Music, the brain and dementia

Taureef Mohammed

Mr Campbell (not his real name) appeared lost.

He was sitting in the living room in his suburban Ontario home, where he and his wife had lived for decades. There were family photos on the walls. Souvenirs from around the world were neatly arranged on side tables alongside miniature porcelain dolls.

In another corner was a stereo system and next to it was a shelf with books, CDs and vinyl records. And sitting next to him was his wife, his primary caregiver. Nowhere else in the world was more familiar to him than the place he was sitting in, and nobody else was nearer and dearer to him than the woman he was sitting next to.

But he had advanced Alzheimer’s disease, so he appeared lost.

His brain could not form new memories: he could not register who these strange people in his living room were and what they were here for. (He was amnestic.)
The brain’s “gas pedal”— as one geriatrician called it — that area that drove emotions, was short on gas. (He was apathetic.)
The language centre in the brain was not spared; he hardly spoke. (He was aphasic.)

All of these biological, degenerative changes manifested physically as a man appearing lost in his own living room, next to his wife of over 60 years.

How to meaningfully engage someone who appears lost is the challenge many caregivers face.

“Does he like music?” the geriatrician asked, prompted perhaps by the CDs, records and stereo system in the living room. His wife nodded.

The geriatrician decided to play a track: I Want to Hold Your Hand by the Beatles. Seconds into the song, the blank, expressionless look faded away. A smile emerged. It was a transient moment,  yes – but it was a moment, and for people with dementia, a moment could mean a bath, a pill, some steps, a few words. A moment was an opening.

The instant therapeutic effect was quite a remarkable thing to witness: the appearance of the smile – the appearance of the person – seconds into the song. Music and the brain had a special connection. It was a connection that persisted when all other connections appeared to be lost.

In his book Musicophilia: Tales of Music and the Brain, Oliver Sacks, the late neurologist and writer, described the connection between music and the brain.

In the last chapter, he described the role of music therapy in people with dementia.

“It seeks to address the emotions, cognitive powers, thoughts, and memories, the surviving 'self' of the patient, to stimulate these and bring them to the fore. It aims to enrich and enlarge existence, to give freedom, stability, organisation, and focus.”

He added: “Music of the right kind can serve to orient and anchor a patient when almost nothing else can.”

Dr Sacks told stories of patients with advanced dementia who continued to play musical instruments, remembering every note despite having forgotten everything else.

He told a story of a patient whose behaviours turned around for the better with a simple change in the television station: from regular TV programming to classical music.

In reading up more on this topic, I came across the Alzheimer Society Music Project.

It is an initiative in Canada that offers MP3 players with personalised music playlists – it is important that the music is known, liked and, if possible, chosen by the person it is for – to people with dementia.

The testimonials on the project’s website confirmed that what I saw in Mr Campbell’s living room was not a one-off thing.

One spouse said: “The MP3 player has turned his life around! I set it to shuffle and he listens almost constantly, often until the battery dies…It’s a joy to behold!”

A daughter said: “My mother is held hostage in the later stages of Alzheimer’s disease and her most responsive moments occur when she has her headphones on and is listening to the music of her time.”

Another spouse said: “Alzheimer’s is a heartbreaking disease, and it is such a relief to be able to penetrate the darkness with the joy that music brings.”

Recently, in clinic, I saw another patient with advanced dementia. I asked him what he enjoyed. He said he liked playing the guitar and singing. I asked him to sing. He serenaded his wife and me. He had a gentle voice and the lyrics flowed effortlessly.

It was a moment more for me than for him.

Taureef Mohammed is a graduate of UWI and a geriatric medicine fellow at Western University, Canada