Music can improve the mood of those who suffer from Alzheimer's and boost cognitive skills.
En español | "I've been a bad girl. Am I in trouble?" asks an obviously distraught Naomi. Tears begin to form in the corners of her eyes. She wrings her hands as she sits in her wheelchair in the lobby of an Alzheimer's disease care facility.
"No, you're not in trouble," says recreational therapist Mindy Smith. But nothing seems to help Naomi's mood. "I've been a bad girl," she repeats over and over.
Then Mindy says, "Do you want your music?" Naomi's face brightens as headphones are gently placed over her ears. And as a big band arrangement of George Gershwin's " 'S Wonderful" flows from her iPod, Naomi begins to smile.
Scenes like this are being repeated in nursing facilities and homes across America. New research is confirming and expanding an idea long held by those who work with dementia patients: Music can not only improve the mood of people with neurological diseases, it can boost cognitive skills and reduce the need for antipsychotic drugs.
Music therapists who work with Alzheimer's patients describe seeing people "wake up" when the sounds of loved and familiar music fills their heads. Often, after months or even years of not speaking at all, they begin to talk again, become more social and seem more engaged by their surroundings. Some begin to remember names long forgotten. Some even do what Alzheimer's patients often cannot do as their disease worsens: They remember who they are.
Neurologist Oliver Sacks wrote in his book Musicophilia that for Alzheimer's patients, music can be very much like medicine. "Music is no luxury to them, but a necessity, and it can have a power beyond anything else to restore them to themselves, and to others, at least for a while."
More than 5 million people in the U.S. have Alzheimer's, a disease for which there is no cure. One in 8 boomers will get the disease, according to estimates. About 15 million family members in the U.S. are locked in what can become a heartbreaking nightmare of taking care of a loved one with whom they can't communicate. For many, music can be an important part of easing that suffering. Researchers are finding new ways to use music as part of the treatment of dementia.
Jane Flinn, a behavioral neuroscientist at George Mason University, and graduate student Linda Maguire tested the effects of singing on people with Alzheimer's disease with songs like "Somewhere Over the Rainbow" and "Isn't It Romantic?" Flinn and Maguire followed a group of 45 people impaired with Alzheimer's or other dementia who regularly sang. They tested the group constantly with the Mini Mental State Examination, a cognitive diagnostic test. Flinn and Maguire showed that the mental acuity of those people who regularly sang went up sharply over a four-month period. "Twenty-one drugs to treat Alzheimer's have failed in the last nine years," Flinn says. "I do believe they will eventually find the right drug. But it's going so slowly. In the meantime, these non-pharmaceutical approaches are helpful."
Connie Tomaino is one of music therapy's pioneers. More than 37 years ago, she walked into a dementia unit carrying her guitar and looked at the patients. "Many were overmedicated. Half of them were catatonic and had feeding tubes. The ones that were agitated had mitts on their hands and were tied to wheelchairs," she says. "I just started singing 'Let Me Call You Sweetheart.' Many of the people who were considered to be catatonic lifted up their heads and looked at me. And the people who were agitated stopped being upset. Most of them started singing the words to the song."
She founded the Institute for Music and Neurologic Function to encourage study of the effects of music on the brain. "Music is very complex," she says. "The auditory nerve has an immediate contact to part of the brain called the amygdala — what's often called the 'fight or flight' area of the brain. So the immediate thing with sound is arousal. The person becomes startled or suddenly pays attention."
Tomaino found that even some late-stage Alzheimer's sufferers could respond to songs meaningful to them. "One woman who was nonverbal — after one month, she started speaking again. She said things like, 'The kids are coming, I have to get home to make dinner.' They were memories and words elicited by the songs." Her advice: If someone you know is in the early stages of Alzheimer's, start associating key songs with family members or important ideas. Later, those songs may trigger that association.
A father's pain eased
I have seen the healing power of music up close. When I quit my job as a radio news anchor in New York to come home to help my mother care for my father, who had Alzheimer's, we used music in every aspect of caregiving. I sang or played Frank Sinatra's "In the Wee Small Hours of the Morning" to wake him up. Instead of being lost and confused in the mornings, as often happens for people with Alzheimer's, the song made him realize where he was and who my mother and I were.
My father loved jazz and had been an accomplished singer. Jazz classics like George Gershwin's "Summertime" and Cole Porter's "Night and Day" were great for showering, brushing teeth and getting dressed. I used the songs to distract him during these tasks. In the afternoons, when what's called "sundowning" sometimes occurs and Alzheimer's patients get anxious or angry, Diana Krall's version of "I Get Along Without You Very Well" would calm him down. As his disease progressed, when he would become almost catatonic, all I had to do was start singing the words to the fight song of his alma mater, the University of Michigan — and his eyes would engage and he would sing along.
When my father died in 2010 at age 83, our sadness was relieved a bit by the sense that his last years of life were less isolated and dark than they might have been otherwise.
Programs spread nationwide
Music therapy programs are a critical part of care in several states and cities.
In Wisconsin, two-thirds of the state's nursing homes use personalized playlists of music as part of daily caregiving routines. Tom Hlavacek, director of the Southeastern Wisconsin Chapter of the Alzheimer's Association, says something unexpected happened when the program began: a drastic reduction in the use of psychotropic drugs. "Three years ago, when they started ranking states' use of psychotropic drugs in nursing homes, Wisconsin came in 14th," he said. "Now we're fourth in the country. We're way ahead of the curve."
A choir has been formed in Minneapolis from people living with Alzheimer's and other brain diseases and their caregivers. The cofounder of the Giving Voice Chorus, Mary Lenard, says so much of the disease involves "things they can no longer do or navigate. So the choir is something they can do. They can be joyful and laugh and sing and be part of this new community." One choir member told Lenard, "When I'm here, it's like I don't have Alzheimer's."
Jewish Family Services in Utah hopes personalized music can help keep Alzheimer's patients at home with their loved ones longer. "We're one of just a few agencies in the U.S. that's doing this more home-based than institution-based," executive director Ellen Silver says. Alzheimer's hits married couples particularly hard. "Some other kinds of intimacy are lost," she said. "What I've seen this music do is create an intimacy that is so meaningful to the caregiver."
'An absolute lifesaver'
Dan Cohen, who was trained as a social worker in New York, runs a program called Music and Memory. He uses webinars to teach elder-care professionals how to set up personalized playlists delivered to patients on digital devices. Cohen says, "Unfortunately, as a society, we view persons with advanced dementia as no longer being able to experience pleasure. Music obliterates that misconception."
Cohen's program now operates in more than 1,000 locations across the U.S. and Canada and in a dozen caregiving facilities in eight other countries. While waiting for a cure, he says, "we must focus on maximizing the quality of life for persons with the disease. "We must use tools at our disposal, such as music, to help us keep in touch with those we care about and for."
For many, those tools can mean the difference between tender interactions with loved ones and losing them completely.
Kathleen Keller uses iPods and headsets to help take care of her 93-year-old father and mother, who both have dementia. They listen to Bing Crosby, Tony Bennett, Rosemary Clooney, Patti Page and Louis Armstrong. She plays personalized music for them during caregiving, and calms her father during long doctor visits with his iPod. "For us, this gift of music has been an absolute delight," she says. "And for me as a caregiver, it has been an absolute lifesaver."