Introduction

Dance therapy may help patients with Alzheimer's disease ‘go down memory lane’ and jazz up their life by activating certain areas in the brain where neuronal damage appears to initiate.

What makes dance particularly special in the context of brain health and cognitive functioning? Should dance be used as an intervention tool in place of or in addition to other current Alzheimer's disease treatments? 

Do you want to have these questions and more answered? ‘Dance your way’ through this article! 

What is Alzheimer's disease?

Alzheimer's disease, named after Dr.Alois Alzheimer, a German psychiatrist, is a neurodegenerative disease that affects the brain and leads to a progressive decline in cognition, mood, behaviour, social and emotional function.¹

What does the brain of someone with Alzheimer's disease look like?

People with Alzheimer's have an excess of two abnormal proteins in the brain: amyloid-beta (A𝛃) neuritic plaques and tau neurofibrillary tangles. These proteins are found in the cerebral cortex and medial temporal lobe.¹ These brain regions are essential for learning cognitive and emotional function. The medial temporal lobe, in particular, contains the hippocampus, a subregion in the brain that plays a role in forming and storing memories, specifically short-term (recent) memories. 

Due to the extensive neuronal damage, patients with Alzheimer's disease have a significantly smaller cerebral cortex and hippocampus compared to normal, healthy individuals.¹ 

How common is Alzheimer's disease?

Alzheimer's disease is the seventh leading cause of death worldwide.² It is considered to be the most common type of dementia which is an umbrella term for all the brain syndromes that affect cognition, mood, behaviour, social, and emotional function.³ 

Research studies suggest that over 50 million people worldwide are currently affected with Alzheimer's disease. Due to the ageing population, this number will rise to as high as 115.4 million by 2050.²

Signs and symptoms of Alzheimer's disease

The signs and symptoms of Alzheimer's disease vary depending on its stage and severity. However, the main signs and symptoms of Alzheimer's disease include:

• Memory problems and memory loss: this appears to be the most common sign and symptom of Alzheimer's disease -damage to neurons is believed to initiate in the hippocampus¹
• Vision issues (posterior cortical atrophy): although this is not a recognised sign and symptom of Alzheimer's disease, a recent study published in 2024 showed that over 94% of patients with Alzheimer's have a rare condition that affects vision called posterior cortical atrophy⁴

Scientists in the study thus concluded that followed by memory loss, vision issues could act as an early, predictive warning sign for Alzheimer's disease.

Stages of Alzheimer's disease

Alzheimer's disease occurs in four main stages:¹ 

• Pre-clinical or pre-symptomatic stage: pathological changes start to occur in the hippocampus and cortex regions of the brain, but no signs and symptoms arise
• Mild or early stage: signs and symptoms of Alzheimer's start to appear at this stage including: 
  • Memory and concentration difficulties 
  • Disorientation of place and time 
  • Difficulty carrying out daily activities 
  • Changes in mood and behaviour: e.g. depression 
• Moderate stage: at this stage, Alzheimer's disease spreads further to the cerebral cortex, leading to:
  • Memory loss: hippocampus size shrinks dramatically by this stage, causing some patients to have difficulty recognising friends and family members
  • Impulsive behaviour: patients may make risky and reckless choices at this stage
  • Difficulty reading, writing, and speaking 
• Severe or late stage: by this final stage, the entire cerebral cortex and hippocampus become saturated with neuritic plaques and neurofibrillary tangles, causing patients to: 
  • Have complete memory loss: some patients may fail to recognise their friends or family 
  • Become completely dependent on others
  • Have difficulty urinating and swallowing
  • Become bedridden

Sadly, most patients with severe Alzheimer's eventually die as a result of these complications.

The therapeutic potential of dance for Alzheimer's disease

What is dance therapy?

According to the American Dance Therapy Association,⁵ dance/movement therapy (DMT) is “the psychotherapeutic use of movement which furthers the emotional, cognitive, physical and social integration of the individual.” It is a holistic therapeutic tool focusing on healing the mind, body, and spirit.

How can dance therapy stimulate cognitive function?

Dance therapy has been investigated for its potential as a therapeutic intervention tool for many neurodegenerative diseases including Alzheimer's disease because it involves several features that have been demonstrated to improve mood as well as cognitive and social function. These include:

Repetitive body movement exercise

The positive effects of movement and physical activity on cognition and mood are well-established.³ Dance, however, is believed to be especially beneficial for people with Alzheimer's as it has been shown to activate brain areas essential for cognitive function including the superior temporal gyrus, superior parietal lobule, frontopolar cortex, and middle temporal gyrus.² The middle temporal gyrus is located on the medial temporal lobe which houses the hippocampus, where Alzheimer's disease is believed to be initiated. 

Dance therapy stimulates these brain regions as it requires, repetitive body movement exercise, rhythmic variation and extensive focus, cognitive processing, social interaction, creativity, and emotional expression.²

The use of music

Although not mandatory, most dance therapists use music, particularly when working with people with dementia.³ Interestingly, music may help patients with mild to moderate Alzheimer's disease recall certain memories because their caudal anterior cingulate gyrus and ventral pre-supplementary motor brain areas, both responsible for musical memory, remain intact.⁶

What are the emotional and social benefits of dance therapy?

Although this is not always the case, dance therapy usually requires patients to interact and engage with a group socially and emotionally through verbal or non-verbal communication.³ This ‘boosts’ their emotional and social functioning, as has been demonstrated in some studies.⁷

Case studies and research findings

Highlighting studies that explore the effectiveness of dance therapy for Alzheimer's patients

To the best of the author’s knowledge, as of 2024, a total of four clinical studies are currently available investigating the effect of dance therapy on Alzheimer's patients; three of which are systematic analyses of moderate quality and one of a low-quality randomised control trial (RCT).²

The systematic analyses reported different results, with one suggesting no role for or against dance therapy as an intervention tool for Alzheimer's disease³ in contrast to the other two which demonstrated a positive effect of dance therapy on cognition function, mood, motor symptoms, and quality of life in patients with Alzheimer's disease.^8,9

Limitations of the studies 

There are many limitations to the above studies including:^2,3

• Weak evidence: the studies are of low to above-moderate quality 
• Small sample size
• Poor experimental design
• Inconsistent and inconclusive results 

What is the best type of dance for Alzheimer's disease?

It is important to note that all dances are believed to offer the same cognitive, emotional, social, and behavioural benefits; their effectiveness and suitability primarily depend on the type and severity of a patient’s neurodegenerative disease.² For example, tango is beneficial and suitable for patients with Parkinson’s disease as it focuses primarily on improving balance, coordination, flexibility, and posture; which are negatively impacted in patients with Parkinson’s.²

The most suitable and effective dance style for Alzheimer's disease treatment, on the other hand, is unclear. One study showed that patients with Alzheimer's who performed waltz, group-based circle waltz in particular, once per week for 45 minutes, through a 10-week programme experienced an improvement in mood, social interaction, and concentration.¹⁰

Summary 

In conclusion, dance therapy is a promising, safe, non-pharmacological, affordable, and easily accessible adjunctive intervention tool for older patients with Alzheimer's disease. 

Dance stands out from other forms of physical activity in the context of brain health and cognitive functioning because it involves multiple features that may help activate certain brain areas that become damaged during the early stages of Alzheimer's disease. 

The key features of dance therapy involve:

• Repetitive body movement exercise
• Rhythmic variation
• Use of music (not essential, however)
• Social interaction
• Emotional expression
• Extensive focus 
• Extensive cognitive processing
• Auditory feedback 
• Creativity

Unfortunately, however, the research studies available demonstrating and supporting the potential for dance therapy as an intervention tool for Alzheimer's disease are insufficient, inconclusive, and poorly designed. 

Further studies of larger sample sizes as well as better methodological quality and experimental design are needed to assert the positive effects of dance on the cognitive function and overall quality of life of patients with Alzheimer's disease. 

Perhaps, for now, until further research suggests otherwise, dance should be used as a recreational activity and as an adjunctive, rather than a substitute or primary treatment for Alzheimer's disease. 

Research with larger sample sizes, better experimental design, and improved higher methodological quality, and clarity are strongly needed before a definitive conclusion can be made about the therapeutic potential of dance therapy for Alzheimer's disease. 

That being said, dance therapy may still be used to treat Alzheimer's disease, but perhaps as an adjunctive rather than primary treatment until further research suggests otherwise.