Overview

We often think about memory loss when it comes to Alzheimer’s disease, but it goes much deeper than that. Since it is incurable, and medication has not been much of a help, the focus on alternative treatments like music therapy has been researched.¹ Someone might think, ‘But how can music help in this situation?' Let’s compare it with another simple element that helps people suffering from an irreversible disease. An individual with an incurable disease, such as Addison’s disease, can present with hypotension (low blood pressure) as a symptom. In order to lower their chances of fainting when the blood pressure drops, they consume something salty. This doesn’t mean that their condition is cured; it means that they can manage their symptoms in a quick and simple way. In our case, music is the salt for people with dementia. Music therapy is used to ease the symptoms of dementia and try to improve the patient’s quality of life

What is alzheimer’s disease?

Alzheimer’s disease (AD) is a degenerative neurological condition which is currently incurable. It is a spectrum of dementia, and it is rather progressive.  

What causes alzheimer’s?

Various causes and risk factors contribute to this condition. Pathologically, there is an accumulation of abnormal proteins in and around the brain cells. The proteins that play a part in this pathology are amyloids, which creates a build-up of plaque around the cells, and tau proteins, which create twists inside the cells. This causes the brain to malfunction and results in the shrinkage of it, leading to memory loss.²

Risk factors

• Family history (Genetics)
• Age
• Diet
• Diabetes
• Impaired immune system
• Brain injuries
• Cardiovascular disease
• Mental health conditions³

Symptoms

• Cognitive decline
• Memory decline
• Emotional control issues
• Vision and speech problems
• Apathy
• Depression
• Anxiety
• Agitation
• Sleep problems
• Orientation problems^1,2,4

Treatment

The treatment includes medicine that focuses on enhancing cognitive function and eliminating behavioural symptoms. However, they are still not as beneficial as predicted, so ongoing research focuses on non-pharmacological treatments such as music therapy.¹

Diagnosis

• Looking at family and medical history
• Cognitive tests
• Blood tests
• Psychiatric evaluation
• Taking cerebrospinal fluid (CSF) (to take measurements of the proteins related to the disease). 
• Brain scans (CT, MRI, PET)

All these tests are conducted to rule out other diseases, ensuring that the diagnosis is correct.⁵

What is music therapy? 

Music therapy was first introduced in the late 19th century when Dr Rodríguez-Méndez used music as a therapy tool. Also, Dr Vidal-Careta conducted the first ever PhD thesis, connecting medicine with music. With a title: “Music in its relations with medicine” he highlighted that music can be used to take your mind away from worries and help you relax.⁴  Later on, music artists were playing music for patients in different departments of the hospital and it was observed that it eased pain and provided a calmer environment.⁶

Types of music therapy

The most common types of music therapies are active and passive. In active therapy, singing, dancing, and spontaneity are included, whilst in passive therapy, only listening to music is included, either with a song chosen by the patient or a random song. Music therapy is provided by a music therapist who works with the patients, either providing a personal playlist for them or the therapist choosing their own music to present.¹ Other subcategories are songwriting, discussion about the lyrics, loosening exercises to music, and also learning how to play a musical instrument.⁶

How is musical memory stored? 

Music therapy has drawn attention as a non-pharmacological treatment for AD for various reasons. Even though there is a rapid decline in autobiographical memories with AD, scientists suggest that there is an explanation for why a patient's musical memories aren’t as altered.

Memory is stored in the temporal lobe of our brain, where the hippocampus is located, and plays a vital role in the process.⁷ However, musical memory has its own special way of getting stored in the brain that differs from the usual mechanism the brain uses to keep memories. This is why, when trying to recall music,  not only does the temporal lobe play a part in the process but also in areas outside of it. There isn’t a particular place for musical memory to be kept. The research was conducted performing a PET  to examine the impact of AD in the areas of the brain that store musical experiences in comparison to the rest of the brain. The results showed those areas were the least affected by the disease.¹

Since music-evoked autobiographical memories are still intact (MEAM), a melody can trigger the memory to be retrieved, and it is believed to provide a sense of self to a patient with AD.² It is suggested that MEAM has the same mechanism as ‘involuntary memories’ as these memories are being retrieved due to a response of a cue like MEAM.¹ A patient with AD can have quite an emotional response to MEAM as those spontaneous memories can be intense and heavily detailed.²

Benefits of passive music therapy

Several studies support music therapy as they have highlighted the benefits found by conducted research. It has been found from cortisol (stress hormone) measurement levels in saliva that music therapy can lower anxiety and depression levels, as it has a calming effect on patients. It also improves the quality of sleep since it raises melatonin levels and generally balances the hormones.¹ Moreover, pain is reduced, as well as any complications of congestive heart failure.⁶ A study supports that passive music therapy to a familiar melody has more advantages than active listening therapy. It has been suggested that since the song is individualised, patients experience MEAM due to the unique mechanism of the brain to store musical memory.¹ This works as a stimulus and improves mood (by reducing anxiety and providing a calming effect) thus improving cognition as well as reducing behavioural symptoms such as agitation. Most importantly, it brings self-awareness to patients since they have associated the specific musical piece with a personal event.² Music therapy has been speculated to help short-term memories.⁴

How the studies were conducted

There were different techniques used for passive music therapy. One of them, for the non-individualised type of music therapy, had the patients listen to classical music, especially Mozart’s Sonata for Two Pianos in D major for half an hour in the morning and Pachelbel’s Canon in D major for Violins for half an hour at night. For the individualised approach, personal music was selected to listen to in the same routine.¹ In another study, people with mild AD were told to discuss their important events in life while  Vivaldi’s “Spring” from The Four Seasons was played in the background. It was found that there was a strong autobiographical memory retrieval and elimination of anxiety. As a result, it is supported that it is beneficial when the patients themselves choose their own music.²

Benefits of active music therapy

Active music therapy can also bring positive effects, resulting in the development of global cognition.^1,4 Additionally, there are social improvements since they can participate in a group and collaborate within the team, resulting in elevated arousal (shown by increased heartbeats when monitored), which eliminates unpleasant behavioural symptoms.¹ Other contributions that are made through activities such as singing, songwriting, playing instruments, etc., are signs of progress in the sense of direction in their life, in verbal communication, a decrease in apathy and on top of this, improves cognitive function and memory domains in the brain.⁶

Summary

Alzheimer’s disease is considered to be one of the most common types of dementia. The hallmark of the disease is cognitive decline and memory loss, through many risk factors the brain starts to build up atypical proteins making the brain shrink. It is incurable, and medicine only slows down the progression of the disease. Music therapy has been adopted as a non-pharmacological treatment. It can be divided into two groups: active and passive music therapy. It has been shown that it can improve short-term memory, and both types are helpful. 

Passive music therapy with individualised songs can lower behavioural symptoms such as impaired cognition and bring self-awareness to patients with AD since they can relate the melody to an event in their lives. Active music therapy can also improve cognitive function, reduce behavioural symptoms, and improve social ability and communication since there is an improvement in speech. Lastly, it is shown that apathy is reduced. However, there is a need for more research on the matter as it seems beneficial to patients’ quality of life.