Music Experiences for Persons with Alzheimer’s Disease

Music is a wonderful, non-pharmacological intervention to be considered for persons with Alzheimer’s disease (AD). In order to provide appropriate and beneficial music interventions for persons with AD, it is important to understand the range of music experiences that may offer effective complementary management of symptoms associated with AD. Many of you have probably seen recent news stories about the use of music for persons with AD. The movie Alive Inside: The Story of Music and Memory received worldwide attention for the use of iPods for persons with dementia and cognitive impairments [1]. While it is exciting that the movie raised the awareness of the significance of music, the movie distorts the importance of carefully choosing the type of music and appropriate music interventions. The clip of ‘Henry’ from the movie, portraying a man suddenly “awakening” when he hears his favorite music on the iPod went viral on the internet. While there is no doubt there was a great musical connection for Henry, it is not as simple as putting on music we think are someone’s favorite songs and leaving them to listen to the music by themselves. When working with persons with AD we must consider questions like: What happens if the person does not like the music and wants to turn it off? What happens if the music brings back a sad memory, and they have a negative response to it while listening alone? Or, What happens when the headphones are “annoying” to the person, causing increased agitation?

For persons with cognitive impairments including AD, benefits of music engagement point to a reduction in irritability [2] and decreased agitation [3, 4]. I see benefits in all music experiences, and describe them on a continuum from passive to active. In this blog, you will find short definitions and examples of music interventions to consider including in your role as healthcare professionals and caregivers for persons with AD.

On the passive end, music listening is an intervention that can be provided using speakers and listening to the music together. I strongly advise against the use of headphones and individualized listening for persons with AD in most situations. My rationale for this is wanting to safeguard that the music the person is listening to is appropriate; ensuring they have an opportunity to share it with another, in order to prevent and/or assist with any adverse emotional responses to the music. As we are well aware, a person with AD is often times isolated, and by using headphones, it further isolates the person instead of connecting them with others in the listening experience. Caregivers can create playlists for persons with AD for various situations, such as: motivation, relaxation, and reminiscence. Further, caregivers can use music in their care routines. For example, playing music while bathing or dressing a person.

Entertainment is also a passive music intervention which has many benefits. Many long-term care homes bring in musicians to provide concerts for their residents and these are experiences that can be shared with both professional and familial caregivers. A recent study on the impact of chamber music experiences for persons with cognitive impairment found statistically significant reductions in pain and increased mood and energy [5].

Music medicine interventions are another example of passive interventions for persons with AD. In a recent study published in the Journal of Alzheimer’s Disease, assessing the effect of stimulating the somatosensory system of AD patients at three stages of their illness with 40 Hz sound, results showed that 40 Hz treatments were successful in an increase in the Saint Louis University Mental Status (SLUMS) test over time with an increase in score of approximately 0.5 points for each treatment, and virtually 0 or negative with DVD treatment [6].

On the active side of the continuum we find experiences like singing and playing instruments. For persons with AD, singing experiences include choirs and participation in music therapy or sing-along programs facilitated by music therapists or therapeutic recreationists. According to Kreutz [7], singing augments a release of oxytocin which contributes to reduced anxiety and stress. Further, singing in a group facilitates the development of bonding and trust [8-10]. Outcomes of a recent three-phase study on choral singing with persons having cognitive impairment including AD included: reduced anxiety, happiness, and establishing friendships [11]; statistically significant decreased pain perception and increased energy, happiness, and mood [8]; as well as decreased pain perception and anxiety, and increased mood for persons with cognitive impairment as well as their caregivers who participated in the choir [12].

Another active musical group activity for persons with AD is recreational music making. According to Bittman, Bruhn, and Stevens [13], recreational music making facilitates personal expression and the building of group support, while enhancing overall quality of life. In this music experience, persons with AD might be invited to play small percussion instruments (i.e., tambourine or maraca) along with a person playing piano or guitar or in conjunction with a sing-a-long experience. These might be provided by therapeutic recreationists, music volunteers, and community musicians. Persons with AD could also be invited to join a rhythm band or a drum circle enabled by a trained drum facilitator.

Persons with AD could also be invited to engage in music lessons. Especially at the early stages of the disease, adapted music lessons can help to maintain pathways in the brain, and for those that played an instrument in earlier years, music lessons can help re-engage them in a familiar and valuable activity. These are often provided by a professional such as a music therapist who can be sensitive to the cognitive issues associated with AD.

The final music experience I will discuss is music therapy. Music therapy for persons with AD holds numerous benefits, and involves both passive and active experiences. Music therapy can be defined as:
…the professional use of music and its elements as an intervention in medical, educational, and everyday environments with individuals, groups, families, or communities who seek to optimize their quality of life and improve their physical, social, communicative, emotional, intellectual, and spiritual health and wellbeing. Research, practice, education, and clinical training in music therapy are based on professional standards according to cultural, social, and political contexts [14].

A music therapist develops goals, objectives, and a treatment plan after a formal assessment in a number of domains: cognitive, communication, emotional, physical, social, and spiritual [15]. Music therapists primarily use live music to accomplish goals. Some examples of music experiences for persons with AD include: singing familiar songs and engaging persons in discussion to promote reminiscence; improvising music to match a client’s mood; and playing instruments to maintain motor movements and enhance cognitive functioning. These interventions help to foster social interaction, decrease isolation, reduce anxiety, and aggressive behaviors. The therapist-client relationship is the key along with the music in accomplishing goals. Through this relationship and the ongoing evaluation of the treatment plan this music experience differs from others described in this blog.

Concluding Thoughts
There are some other musical experiences I did not touch on in this blog, such as using music for sleep assistance, or providing music education experiences such as music appreciation programs for persons with AD. I encourage you to include a variety of music experiences in the work you do with older adults, and to inspire family and friends to also engage with their loved ones using music. Music offers a wonderful new way of visiting with a person having AD, providing opportunities to engage the individual in reminiscence and movement. In closing, I would like to leave you with two tasks.

1. Think about the value of music in your own life? What are some songs that are particularly meaningful for you and why? If you are so inclined share these with our readers.

2. Share your stories of using music in care, or write on how you will plan to include music experiences (in reply to this blog) so others can comment and also learn of new ideas.

[1] Rossato-Bennett M (Director) (2014) Alive Inside: The Story of Music and Memory [Motionpicture on DVD]. Projector Media, USA.
[2] Suzuki M, Kanamori M, Watanabe M, Nagasawa S, Kojima E, Ooshiro H, Nakahara D (2004) Behavioral and endocrinological evaluation of music therapy for elderly patients with dementia. J Nurs Health Sci 1, 11–18.
[3] Cohen-Mansfield J (1986) Agitated behaviors in the elderly. II. Preliminary results in the cognitively deteriorated. J Am Geriatr Soc 34, 722–727.
[4] Vink A (2000) The problem of agitation in elderly people and the potential benefit of music therapy. In Music Therapy in Dementia Care (2nd ed), Aldridge D, Jessica Kingsley, London, UK, pp. 102–118.
[5] Clements-Cortés A (2017) Artful wellness: Attending chamber music concert reduces pain and increases mood and energy for older adults. Arts Psychother 52, 41-49.
[6] Clements-Cortés A, Ahonen H, Evan M, Freedman M, Bartel L (2016) Short term effects of rhythmic sensory stimulation in Alzheimer’s disease: An exploratory pilot study. J Alzheimers Dis 52, 651-660.
[7] Kreutz G (2014) Does singing facilitate social bonding? Music Med 6, 51-60.
[8] Clements-Cortés A (2014) Buddy’s Glee Club two: Choral singing benefits for older adults. Can J Mus Ther 20, 85–109.
[9] Gordon I, Zagoory-Sharon O, Leckman JF, Feldman R (2010) Oxytocin and the development of parenting in humans. Biol Psychiatry 68, 377-382.
[10] Gordon I, Zagoory-Sharon O, Schneiderman I, Leckman JF, Weller A, Feldman R (2008) Oxytocin and cortisol in romantically unattached young adults: Associations with bonding and psychological distress. Psychophysiology 45, 349-352.
[11] Clements-Cortés A (2013) Buddy's Glee Club: singing for life. Act Adapt Aging 37, 273-290.
[12] Clements-Cortés A (2015) Singing for health, connection and care. Music Med 7, 13-23.
[13] Bittman B, Bruhn, KT, Stevens C, Westengard J, Umbach PO (2003) Recreational music-making: a cost-effective group interdisciplinary strategy for reducing burnout and improving mood states in long-term workers. Adv Mind Body Med 19, 4-15.
[14] WFMT, What is music Therapy. World Federation of Music Therapy. Retrieved from: Last updated July 2015, Accessed on August 6, 2017.
[15] CAMT, About music therapy: Music therapist: clinical process. Canadian Association for Music Therapists website, Last updated June, 2016, Accessed on July 12, 2017.