3 Music Listening and Dementia

Introduction

Dementia in older adults is incredibly common. While memory loss is the most widely known symptom, other symptoms exist that can negatively impact a person’s well-being. Thus, awareness of ways to mediate symptoms is critical in maintaining well-being. Many studies have researched the benefits of music on symptoms of dementia. This chapter will examine the benefit of music listening on persons with dementia. First, we will explore the relationship between music and memory in those with dementia. Then, we will learn the benefits of music listening to well-being, and what music best facilitates this. Next, we will examine how music impacts behavioral symptoms. Finally, we will delve into music’s influence on caregiver relationships.

Musical Processing

Musical processing in people with dementia is present and tied to memory. Arroyo-Anlló and Dauphin (2019) suggest that musical processes are commonly weakened in Alzheimer’s disease. However, Kerer, Marksteiner, Hinterhuber, Mazzola, and Georg (2013) clarify that structural knowledge of music remains intact and accessible. Many people with dementia can:

• identify and predict musical patterns
• distinguish tempo and dynamic changes
• differentiate a rhythm versus a beat
• note variations in familiar music
• process musical emotion

The ability of those with dementia to detect timbre and distortion supports that a specialized memory system for music, distinct from verbal and visual memory, exists (Elliot, 2016). Arroyo-Anlló et al. (2019) note that musical element recognition showcases working and long-term memory capacities. Familiarity influences these capacities as patients with Alzheimer’s disease can positively identify previously heard melodies (Kerer et al., 2013). Elliot (2016) elaborates that songs, especially with cultural and emotional relevance, were more easily recognized than instrumental pieces. Additionally, Simmons, Andrew, and Ally’s 2010 study observed higher recognition for lyrics in sung compared to spoken recordings, as well as a need for determining if instrumental accompaniment is impactful or not. The fact that music is accessible to persons with dementia helps support that music can impact well-being.

Music Listening

Music listening positively impacts the well-being of people with dementia. Care for dementia patients is often depersonalizing and infantilizing (Elliott, 2016). Clare and Camic (2019) state that, as a non-pharmacological approach, music promotes emotional well-being through a person and relationship-centered model of care by encouraging “a sense of security, belonging, continuity, purpose, achievement, and significance for both people with dementia and their carers” (p. 20). Furthermore, Kulibert, Ebert, Preman & McFadden (2019) note that personalized music is calming and generated positive feelings, although their study lacked consistent participation throughout which could have positively skewed the results. While on a whole music listening can promote well-being, different elements impact these benefits.

Music listening that is receptive, group based, and live, positively impact a person with dementia’s well-being. Garabedian and Kelly’s 2018 study details the positive impact of “receptive music” by re-introducing the study, obtaining consent, and giving each participant musical control each session. Additionally, group music may help prevent isolation by encouraging interaction and communication (Clare & Camic, 2019). Likewise, live music, which can be improvised and personalized, lends itself to interaction and thereby supports person-centered care, although recorded music is said to more positively impact cognitive function and behavioral symptoms (Clare & Camic, 2019). However, these findings may be due to the more methodologically rigorous studies for recorded music (Clare & Camic, 2019).

Music positively impacts dementia’s behavioral symptoms. Several studies note that music successfully reduces behavioral disturbances (Elliott, 2016). Consistent benefits relate to irritability, anxiety, agitation, depression, and dysphoria (Clare & Camic, 2019). Shiltz et al. (2018) state that individualized music, in comparison to generalized classical music, significantly reduces agitation. However, increased attention from staff may have contributed (Shiltz et al., 2018). Similarly, Shibazakia and Marshall (2015) observed increased levels of cooperation, interaction, and conversation, although they did not note the length of such effects. The benefits of music offer a sharp contrast to popular pharmacological treatments that, while often enabling older adults to remain at home, do not effectively alleviate behavioral symptoms and have many possible negative health related side effects (Elliott, 2016). The reduction of behavioral and psychological symptoms through music listening also works to support patient-caregiver relationships (Clare & Camic, 2019).

Music listening benefits patient-caregiver relationships. Music supports these relationships by increasing opportunities for engagement (Elliott, 2016). Garabedian and Kelly (2018) noted an increase in frequency and length of visits from loved ones. Moreover, music provides alternative communication when verbal language is impaired (Elliott, 2016). Despite this, Clare & Camic (2019) state that research examining music as a means of communication in this population is lacking. Music can also relieve caregiver burnout (Elliott, 2016). Personalized interventions, like MP3 players, often calm those with dementia, thereby reducing caregiver stress (Elliott, 2016). However, while some caregivers were relieved, others remarked that the equipment created stress (Kulibert et al., 2019). Garabedian and Kelly (2018) expand that other caregivers experienced joy upon seeing their partner’s happiness. Additionally, staff members reported increases in cooperation and assessment opportunities (Shibazakia & Marshall, 2015). While these studies are promising, Elliot (2016) states is important to consider the lack of the perspective from the person with dementia.

Conclusion

In summary, the reviewed literature supports that music listening benefits memory, well-being, behavioral symptoms, and relationships, for persons with dementia. Thus, the provision of opportunities to listen to music, such as through music and health practices, can be effective in maintaining the well-being of those with dementia. Beyond the specific limitations mentioned throughout the discussion, two main limitations surfaced: inadequate and inconsistent sample sizes and participants’ predisposition to music due to the voluntary nature of studies. These limitations not only impact the integrity of the results but also imbue doubt as to whether they are reflective of the population. Furthermore, as all the studies surveyed a range of dementia, future research is needed for specific types and severity levels of dementia to further promote person-centered care. Knowledge of the impact of music on persons with dementia is crucial in informing music in health practices.

References

Arroyo-Anlló, E., Dauphin, S., Fargeau, M., Ingrand, P., & Gil, R. (2019). Music and emotion in Alzheimer’s disease. Alzheimer’s Research & Therapy, 1, 1. https://doi.org/10.1186/s13195-019-0523-y

Clare, A., & Camic, P. M. (2019). Live and recorded group music interventions with active participation for people with dementias: a systematic review. Arts & Health, 1-24. https://doi.org/10.1080/17533015.2019.1675732

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Garabedian, C. E., & Kelly, F. (2018). Haven: Sharing receptive music listening to foster connections and wellbeing for people with dementia who are nearing the end of life, and those who care for them. Dementia, 1-15. https://doi.org/10.1177/1471301218804728

Gardner, Elliot. (2016). The role of music in the lives of older adults with dementia ageing in place. Dementia, 17(2) 199–213 http://www.ncbi.nlm.nih.gov/pubmed/26993049

Kerer, M., Marksteiner, M., Hinterhuber, H., Mazzola, G., & Georg, K. (2013). Explicit (semantic) memory for music in patients with mild cognitive impairment and early-stage Alzheimer’s disease. Experimental Aging Research, 39, 536-564. https://doi.org/10.1080/0361073X.2013.839298

Kulibert, D., Ebert, A., Preman, S., & McFadden, S. (2019). In-home use of personalized music for persons with dementia. Dementia,18(7–8) 2971–2984 https://doi.org/10.1177/1471301218763185

Shibazakia, K, & Marshall, N. (2015). Exploring the impact of music concerts in promoting well-being in dementia care. Aging & Mental Health, 21(5), 468-476. http://doi.org/10.1080/13607863.2015.1114589

Shiltz, D. L., Lineweaver, T. T., Brimmer, T., Cairns, A. C., Halcomb, D. S., Juett, J., Beer, L., Hay, D. P., & Plewes, J. (2018). “Music first”: An alternative or adjunct to psychotropic medications for the behavioral and psychological symptoms of dementia. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 31(1), 17–30. https://doi.org/10.1024/1662-9647/a000180

Simmons, N. R., Andrew, S. E., & Ally, B. A. (2010). Music as a memory enhancer in patients with Alzheimer’s disease. Neuropsychologia, 48(10), 3164-3167. https://doi.org/10.1016/j.neuropsychologia.2010.04.033

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