Dementia and Music Therapy (Chapter 29 of Oliver Sacks' Musicophilia)

Reference:

Oliver Sacks' Musicophilia (2007)

Chapter 29: Music and Identity: Dementia and Music Therapy

Summary:

Alzheimer's is generally recognized by the loss of certain forms of memory, with more profound cases progressing to a profound amnesia. Alzheimer's can also cause the loss or impairment of language and the diminishing or loss of judgment, foresight and the ability to plan. Most drastically, patients can lose the capacity for self-awareness, though Sacks suggests that some aspects of one's essential character remain intact even during advanced dementia.

One example is that some patients still have the capacity to respond to music. Music therapy for dementia aims to access the emotions, cognitive powers, thoughts and memories that may have been long forgotten. Sacks notes that musical perception, musical memory, musical emotion and sensitivity can survive longer than other forms memory (p. 373).

Sacks notes several patients - a woman with advanced Alzheimer's who is still able to memorize complicated (newly learned) piano compositions; he also describes a musician with Alzheimer's who no longer had the capacity for language, but who continued to play and record at possibly an even higher level than previously; another example is an older gentleman who knows baritone parts to acapella songs from memory but could not otherwise say who he was.

One patient's family wonders if song could be used for amnesiac patients to learn new information - such as a song about the date and time of day, or filled with other practical information that they would like the patient to absorb - but without context, such information is meaningless. Sacks suggests that learning new information from performance and procedural memory seemed unlikely, though research is still ongoing.

Music that is most helpful for patients with dementia is music with which the patient has some familiarity and that can call on personal memory. Group therapy sessions often take patients of a similar age and background, choosing music they would all be familiar with. Patients that are incapable of any coherent reactions or interactions can focus and engage in a group. Some patients that were without the capacity of language for years can sometimes sing.

Incorporating movement into the therapy is also tremendously useful. Dance is particularly helpful because it is multi modal, allowing patients who were otherwise reactionless to become animated and move among others. Sacks also mentions drum circles as a possible therapy because it calls upon "very fundamental, subcortical levels of the brain" (p. 382).

Sacks also suggests longer-term effects by mentioning patients with advanced Alzheimer's that would have hallucinations. After listening to certain types of familiar music these patients could become calm and ultimately stop hallucinating, even while not listening to music.

In some cases, even previously unfamiliar music can provoke an emotional response - pointing to the fact that musical response is, not only cortical (Alzheimer's is a cortical disease) but also sub-cortical, which allows it to persist throughout the advanced stages of Alzheimer's.

Reflection:

This chapters shows just how far-reaching the effects of music can be. One of the most striking things that we have learned in class is that it is the multi-modality of music that makes it so complex and useful as a treatment.

Music therapy helps patients with Alzheimer's because they can find an activity that they are fully engaged in and allows them to revisit long-forgotten memories. However, I wonder if the greatest gift that music therapy gives is the relief that comes from the mental clarity that patients can temporarily gain from this activity. I wonder if this also has a therapeutic effect for the families of those patients, who can see their loved ones revisit their former selves with such immediacy, even if it is for short periods of time.

Most strikingly, music, even unfamiliar music, can have an emotional effect on patients with dementia, also owing to the fact that music processing is spread throughout the brain. This indicates that the emotional response to music is so ingrained in our character that it is cannot be easily forgotten.