Music therapy provides connection, relief for patients living with dementia

Photo Cred: Anna Shvets/Pexels

By Kat Black, Kat Black

Behavioral changes are some of the most challenging conditions of dementia to treat, said Concetta Tomaino, DA, LCAT, MT-BC, executive director and co-founder of the Institute for Music and Neurologic Function in Mount Vernon, New York.

During an appointment, with an “intelligent, successful” frontotemporal dementia patient from France, Tomaino and the patient’s neurologist watched the woman run around the room in an increasingly agitated state. Dementia made her “incredibly restless,” recalled Tomaino. “She would cry out. The doctor was looking at me and said, ‘What are we going to do with her?’”

Tomaino started to play a French song on the accordion. “She sat down in front of me and started singing all the words. She was absolutely engaged. For those minutes following her singing, she could talk about the music – in English and French.”

This patient is one of 55 million people who live with Alzheimer’s disease and other causes of dementia. That number is projected to rise to 139 million by 2050, according to the World Health Organization (WHO). In addition to memory loss, impaired functioning, and overall cognitive decline, dementia is associated with neuropsychiatric symptoms – known as behavioral and psychological symptoms of dementia, or BPSD – that may include distress, depression, apathy, agitation, irritability, and anxiety.

Experts generally recommend non-pharmacological interventions, including music therapy, as a first-line treatment for BPSD. Tomaino warned against the limitations and side effect burden of psychotropic medications typically used to treat mental health symptoms in patients with dementia. “That medication also slows down responses. When you have somebody with a compromised memory system anyway, and that gets slowed down because of a medication to combat behaviors, it diminishes that person’s capacity to be engaged in a meaningful way.”

Conversely, said Tomaino, music therapy helps to improve patients’ engagement with their surroundings by tapping into the wealth of emotional and biographical associations attached to specific songs. Research published in The Journal of the Alzheimer’s Association concluded that repeated exposure to music can promote neuroplasticity in patients with dementia by increasing functional brain connectivity in the Default Mode Network (DMN) – an area of the brain significantly impacted by Alzheimer’s disease. The study noted that the playlists patients listened to were specifically curated for them and featured songs they had been familiar with for years.

In the largest study of its kind to date, conducted with 4,107 residents in 265 California nursing homes, researchers from University of California, Davis found that music therapy decreased the odds of antipsychotic use by about 11 percent, anti-anxiety medication use by 17 percent, and antidepressant use by nine percent per quarter. Participation in a music therapy program was also associated with significant reductions in aggressive behaviors, depression, reported pain, and falls.

Another 2017 study published in The American Journal of Geriatric Psychiatry, which compared resident outcomes before and after implementing the Music & Memory (M&M) program, discovered a 17.6 percent to 20.1 percent increase in the number of residents who discontinued antipsychotic medication over a six-month period after receiving music therapy.

Allison Reynolds, LCSW-R, LCAT, MT-BC, a music psychotherapist at Music is Life in New York, said that music therapy can be used to “meet dementia patients where they are” and provides them with a sense of autonomy and empowerment.

“I usually start with singing songs, but I also test out if there is movement. Are they able to get up and move and dance with me? Do they want to discuss memories that are triggered? Other times I’ll try improvising. We’ll just make up a song using the client’s words or melodies.” Specifically, she looks for music that is autobiographically significant to the patient or was popular during a formative period of the patient’s life.

This kind of musical mirroring, said Reynolds, can facilitate communication and expressing emotions – functions that are frequently impaired in patients with dementia. Connecting through music can also lessen the isolation of dementia and normalize distressing feelings, she added

“This person [patient] had a down slump for a few weeks and she would say, ‘It’s not easy, it’s just not easy.’ She had certain phrases that she would repeat. I put those phrases into the music. When I was doing that, matching her feeling through the music, she was looking at me. She was connecting. She was saying more about her feelings.”

Though Tomaino recommends three sessions per week for maximum therapeutic benefit, she emphasized that music therapy can and should be implemented outside the sessions by caregivers. They can be trained to use the songs and protocols, but sometimes it is as simple as playing recorded music and seeing what comes up for the patient. She said that consistency is key, especially in the beginning stages of dementia.

“We can’t cure dementia, we can’t cure the fact that the person is going to decline, but we’ve done studies where we’ve seen engagement in consistent music therapy and memory actually improved – short-term memory and attention over time. They do progress, but at a slower pace.”