Friday, April 13, 2012

Music in Alzheimer’s Disease

"As a family, we didn't know what to do when our father was diagnosed with this Alzheimer's disease. We have been through so many stages and now he seems to just be deteriorating to nothing. However, the music seems to have brought back some of his brain to him!"

By Nicholas Simmons-Stern

When I tell people I study the role of music in the lives of patients with Alzheimer’s disease I am often swept up into fascinating and poignant conversations about just how special music is for those affected by this devastating illness.

It seems that nearly everyone who has a loved one affected by Alzheimer’s has some story to tell about the transformative power of music.

I’ve heard tales of patients who are able to sing songs they learned decades ago or use music to remember times of their lives that were otherwise lost, beautiful anecdotes about parents or grandparents that were once avid musicians and who, despite an inability to dress themselves or perform other basic activities of daily life, are still able to play songs on the piano or violin with ease.

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Even when Alzheimer’s has crippled the brain to the point where close family members become unrecognizable, music can cause what many describe as an “awakening,” a state of lucid calm that is incredibly uplifting for both the patient and his or her caregivers.

One woman – Pattie Wood from Tallahassee, FL – wrote our lab last year to tell
us about her family’s use of music to cope with the effects of Alzheimer’s disease in her
My sister and I decided to try using music with [our father] to see if it would help us in any way, mostly because he has always loved music. We were much surprised when we put 1940s music (Dad's favorite type of music) on and Dad was able to remember the artists and names of songs, as well as lyrics to the music, for approximately 90% of the songs that were played. But even more surprising, while the music was playing, he was able to form complete sentences that actually fit together and have a conversation that was completely coherent.

He was also able to remember things that he had not remembered for quite some time. He was so happy during that time and during the days after the visit, so we decided to try it again. My niece took my Dad's cat to visit him and played music for him. While the music was playing, he was able to remember his cat's name, as well as my niece's name, and have a good coherent conversation with her. We were completely surprised at this, as he had fallen the day before and broke his hip. The following day, he was able to tell me when I visited him that my niece had come to see him and had brought his cat, including remembering my niece's name and his cat's name. I was completely amazed!

While stories like this one are common, it is easy to overlook just how incredible they are. In particular, the suggestion that music can help Alzheimer’s patients form new memories is an astounding one. Indeed, one of the first hallmark symptoms of Alzheimer’s is a difficulty forming new memories about events or details of one’s daily life – what we call episodic memory – and doctors and caregivers alike struggle to find ways to overcome this difficulty. Could music be the answer?

Despite the prevalence of personal anecdotes describing the healing power of music in Alzheimer’s, the scientific community has been slow to study the phenomenon and little is known about where music gets its power from, or even if that power exists at all.

Two years ago our research team at the Boston University Alzheimer’s Disease Center and the VA Boston Healthcare System set out to see if the stories are true: can music really enhance memory formation in patients with Alzheimer’s disease?

Under the leadership of Drs. Andrew Budson and Brandon Ally, we designed a preliminary study, using excerpts of simple children’s songs, to see whether musical learning (sung lyrics) results in better memory than nonmusical learning (spoken lyrics) and were surprised by what we found: Alzheimer’s patients did in fact remember the lyrics of songs they studied in their musical form better – nearly 43% better – than those of songs they studied in their nonmusical form.

To learn more about the study, see Music Boosts Memory in Alzheimer’s Patients, or Music and Memory.

This experiment provided some of the first scientific evidence that music holds a special place in the minds of those with Alzheimer’s disease.

It supports stories such as that shared by Ms. Wood, and opens the door for a whole new range of possible therapies: if music can help an Alzheimer’s patient remember a set of words or the name of his great niece, what else can it do? Would it be possible, for example, to help someone remember when to take his or her medications by making a song of the pill schedule?

Although ideas like this are exciting, it is important not to overstate the scope of what we’ve shown so far. Our preliminary study demonstrated that music might boost one type of memory: recognition for a set of words, as lyrics. We have much work to do before we understand, from a scientific perspective, the extent to which music can improve the day-to-day lives of patients with Alzheimer’s disease.

With this in mind, our research team has two goals moving forward: first, to explore the ways we can take advantage of music’s memory-enhancing properties to create practical therapies for Alzheimer’s care, and second, to uncover the specific neurological mechanisms responsible for giving music its apparent power. We want to not only learn what we can do with music, but also understand why we can do it.

What is it about music that makes it so apparently resilient to the ravages of Alzheimer’s disease?

We expect that a number of factors are involved in the answer to this question. For one, listening to music is a deeply emotional process. We all know this on an intuitive level, and recent neuroimaging research has demonstrated that the emotion and reward centers of the brain – the amygdala and nucleus accumbens, for example – are indeed activated when we listen to music. In part due to its emotionality, music increases attention, and for patients with Alzheimer’s, who often develop severe attentional deficits as a result of the disease, this may create stronger and longer-lasting memories.

We also know from neuroimaging studies that musical processing involves a wide range of brain areas, including many that are affected minimally by the degenerative effects of Alzheimer’s disease, especially in its early stages.

Musical memory may as a result be less hindered by Alzheimer’s than nonmusical memory, which relies only on standard memory areas, such as the medial temporal lobes, that are some of the first parts of the brain to be affected by the disease. In other words, music may provide a form of “backup” memory, one that Alzheimer’s patients can rely on when their normal memory systems fail.

On top of this, the emotional strength of music makes it a powerful tool for helping people cope with Alzheimer’s disease.

Various forms of music therapy have long been used to improve the quality of life of those living with Alzheimer’s and other types of dementia, and studies have shown that simply listening to music can improve a patient’s mood and ability to recall autobiographical memories.

It is likely that many of the same brain processes that allow music to act as an effective memory aid are responsible for the benefits of music therapy in dementia care.

As we continue to test these theories, I am optimistic that we will one day unlock the secrets of music and learn to harness them to better combat the debilitating effects of Alzheimer’s disease. For now, we may find hope in the many stories of the power of music.

Ms. Wood’s account provides a perfect example:
“As a family, we didn't know what to do when our father was diagnosed with this horrible disease. We have been through so many stages and now he seems to just be deteriorating to nothing. However, the music seems to have brought back some of his brain to him!”
While I cannot yet tell how to best capture this brain-restoring power, I would encourage all those with loved ones suffering from Alzheimer’s to add a little more music to their lives.

Nicholas Simmons-Stern is an undergraduate at Yale University, where he studies the cognitive neuroscience of music. He has worked for four years as a research assistant at the Center For Translational Cognitive Neuroscience, a research center based out of the VA Boston Healthcare System and part of the Boston University Alzheimer’s Disease Center. In 2009, he and the research team at the CTCN began their exploration of the memory-enhancing properties of music in Alzheimer’s disease (see Simmons-Stern, Budson, and Ally, 2010). They are currently conducting a series of experiments aimed at exploring the neurological mechanisms and practical applications of musical mnemonics in Alzheimer’s. You may reach Simmons-Stern by email at

Full Citation:
Simmons-Stern, N. R., Budson, A. E., & Ally, B. A. (2010). Music as a memory enhancer in patients with Alzheimer's disease. Neuropsychologia, 48(10), 3164-3167.

More About Music in the Alzheimer's Reading Room

Original content Nicholas Simmons-Stern, the Alzheimer's Reading Room