Clearing the fog of dementia with song

Anyone who’s known a loved one with dementia can testify to its cruelty – the frustration, anger and sadness that comes from watching someone you love slip away.

Dementia, the umbrella term for conditions with a severe decline in mental function, can be an incredibly painful experience, marked by confusion, distress and a profound sense of loss. It’s also increasingly common. Dementia is now the second leading cause of death in Australia.

There is no cure, but researchers, including Professor Felicity Baker, co-director of the University of Melbourne’s National Music Therapy Research Unit, are looking for new ways to help people cope.

Professor Baker studies how music, especially singing and songwriting, can be used to treat people with a range of conditions – from young people with traumatic brain injuries to adults with substance abuse issues. She says music therapy can be a way for people living with dementia – and their carers – to deal with its symptoms.

“We know that managing dementia with medication actually can make people more confused,” she says. “We need to be creative in finding ways that people with dementia can manage the challenges they face, and to address distressing symptoms such as agitation and depression.”

Professor Baker recently developed a songwriting program for people living with dementia and their carers at Caladenia, a care centre based in Melbourne’s eastern suburbs. Participants worked together in small groups to write and compose songs with a music therapist.

In one 10-week session, participants wrote seven songs. They sang about family, cruise ship holidays and staying out until the sun comes up. They thought about, talked about and even argued about songs they created, from the lyrics to the musical direction.

Even participants who normally struggle with conversation and interaction were able to work together on a music project.

“With music, they’re really engaged in a way that they’re not in other activities,” says Professor Baker. “They’re offering their ideas and perspectives. They’re happy to argue with each other about what they think the lyrics should be and whether the lyric fits the melody.”

But what really struck Professor Baker was that participants remembered the music they created.

“There’s this assumption that people with dementia can’t learn, that they’re just losing memories,” says Professor Baker. “But what we found is that they were actually remembering lyrics from week to week.”

Professor Baker’s findings will be used to inform her next project, a large-scale study funded by a grant from the National Health and Medical Research Council. She hopes to find out more about how collaborative music therapy, such as group music therapy or choir groups, might affect the cognitive function, depression, neurological symptoms and quality of life of people with the condition.

The project will include a major randomised control trial, comparing standard dementia care practices with three music-based interventions – group music therapy, larger choir groups and a combination of both.

There’s no doubt that music is a huge part of our lives. The simple act of listening to a song can evoke memories and emotions of heartbreak, love affairs, places or people in our past. And scientists, too, have long known that music has a powerful effect on brain function.

Unlike other stimulants, Professor Baker says, music engages all parts of our brain.

“When we engage in some activities, specific neural networks are activated. But when we listen to music, we actually engage quite a distributed network of neuronal activity.”

Studies have also shown that the act of creating music – songwriting, singing or playing an instrument – is more effective in stimulating our brain than just listening to music. In other words, it’s more stimulating to write and sing a song than listen to your favourite album.

“When we sing, we’re stimulating our auditory system, we’re stimulating our physical system,” she says. “When we use language in song, it’s tapping into our emotions and it’s tapping into physiological processes like our heart rate and our breathing.”

Since music is an emotional and physical stimulant, Professor Baker wants to see how much it can trigger memory function for people living with dementia.

“The theory is that pairing music and lyrics with an emotional experience can reach the threshold for memory,” she says. “It connects people and helps them to remember.”

A 2009 study by the University of California, Davis, for example, found that the area of the brain that holds our memories and links music to emotions is also the last part of the brain to atrophy during Alzheimer’s disease, the most common form of dementia.

Professor Baker’s research project is the Australian arm of a much larger study into the effects of music therapy on people living with dementia. Work in Australia will involve 500 participants, but academic colleagues in Norway are leading similar and even larger initiatives.

“It’s going to be the biggest music therapy study in dementia care ever and it’s certainly a game-changer for the dementia field,” she says.

Previous literary reviews about the effects of music therapy have been promising but inconclusive, citing the need for larger studies and more evidence.

“Worldwide, we have amassed a lot of small scale studies that show it’s effective but nothing big that will help us be taken more seriously when healthcare policies are being made.”

The NHMRC grant used to fund Professor Baker’s research is part of the Boosting Dementia Research Initiative, which gives $200 million to dementia research projects, including several other studies based at the University of Melbourne. Nearly 1 million Australians are expected to have dementia by 2050, and health policymakers are wondering how the system will deal with it.

“Dementia is going to be a challenge for this country,” says Professor Baker. “And they want to invest extra funding into projects that will help us with this massive problem that’s ahead of us.”

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