Familiar Music May Help Caregivers and Loved Ones Living with Dementia to Connect with One Another

by Aaron Colverson, on 16 May 2022

Music has a profound impact upon the lives of individuals living with Alzheimer’s disease and related dementias. Music can help these individuals reconnect with familiar moments in their pasts, find and identify themselves within foreign locations and new living conditions, even help with social connection and enjoying moments with others that may otherwise make them anxious or agitated. How might music do this? And what might we learn by accounting for the processes involved? Toward addressing this, we synthesize a scoping review of the literature accounting for ways in which familiar music may help individuals living with dementia and their caregivers to connect [1].

Research shows that the complicated nature of musical memory is largely spared throughout the neurodegenerative process of Alzheimer’s disease. Musical memory involves the coordinated action of several brain networks including motor, sensory and association areas [2, 3]. The relative preservation of several of these networks underlies the ability of patients with neurodegenerative disease to continue to enjoy music and evoke remote memories, often accompanied by noticeable improvement in affect and demeanor [4].

Research also shows how familiar music helps individuals living with dementia and their caregivers to connect with one another [5]. A recent scoping review provides a four-step conceptual model accounting for how familiar music may facilitate this connection [1]: 1) music may be delivered either through a therapist or not, with headphones, or active participation; 2) familiar music may trigger memories in persons living with Alzheimer’s disease and related dementias; 3) memories of positive experiences can have a positive impact upon an individual’s mood state; 4) shifts in mood can help shift often tense or anxious social atmospheres into joyous exchanges with others and also assist in symptom management that may help to reduce caregiver burden (e.g., allowing for successful bathing and dressing interactions, or administration of medications).

To help an individual living with dementia engage with familiar music, it is important to gather information on the kinds of music they most enjoyed. Clues from an individual’s autobiography may be helpful in ascertaining different era associations with their music preferences. One might interview loved ones, family members, and friends or, by trial and error, if the patient is unable to tell you what they like, play music from time frames in which their thinking would have been intact and observe the effect. These days, access to any musical genre is literally at our fingertips. Tools include YouTube, Spotify, or Apple Music, or perhaps CDs. One can transfer those digital recordings onto an iPod, iPad, or other digital device to use for personalized music delivery. Playlists may be composable in advance to enable better completion of important tasks or just to foster a better mood. If this is intended for individual delivery (i.e., only experienced by the patient), use comfortable headphones (over the ear tend to be more comfortable over longer listening sessions). This process is part of the Music and Memory organization’s toolkit for caregivers to better care for their loved ones [6]. Also, reminiscence is a recommended approach to interacting with people who are struggling to learn new information. Music from an era that is the target of reminiscence may be helpful in this pursuit.

There is a lot of work to be done to better understand how familiar music helps individuals living with dementia and their caregivers to connect with one another. Of particular importance is standardizing intervention designs to validate mechanisms of action and clarify reliability of current study designs. Future research would benefit from establishing common data element standards for the definition and measurement of prosocial behaviors in the Alzheimer’s disease and related dementias populations in and outside of the contexts of musical engagement. This research could help clinicians and extension services to better serve their communities with reliable information, ultimately to reduce caregiver burden-related concerns as the incidence rates of Alzheimer’s disease and related dementias continue to rise.

Aaron Colverson, Erin Trifilio, John Williamson

REFERENCES
[1] Colverson AJ, Trifilio E, Williamson JB (2022) Music, mind, mood, and mingling in Alzheimer's disease and related dementias: a scoping review. J Alzheimers Dis 86, 1569–1588.
[2] Jacobsen JH, Stelzer J, Fritz TH, Chételat G, La Joie R, Turner R (2015) Why musical memory can be preserved in advanced Alzheimer’s disease. Brain 138, 2438-2450.
[3] Peck KJ, Girard TA, Russo FA, Fiocco AJ (2016) Music and memory in Alzheimer’s disease and the potential underlying mechanisms. J Alzheimers Dis 51, 949-959.
[4] Gubner J (2018) The music and memory project: understanding music and dementia through applied ethnomusicology and experiential filmmaking. Yearb Tradit Music 50, 15-40.
[5] Faw MH, Luxton I, Cross JE, Davalos D (2021) Surviving and thriving: Qualitative results from a multi-year, multidimensional intervention to promote well-being among caregivers of adults with dementia. Int J Environ Res Public Health 18, 4755.
[6] Music and Memory (2022, May 5). https://musicandmemory.org/

Last comment on 25 May 2022 by JAD Admin,

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Very interesting blog by Aaron Colverson, Erin Trifilio and John Williamson on the importance of familiar music and potential mechanisms through which it may provide therapeutic benefits to patients living wiht AD.  Further supporting their conclusions, in a recently published paper by our group (J Alzheimers Dis. 2021;84(2):819-833. doi: 10.3233/JAD-210610. PMID: 34602475) we showed changes in brain structure and function in cognitively impaired older adults over a 3 week time period in which familiar music was played daily.  The authors importantly highlight the role played by technology, which has significantly improved access to familiar music, and the need for further standardized studies to validate the brain mechanisms through which familiar music enhances both memory and mood.  

Colverson et al provide a useful summary of their scoping review to examine how music familiar to people living with dementia might serve as a therapeutic tool for both they and their caregivers. As the aducanumab debacle has recently helped underscore (https://pubmed.ncbi.nlm.nih.gov/35404287/), it is risky to bet on biotechnical fixes for a syndrome as complex as Alzheimer’s, and thus a measure of wisdom in focusing on the benefit of ancient artforms like music that touch something quintessentially human within all of us.
 
Many of us who work in skilled care environments have no shortage of stories about the power of music for residents and caregivers. Out of all the arts-based approaches I have been privileged to experience with people living with dementia (storytelling, poetry, pet therapy, gardening, expressive artwork, etc.) music remains the one with the most primal therapeutic power. Its appearance in assisted living settings can often alter moods (usually in a positive direction, though not always), foster or deepen relationships and bonding, and bring joy and vitality into settings where one least expects them.
 
Most moments in residential care settings come and go, stirring ancient emotions, providing a warm glow, and giving a momentary lift to the spirit in places that badly need it. However, instances of the magic of music in the care of adults living with dementia have been powerfully captured in recent years, giving the public a window into this special dynamic. Those interested would do well to start with the documentary Alive Inside (http://www.aliveinside.us/), and also the now-famous clip of Naomi Feil with Gladys Wilson (https://www.youtube.com/watch?v=CrZXz10FcVM&ab_channel=memorybridge).
 
In fact, it was Alive Inside that internationally sparked the idea that old repurposed ipods could be used to build specialized playlists for residents. In recent years, one of my medical students at Penn State employed this approach, developing individualized sets of songs for a cohort of residents living with dementia in a local skilled care facility and playing the music on a Bluetooth speaker using an old ipod touch. However, as touched on by Colverson et al, the student also involved family caregivers in the music experience to provide added benefit. Thus, not only did the residents often come to life during sessions, tapping wheelchairs, gyrating, and singing as they recalled old familiar lyrics from Elvis and Beatles’ songs, but their loved ones were able to share in this experience and observe the fleeting metamorphosis that music can induce. Such moments provided a welcome reprieve from the monotony, redundancy, and resignation caregivers can often feel. Those interested can read the study, published in JAD Reports earlier this year (https://content.iospress.com/articles/journal-of-alzheimers-disease-repo...).
 
I’m reminded of another uplifting instance involving a medical student from earlier in the school year who participated in a course I teach on the skilled unit of a nursing home. I have fourth-year students train in facilitating TimeSlips sessions—a form of creative improvisational storytelling that shifts people living with dementia from the pressure to remember into the realm of imagination. Over the course of a month, students help residents build stories, and they then develop a final project from the rich trove of content they’ve accumulated. One student, a former Broadway performer, rewrote a show-tune from The Greatest Showman with lyrics and imagery borrowed from stories the residents had told during TimeSlips sessions. The student forged such a connection with the residents during her performance of the song that she began visiting the nursing home on her own time after the class ended to play piano and continue sharing music with residents. There are few human activities capable of fostering such deep bonding—and this is certainly far exceeding of the accomplishments of anti-amyloid drugs that have so far achieved a 100% fail rate at a cost of billions of dollars.
 
As Colverson et al write, there is much work to be done in this area. To their good suggestions I would add that mixed methods may represent the best possible approach to evaluating the benefit of music interventions. The power of the arts can sometimes be ineffable and resist quantifiable measurement. Thus, there is value in having qualitative data that helps contextualize statistical results and explore the human facets of arts-based interventions that may not appear in p-values. I also recently used an oculus virtual reality device. While I am hesitant to over-hype technology in dementia care, I cannot deny the inherent coolness I felt listening to music in an immersive virtual environment that also provided an aesthetic visual experience. This sort of altered state could potentially have value in dementia care and should be studied. But we of course can’t and shouldn’t let technology decontextualize music, as listening, dancing, and playing music together is an ancient activity at the heart of quality of life, and that is where our main efforts should remain.  
 
In closing, I would also ask people to think about how music could be additive to other programming for older adults, especially during the pandemic. For instance, a medical student here is currently enlisting other talented students to play live porch concerts with personalized music in conjunction with Meals on Wheels deliveries around our hospital. How else might we imagine music as a tool to help add value to elder care services while breaking through the alienation and loneliness that have so defined the Covid era? Much good work to be done.