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Rachel Leah Blumenthal – 12/18/08
Unpublished article for a science journalism graduate course

Musical Memories Can Survive Alzheimer’s Destruction

An 84-year-old British woman, a retired high school teacher, can no
longer remember her name, where she lives, or what day it is. She has
trouble with a wide range of cognitive tasks, and her speech, though full of
large vocabulary, is garbled and confusing. She is incontinent and confined
to a wheelchair, but despite all this, she remains cheerful, hardly knowing
that something is wrong. She was diagnosed with Alzheimer’s disease in
2000. Three years later, Dr. Lola Cuddy and Dr. Jacalyn Duffin, researchers
at Queen’s University at Kingston in Ontario, Canada, found that despite the
woman’s cognitive difficulties, her musical memory seemed to be intact.
This is just one of many case studies published in recent years suggesting
that Alzheimer’s destroys many memory functions but may leave the ability
to remember music alone.

The implications of findings like these are not immediately clear. Many
other brain functions, especially those involving memory, are disrupted in
Alzheimer’s patients, so it may seem that a bit of functional music memory
means nothing. Some researchers, however, think that they can use music
to treat Alzheimer’s and many other diseases and disorders, including
substance abuse problems, brain injuries, and chronic pain. Although it has
been practiced in various forms for centuries, music therapy has been
gaining in popularity and scientific legitimacy just over the last few decades.
“[Music therapy] 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,” wrote Oliver Sacks, a neurologist, in his new book
about music and the brain, Musicophilia. “It aims to enrich and enlarge
existence, to give freedom, stability, organization, and focus.”

To understand the treatment potential of music therapy, one must first
understand the relationship between Alzheimer’s disease and music. Since
the early 1990s, researchers throughout the world have published a
multitude of case studies detailing the effects of Alzheimer’s disease and
other dementias on patients’ abilities to recognize and play music. The
aforementioned elderly woman underwent tests that showed that she
recognized songs from her childhood, and she was even able to continue
singing along with correct lyrics after the recordings stopped playing. She
was also able to identify wrong notes in these familiar songs, responding
with a frown, a laugh, or an exclamation – “Oh dear!”

It’s difficult to conduct a well-designed research study on Alzheimer’s
and music, so anecdotal studies are somewhat more prevalent. Musical 
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Rachel Leah Blumenthal – 12/18/08
Unpublished article for a science journalism graduate course

tests that have been used in studies with brain-damaged patients require a
patient to have some memory and other cognitive skills to even understand
the test. Patients with severe Alzheimer’s are unable to comprehend or
remember what they are doing, so these tests are not very useful for
studying Alzheimer’s. Additionally, the progressive nature of the disease
makes it tricky to find research subjects who are at the same stage of the
disease and will still be at comparable stages when the study ends.

Music has been used as a way to heal the sick since ancient times;
even writings by Aristotle and Plato mention the healing powers of music. In
the United States, music therapy became an organized profession during
World War I. Musicians occasionally performed for injured soldiers at
Veterans’ Administration hospitals, and the hospitals began hiring full-time
musicians once doctors and nurses saw the positive emotional and physical
effects the music had on patients. The first music therapy degree program
was founded at Michigan State University in 1940 with a curriculum that
included music, psychology, and biology. In 1950, a group of music
therapists who worked with veterans as well as patients with various mental
illnesses formed the National Association for Music Therapy, which later
joined with another similar group to become the American Music Therapy
Association (AMTA) in 1998.

Music therapy sessions vary widely depending on the needs of the
patients, but they may be individual or group sessions, usually lasting thirty
minutes to an hour, according to Roberta Leecock, a music therapist at
Quaboag on the Common Nursing Home in West Brookfield, Massachusetts.
At group sessions, Leecock sits at a round table with five to eight patients. “I
encourage decision-making by having the residents choose a small rhythm
instrument to play,” said Leecock. “We then make ‘live’ music, vocalizing
and playing the instruments...I go with the flow of the session. If someone
wants to comment, reminisce, discuss a song, then that’s what we do.”

Music therapy for Alzheimer’s and other memory disorders tends to be
focused on nostalgic songs to trigger childhood memories in the patients,
whereas other diseases are treated differently. Patients with Parkinson’s
disease, for example, are treated with rhythmic music; nostalgia is
unimportant. The rhythmic beats seem to help Parkinson’s patients move
more easily, at least during the session. With Alzheimer’s patients, though,
the key is to trigger old memories. “Most patients have lost their short-term
memory but retain their long-term memories for a while,” said Leecock.
“They will sing all the words of a song and be so pleased they remembered
the song. Usually a song will spark a memory as well.” For example, Arthur,
a man in his 80s, lived at Quaboag on the Common, confined to a wheelchair
and suffering from dementia. His wife visited daily. Leecock was conducting
a “celebration-themed” music therapy session with Arthur and his wife. After
playing “Anniversary Waltz” Leecock asked Arthur how he spent his 
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Rachel Leah Blumenthal – 12/18/08
Unpublished article for a science journalism graduate course

anniversaries. “In bed!” he responded, to which his wife exclaimed, “That’s
my Artie!”

Another patient, Bernice, reminisced about her past as a heartbreaker
after hearing “Girl of My Dreams.” “That was my husband’s favorite song,”
said Bernice after singing every word of the song, recalled Leecock. “I broke
a lot of hearts. I was engaged a few times...we went to dinner one night and
I looked across the table at him and thought to myself, ‘I don’t want to wake
up to that face every morning!’ so I broke it off right then. He didn’t take it
very well.”

“It still amazes me what memories a song can evoke from a person,”
said Leecock, who keeps a journal of anecdotes about her many patients as
well as quotes from the families. Many family members notice positive
effects on the patient’s mood after a music therapy session.

A vast body of anecdotal evidence shows that music therapy does
seem to be a successful treatment for a wide range of illnesses, including
Alzheimer’s disease, but it is only just starting to gain legitimacy in the
medical community due to the lack of serious research studies. “As we do
more and more research and share our findings, it is being more and more
accepted as an intervention,” said Leecock.

Dr. Charles Duffy, a neurologist specializing in memory disorders at the
University of Rochester, sees music therapy as a positive addition to other
therapies by enhancing the quality of life. “I think that music can do a lot for
people: provide a positive pre-occupation, add calmness in a confusing day’s
activities, encourage exercise and social interactions, and help structure the
day,” said Duffy. Although he thinks that music might provide mental
stimulation that is beneficial for Alzheimer’s patients, he does not know of
any studies that support the idea.

Findings from one recent study show that music therapy may at least
improve verbal skills in Alzheimer’s patients. Dr. Melissa Brotons and Dr.
Susan Koger, researchers at Willamette University, found that conversational
fluency significantly increased after three months of twice-weekly music
therapy sessions, at least during and immediately after the sessions.
“Several investigators have described positive effects from music therapy on
demented patients' verbalization and reminiscence, recall of song Iyrics and
singing,” wrote Brotons and Koger. “However, it remains controversial
whether these abilities recruit brain "language" centers such as those
affected in aphasia. That is, musical ability may be functionally and
anatomically dissociable from language and recent verbal memory.”

As evidence grows to support the idea of music’s ability to heal, many
assisted living communities employ music therapists or find other ways of 
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Rachel Leah Blumenthal – 12/18/08
Unpublished article for a science journalism graduate course

incorporating music into the residents’ daily routines. Meredith Griffiths, an
art therapist and activity coordinator for the Alzheimer’s patients at
Springhouse Retirement Community in Jamaica Plain, Massachusetts, uses
music to calm and comfort the residents when they are agitated, energize
them when they are tired, and help them reminisce. “One thing that I’ve
noticed is that some residents may have such impairment in their short term
memories that they don’t know what they ate for breakfast, but if you put on
a favorite song from their youth they can sing every word,” said Griffiths. “I
think this really speaks to the power of music and shows how people have
really important connections with it throughout their lives and is exactly why
music therapy is so effective for this population.”