Music: Bridging Memories for People With Alzheimer's
Wes Mika started out on drums, but in his heart he was a tambourine man.
“He got fascinated by the little silver discs on the tambourine,” said his wife, Susan Mika. “Sometimes he would hit the tambourine with the little mallets of the drum. He just he loved that tambourine.”
Wes, 77, has dementia and lives in a memory care facility in Arlington Heights, Ill., a northwest suburb of Chicago. He and Susan, 76, participated in a music program designed to help dementia patients connect with their loved ones.
The program, Musical Bridges to Memory, has been shown to enhance patients' ability to non-verbally interact with their caregivers, according to a study published recently in the journal Alzheimer Disease and Associated Disorders.
The music therapy also reduces troubling dementia symptoms like agitation, anxiety and depression.
“He's in a wheelchair, and it was just a nice, close connection for both of us,” Susan said. “We both enjoyed it. I would sing the lyrics I knew, and at times I would see him moving his lips. He doesn't speak loudly but he would move his lips, so I think he knew the words and was connected with the music.”
The music program was developed by the non-profit Institute for Therapy through the Arts, and is designed to help dementia patients who are losing their ability to communicate verbally with loved ones.
In the program, a live ensemble plays music from a patient's youth. The patient and their caregiver are encouraged to interact with the music together by singing, dancing or playing simple instruments like shakers, drums or tambourines.
It's well-established that even as dementia wreaks havoc on the mind and memories, the degenerative brain disorder doesn't appear to affect a person's ability to enjoy music until much later in the disease course, said senior researcher Dr. Borna Bonakdarpour. He is an associate professor of neurology at Northwestern University Feinberg School of Medicine, in Chicago.
Because of this, patients can retain their ability to dance and sing long after their ability to talk has diminished.
“They can process music, they can get it, they receive it, they respond to it, they can dance with it, they can play with it, they can sing along with it,” Bonakdarpour said. “These are components that are pretty much intact, which is amazing.”
The Alzheimer's Association recognizes music therapy as an important non-drug therapy for dementia, said Sam Fazio, senior director for psychosocial research and quality care.
“You're accessing different parts of the brain that may not be affected by the disease's symptoms,” Fazio said. “Sometimes when people can no longer express themselves in words, they can still express themselves with lyrics of a song or feel the melody.”
Helping patients and caregivers
For this study, Bonakdarpour's team asked 21 patients and their caregivers to take part in the Musical Bridges to Memory program once a week. The study was unusual because earlier music therapy efforts have tended to focus solely on the patient, while this involved both patients and caregivers.
The program included 45 minutes of music, as well as a 15-minute talk beforehand so the music therapist could discuss specific communication skills to be addressed during the time together. Overall, patients took part in 12 sessions over three months.
The patient/caregiver pairs also were videotaped for 10 minutes before and 10 minutes after each session, so research assistants could analyze the effect music therapy had on their interactions, Bonakdarpour said.
While the program is designed to help access the musical part of a patient's brain, these sessions also counsel caregivers on ways to patiently engage with their loved one, Bonakdarpour said.
“Things can get escalated between the patient and caregiver because the care partner doesn't know what to do with abnormal behaviors,” he said. “A patient with a memory problem may ask the same question 10 times, and the partner can get exasperated.”
Wes and Susan took part in the program virtually because of the COVID-19 pandemic.
The music included old standards like “You Are My Sunshine,” “Take Me Out to the Ballgame,” and “You're a Grand Old Flag,” but the musicians took requests, Susan said. She and Wes love Josh Groban, so the ensemble added some of his tunes to their repertoire.
“She would play videos and she'd do an opening and an ending song,” Susan recalled. “She asked what we wanted to hear, and she would play it for us, and then we would sing along. I was right next to him, so I would often look into his face, and we'd connect that way.”
The researchers found that non-verbal social interactions significantly increased between the patients and caregivers who took part in the program, while communication declined among eight patient/caregiver pairs who did not participate and served as a control group.
In group conversations after the music, patients were more socially engaged, the researchers said. They maintained eye contact more often, were less distracted and agitated, and were in an upbeat mood.
Bonakdarpour remembered one particular patient “who was very hyperactive and during the sessions would get up and wanted to dance with everybody. The wife was kind of embarrassed, and she would get mad at him.”
“But then as the sessions moved forward, and by the middle to end, this guy was sitting down during all the sessions with his wife,” Bonakdarpour said. “They're communicating. They're using percussion instruments to participate. They dance together. So it really changed their relationship.”
'It just makes him happy'
Based on these results, Bonakdarpour's team has received a three-year grant from the National Endowment for the Arts to expand the program and perform another clinical trial involving more patients.
Fazio praised the study because it was done with professional music therapists and with the right protocols so it could have the best possible outcomes.
“Sometimes people think they're doing music therapy by just playing a record in the background, when that's not really true,” Fazio said. “To have the outcomes we want, like increased engagement and less anxiety or agitation, the correct protocols need to be in place by trained music therapy professionals who understand how to use music to accomplish non-musical goals.”
Bonakdarpour is convinced that music therapy should be an important part of helping manage the symptoms of dementia patients whose capabilities are declining.
“For some of these psychiatric issues of people with dementia, we don't have great drugs,” he said. “When we're really desperate, we have to use some drugs that have side effects. Some of them can really affect the heart. It can even shorten people's lives. And if you can avoid using these toxic medications, wouldn't that be great?”
Wes enjoyed the program so much that Susan now incorporates music into their regular visits, she said. She asks an Amazon device to play a list of songs.
“Alexa plays those songs and then we just play along with the instruments. I try to find songs that he'll remember. It just makes him happy,” Susan said.
The Institute for Therapy through the Arts has more about Musical Bridges to Memory.
SOURCES: Borna Bonakdarpour, MD, associate professor, neurology, Northwestern University Feinberg School of Medicine, Chicago; Sam Fazio, PhD, senior director, psychosocial research and quality care, Alzheimer's Association, Chicago; Alzheimer Disease and Associated Disorders, Aug. 25, 2022