hSM8DCqs

  8. [Alive Inside]. (2018, July 17). ALIVE INSIDE Clip of Henry [Video]. Youtube. https://www.youtube.com/watch?v=DeP6dPm5jdY  

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