The Therapeutic Effect of Music for Dementia

Singer/songwriter Glen Campbell, the original Rhinestone Cowboy, was diagnosed with Alzheimer’s Disease in 2011 after several years of cognitive decline. Despite his diagnosis, he was able to continue to write music and perform live for more than a year. In interviews, Glen’s neurologist stated that music helped with his cognitive function, staving off symptoms of decline for longer than other patients who did not practice daily involvement in music.

Campbell’s experience was not unique.  Numerous studies have shown the therapeutic effects of music for those with a wide array of cognitive impairments, from Alzheimer’s disease to autism. When used appropriately, music can affect mood, interactions, cognitive function, and motor function. A person’s ability to engage in music, particularly rhythmic playing and singing, remains intact late into the progression of dementia because these activities are not dependent on cognitive processing to be successful.

The type of music used varies depending on the desired outcome of the music therapy. Some types of music “activate,” while others calm.  Highly stimulating music, with drum beats and quick tempos, tends to naturally promote movement, such as toe taps. An example is dance tunes and big band music. Slightly stimulating music can assist with activities of daily living: for example, at mealtime to rouse individuals who tend to fall asleep at the table or during bathing to facilitate movement from one room to another. On the other hand, sedative music, like ballads and lullabies, may be used when preparing for bed or initiating any change in routine that might cause agitation.

Songs which have the greatest potential for having an impact on the person with dementia are those which he or she enjoyed during his or her young adult years (18 to 25).  As the disease progresses into the late stages, songs from childhood may work well.  However, caregivers who use music therapy as part of their care routine should take care in their musical selections and be alert for unexpected responses indicating stress or agitation, which may occur because of an individual’s personal association with the song or style of music. A song which the caregiver judges to be soothing may trigger unhappy memories and have an unintended outcome.  When initially associating music with activities, it may be best to begin with unfamiliar music to avoid triggering negative associations.

The Alzheimer’s Foundation of America provides advice for incorporating music therapy at all stages of a dementia diagnosis:

Early stage

• Go out dancing or dance in the house.
• Listen to music that the person liked in the past—whether swing or Sinatra or salsa. Recognize that perceptual changes can alter the way individuals with dementia hear music. If they say it sounds horrible, turn it off; it may to them.
• Experiment with various types of concerts and venues, giving consideration to endurance and temperament.
• Encourage an individual who played an instrument to try it again.
• Compile a musical history of favorite recordings, which can be used to help in reminiscence and memory recall.

Early and middle stages

• Use song sheets or a karaoke player so the individual can sing along with old-time favorites.

Middle stage

• Play music or sing as the individual is walking to improve balance or gait.
• Use background music to enhance mood.
• Opt for relaxing music—a familiar, non-rhythmic song—to reduce sundowning, or behavior problems at nighttime.

Late stage

• Utilize the music collection of old favorites that you made earlier.
• Do sing-alongs, with “When the Saints Go Marching In” or other tunes sung by rote in that person’s generation.
• Play soothing music to provide a sense of comfort.
• Exercise to music.
• Do drumming or other rhythm-based activities.
• Use facial expressions to communicate feelings when involved in these activities

Music as therapy can be used for caregivers as well.  Among other issues, caregivers encounter increased stress over caring for a loved one. Stress can affect sleep, interpersonal relationships, ability to make decisions, and mood. All of these things can lead to burn-out. The Alzheimer’s Association recommends the “5-Note Caregiver Music Therapy Program” to decrease stress and improve mood can help relieve some caregiver burdens:

5-Note Caregiver Music Therapy Program:

1. Discover the “happy times tunes”: Talk to your loved one about happy times in their life and understand the music associations with that time are essential to their sense of happiness.  Whether it is big band, gospel, rock ‘n’ roll, country, opera or blues, find out what tunes make your parent or spouse smile.  Most older loved ones, especially Alzheimer’s patients who retain long-term memory as opposed to short-term memory, find tunes from their youth the most joyful. But be careful, music also can evoke sad memories. 
2. Engage younger generations:  You can help create emotional intimacy when spouses and families share creative music experiences.  Whether it is downloading songs from iTunes, creating a Pandora play list or using the latest technical creation for digital music files, engage your kids in interacting with their grandparent or sibling with special needs to choose their favorite music.
3. Pick the right setting:  It may not be as simple as turning on a radio.  The radio can be distracting with constant advertising that breaks the peace of music.  Instead, try internet radio like Pandora channels, or use an iPod or CD player.  And be careful with headphones: Some may take comfort in the privacy of headphones while others will become irritated or uncomfortable.   Also consider live music situations carefully
4. Let your music play:  As a caregiver, music is your therapy as well. Whether it is creating your own playlist to lift your mood when you have the blues or just taking pleasure in watching your loved one become engaged, music can make your heart soar. 
5. Find a professional music therapist:  The American Music Therapy Association (AMTA), a non-profit organization that represents over 5,000 music therapists, corporate members and related associations worldwide, offers information about music therapy studies and a listing of credentialed music therapists.

Several local facilities regularly have music for their residents.  When choosing a residential facility, the elder, family member, or professional who is assisting with placement may wish to investigate opportunities for engagement with music at the facility.  There are also many opportunities in the community for music-based activities.  For example, Choices in Senior Care offers a “Back in the Day Music and Memory Café” on the fourth Thursday of each month at 1:30pm.  The John T. O’Connor Senior Center also offers regular singing and dance classes and socials.  If you need help finding the right musical activity for yourself or your loved one with dementia, our care coordinators can help you get on the right track.