By: Mary Reiland
A man who cannot speak, sings every word of a song. A woman who will not eat, chews to the beat of the music. A man who does not move, plays the piano with unnerving grace and beauty.
Music therapy is now being used to help Alzheimer’s patients remember shopping lists, grandchildrens names or, simply, how to speak at all. Although Alzheimer’s disease is treatable through medicine and therapy, there is no cure.
Tony Siriano, a music therapist at the assisted living home Atria Kew Gardens in Kew Gardens, New York, recalled one his most heartwarming memories working with Alzheimer’s patients. “I don’t know why, but I like you,’ Mrs. Epstein said to me one day as the elevator doors opened.” Siriano, who has worked in nursing homes playing music for over 15 years, said that Mrs. Epstein was one of the residents that always sat in the front row when he did a sing-a-long. Epstein, a patient whose disease had progressed to where she needed greater care in the Alzheimer’s unit, was usually non-verbal unless singing. “It is such a reward when non-verbal patients respond to you. What could be better than that in an Alzheimer’s unit?”
Epstein represents an increasing population of the elderly living in the United States. Currently, 5.3 million Americans are living with Alzheimer’s disease. That number is expected to jump to 16 million by 2050, according to the Alzheimer’s Association.
Alzheimer’s is a progressive deterioration of the brain. As the disease advances nerve cells die and there is tissue loss throughout the brain. The brain shrinks and damages the areas involved in thinking, planning, and remembering. The disease typically strikes the elderly after 55 and tends to run a seven-to-10-year course. “By the time someone is 85, nearly 50 percent of individuals in that age group will be affected by the disorder,” said Dr. Mark J. Sedler, chairman of the department of psychiatry and behavioral science with a sub-specialty in geriatric psychology at Stony Brook University Medical Center.
The warning signs include memory loss that disrupts daily life, difficulty completing familiar tasks, and confusion with time and place. “The cell loss in Alzheimer’s is spotty at first,” said Dr. Kenneth Sakauye of the University of Tennessee College of Medicine. “Usually in the parietotemporal and frontal lobes, not everywhere.” This is why, he said, some memories can be easily retrieved while others seem to be lost for good. “Memory is frequently divided, in practical terms, into explicit and implicit memory,” he said in an email. Explicit memory is what is needed to answer a question, while implicit memory is applied by being able to do something that cannot be explained, like riding a bicycle. “Alzheimer’s usually leaves implicit memory relatively intact, but explicit memory is severely impaired,” said Sakauye.
With the implicit memory mainly undamaged, Sakauye said it is easy to understand why music is used to treat Alzheimer’s patients. “Music has always been thought to be one of those implicit memories that is often linked to effect—some music can sooth, others excite, bring back old memories, all without any conscious awareness,” said Sakauye.
Music has been proven to drastically decrease anxiety and depression in patients suffering from Alzheimer’s disease, according to a study published in the Journal of Dementia and Geriatric Cognitive Disorders in July 2009. The effects of music therapy were sustained for up to eight weeks after the discontinuation, the study said.
Dan Cohen, the executive director of the non-profit organization Music & Memory, uses iPods to combat Alzheimer’s disease. “One of the characteristics of Alzheimer’s is agitation,” he said. “A lot of agitation comes from the inability to communicate how they feel.” While some patients cannot speak at all, others are at a loss for words or the word the patient wants to use is on the tip of his tongue. These circumstances are aggravating and cause anxiety. Cohen said music drastically decreases that feeling in patients, especially music that is from their time, specifically music that is familiar to them.
While the use of music therapy in nursing homes is not uncommon, the use of iPod’s is. “I heard on the radio in 2006, that iPods are ubiquitous. They are everywhere.” Doubting the truthfulness of that statement, Cohen did an Internet search to confirm his doubts. “iPod’s weren’t used in the 16,000 nursing homes that are in the United States,” he said. He called a nursing home to see if they wanted to use iPods to create personalized playlists for the patients. “The goal is to promote the use of personalized music for people who have Alzheimer’s, are depressed, or just elderly in general, to have a better quality of life,” said Cohen. The program is currently being used in 13 nursing homes in New York, as well as one in Vermont and Louisiana to help treat Alzheimer’s and Parkinson’s disease.
Music Therapist Tony Siriano uses music in his day-to-day activities with his Alzheimer’s residents. “There is the old cliché that music is everything,” he said with a chuckle. “Music is only a tool to jog their memories.” Siriano, who uses music from the era patients were growing up in, plays the song and then asks questions about the music to get a conversation going. He tries to stick with songs that have lyrics with words that are easy to pick out. Take Me Out to the Ball Game is a favorite because he can ask questions about baseball games or if they knew anyone that played baseball, which usually makes the residents start talking about a father, brother, or husband. “There have been incidents where someone doesn’t talk at all and they sing the song,” he said. “After the song, I’ll ask them a question and they have a conversation with me. It’s like magic.”
One of Siriano’s favorite stories is about a former bartender who used to be in the Alzheimer’s unit. “He was non-verbal. I played a love song, a song that he heard at the bar, and he went around the room and told all the ladies ‘You’re beautiful,” said Siriano. “He was looking all the ladies in the eyes and telling them how beautiful they were. He was really sincere about it. There was just a sparkle in his eyes and the ladies had a sparkle in their eyes because they could tell he meant it.”
The ability to regain speech functions after listening to music is not uncommon according to Dr. Concetta Tomaino, executive director and co-founder of the Institute for Music and Neurologic Function. “Consistency and repetition allow the brain to become active. It is like any kind of practice,” she said. “If you do the same thing over and over again, it becomes a skill.” She added that when a song is familiar to the patient, the memory that is connected to the song is brought to the forefront of the mind. By arousing that same type of memory again and again, it is easier for the person to retrieve it without help, she said. “If you have one tiny area that is stimulated and that [area is deteriorated], you won’t get a response. But if you have five or six areas stimulated after you listen to music, then you have a chance you are going to get a response.”
Tomaino who works with Music & Memory agrees with Cohen’s assessment of the effects of personalized music on Alzheimer’s patients. “One of the interesting things is understanding how memories get stored in the first place. A memory is not a single entity, not just an idea of a fact,” she said. “It’s a conglomeration of many things. When music is important to someone, they tend to have a historical, emotional, personal connection. It helps bring back a piece of time.”
Martha Wolf, the director of the Alzheimer’s Unit at the Parker Jewish Institute in New Hyde Park, has witnessed first hand the positive effects music has had on patients. One patient, whom she referred to by the initials of M.S. due to patient confidentiality, was a retired U.S. Marine and postal worker. “He had a gorgeous voice and loved to sing,” she said. “As his disease progressed, he became more and more agitated certain times of the day. The staff would re-direct him and ask him to sing one of his songs, whether it be God Bless America or show tunes from the 40s, it would calm him down.”
“Everyone has a different background and the disease affects everyone differently,” said Laurie Stambler, the Enriched Housing Program Manager for the Amsterdam at Harborside in Port Washington. “Programming should be specialized and individualized based on each patient.”
Although music has been proven to relieve stress and anxiety with Alzheimer’s patients, Dr. Sedler of Stony Brook University Medical Center, finds it more commonly used in nursing homes than in a doctor-patient setting. “Music can have calming effects but there are no specific medical benefits,” he said. Sedler believes that music therapy is best used on a patient that has a strong connection with music, for example a music teacher or a singer. “People with a musical history can retain how to play an instrument, which can be soothing and gratifying. Music therapy is not something I would recommend to just any patient.” Although he doesn’t prescribe it to his patients, he is confident that is has a positive effect on the patients environment but is uncertain of its’ ability to help a patient regain lost memories based on the complexity of Alzheimer’s effects on the brain.
Dr. Richard Isaacson, who spoke at the Music for Memory seminar run by the Alzheimer’s Association, said “Cognitive activity is learning something new. Listening to music focuses attention and increases concentration.” Isaacson even expressed his own initial skepticism of the effects of music therapy. “I didn’t really catch on or believe in music therapy until I saw it with my own eyes…until I started working with [music therapist] Justin Berger,” he said. Isaacson has witnessed the positive benefits having seen the effects last for eight weeks after discontinuation.
Even if music does not bring back the patient’s lost memories, it is one of the best non-pharmacological treatments for the disease, added Isaacson. “If one part of the brain is not working, well, we need to call in reinforcements,” said Isaacson. “Music is that reinforcement.”