Music Therapy for Dementia

Introduction

These days, our exposure to various media has increased our awareness of a condition known as dementia. With this exposure, some of us become more curious about this disease, while others experience fear and concern if this happens to their closest family. 

However, have you ever heard that music has therapeutic potential for dementia? This article will help you understand dementia and explore how music therapy can help those with this condition.

About dementia

What is it?

Dementia is a condition characterised by progressive cognitive decline that affects an individual’s ability to function independently.¹ This condition is not merely memory loss, it also affects how you speak, think, feel, behave, and make decisions. 

Even though dementia is an age-related condition, it is important to note that dementia is not a natural process of ageing. Among various types of dementia, Alzheimer’s disease is one of the most common ones.

Risk factors

Age

The biggest risk of dementia is ageing. As people get older, their risk of developing this condition will increase, with most cases emerging in people aged 65 years or older. 

Age is related to this disease as dementia takes many years to damage the brain enough to cause symptoms. Also, with age, a person is more likely to experience pre-existing health conditions that increase the risk of the disease, such as high blood pressure, vascular damage in the brain, slower ability to recover from injuries, etc. 

Genetics

Having a parent or siblings with dementia will increase your likelihood of also developing it. 

Race or ethnicity

Based on statistics, older Black people are twice as likely to have dementia than White people, and Hispanic people are 1.5 times more likely than White people.

Other risk factors

Poor heart health (having high blood pressure and high cholesterol), smoking, diabetes, being overweight or obese, being physically inactive, being socially isolated, and depression.

Symptoms

Dementia has a spectrum of symptoms that impair cognitive function and daily living activities.

 Common symptoms include:

• Forgetting items and recent events
• Trouble in finding words to express themselves or loss of language
• Unable to participate meaningfully in casual conversations
• Hopelessness and loss of purpose in life
• Losing track of time
• Difficulties in performing familiar tasks
• Changes in mood and behaviour, for example, feeling angry or anxious, inappropriate behaviour, personality changes, and less interest in other people's emotions²

How does music help people with dementia?

Prevent memory decline by stimulating neuroplasticity

The brain is made up of billions of synaptic connections, which constantly change or remodel according to new experiences and environments. A connection can be removed if underused or added a person learns new skills. 

Neuroplasticity is this adaptive quality of the brain. However, as a person ages, this plasticity of the brain will also gradually decrease. This decline is accompanied by the loss of grey matter, the part of the brain where neurons are located, leading to cognitive decline over time.

When a cognitive decline occurs, one of the brain functions most affected is working memory. This memory is responsible for temporarily storing and manipulating information to perform cognitive tasks, such as remembering a telephone number before writing it down. 

Research indicates that engaging in music practice or active listening can help prevent memory decline. Activities associated with music have been shown to stimulate neuroplasticity and increase grey matter in the brain.³

Increase social interaction and maintain relationships

Engaging with music can help people with dementia develop and maintain relationships with others. Through activities such as singing, playing an instrument, or dancing, they can express their feelings and thoughts more easily. 

This engagement with music can help them reduce the feeling of stress and isolation. It will also enhance the quality of interactions between them and their caregivers or family members. 

Memory recall

A study shows that music sessions improved general cognition and executive function, including various cognitive processes such as thinking, learning, attention, memory, perception, self-control, planning, etc. 

Singing or listening to a piece of familiar or meaningful music can evoke personal memories. It can act as a prompt to recall names of families and friends, as well as facilitate immediate short-term story recall.⁴

Reduced behavioural issues and agitation

When you have dementia, agitation is a common problem that can appear especially when there is a certain change in environment, for instance when you are being hospitalised. The common forms of being agitated are aggressive behaviour, repetitive acts, wandering, and restlessness. 

Listening to music can effectively decrease this behaviour because the part of the brain that recognises the music remains unaffected by dementia. This is how music can elicit feelings of happiness and calm. 

Agitation often arises from difficulty in communicating and expressing emotions verbally. Music helps by providing a channel for a more appropriate expression of emotions, allowing dementia patients to communicate and engage in social interaction. This effect can divert attention away from environmental and emotional situations that provoke agitation.⁵

Improved mood and reduced anxiety/depression

Music has been shown to cause strong activity in the brain’s reward network. It can evoke pleasure which will increase dopamine levels, a neurotransmitter that regulates positive mood and emotional well-being. 

By directly connecting with the emotional core of the brain (limbic system) and triggering the release of dopamine, familiar music can evoke positive emotions, improve mood, and potentially reduce anxiety and depression symptoms.⁶

How is this therapy conducted? 

Music therapy is tailored to each individual’s need, it’s not a one-size-fits-all therapy for all dementia patients. Music activities and music therapy are also different. Music therapy is a formal treatment that requires a qualified therapist to address the needs of the patients. 

Generally, your therapist will assess to understand your symptoms, your cognitive abilities, and communication skills, and ensure your music preferences. They will make a strategy where music can help manage your symptoms and achieve a better quality of life. The therapist will also collaborate with your caregiver and other healthcare professionals in setting realistic and achievable goals. The goals usually target mood, social interaction, emotional expression, cognitive stimulation, physical rehabilitation, etc. 

Your therapist will choose appropriate activities that use music for you. The activities can be listening to familiar music, singing along, playing instruments, dancing to music, songwriting, and many more. Your progress will be monitored during all sessions so they can see the progress and also make an adaptation if necessary. The sessions can take place in various settings such as care homes, hospitals, assisted living facilities, or in your home.⁸

FAQ's 

What type of music is best for dementia?

It is personalised to each individual. In general, any music that is familiar and based on the patient’s preferences can help. Familiar music helps as a prompt to reminisce their memories. The therapist usually will tailor the genre of music based on the patient’s preference pre-dementia. 

What are things to never do with your loved one with dementia?

• Ask them if they remember something by saying “Remember when…?” This kind of question sometimes can make them feel like they are being tested and emphasising their memory issues, which can be frustrating for them. It is usually more helpful to lead the conversation and let them join in if they wish
• Argue with them. Arguing with dementia patients can make them upset or angry
• Question recent memories or say “I’ve just told you that…”. This question can be stressful and frustrating for them if they can’t remember the answer
• Reminding them that a person they love is dead. A person with dementia may forget past bereavement. Reminding them of this painful memory will just make it worse because they may react as if they heard it for the first time

What are the 4 types of music therapy?

1. The receptive method. This method can include listening to live or recorded music, allowing them to engage passively with the music and experience its effects
2. Recreative music. In this method, participants will recreate music that already exists by singing a favourite song or playing instruments
3. The improvisation method. Improvisation can be simply clapping a short rhythm or improvising a melody, allowing free creativity. This method can be experienced through the use of voice, instruments, making any sounds in the environment, or body percussion
4. The composition method. The complexity of this method varies. A participant may write an entirely new song, create the lyric and its instruments and play it. It can also be sharing one-word ideas to fill in the blanks of well-known songs

What are the disadvantages of music therapy for dementia patients?

Music therapy can cause various disadvantages, including the potential for triggering unwanted and distressing memories from the past that lead to emotional distress, trauma, and anxiety for some individuals.⁸

Summary 

Music therapy has been shown to positively help dementia patients by preventing further memory decline, increasing social interactions and maintaining relationships, recalling memories, reducing behavioural issues, and improving overall mood. It uses various techniques such as listening, singing a song, playing instruments, or even creating new music. The music that is used in the therapy will be personalised based on patients’s preferences and memories. Music is not a cure, but it can significantly improve the quality of life of patients with dementia. It is a powerful tool to manage symptoms and bring joy to their lives.