Violin Lessons Strike a Chord With Alzheimer's Patients

Nancy A. Melville

April 05, 2012

April 4, 2012 (Houston, Texas) — Patients with Alzheimer's disease with otherwise limited cognitive function who had never before played the violin showed the potential not just to learn to play the instrument, but demonstrated improvements in mood and neuropsychiatric function in relation to the learning of the skill, according to a poster presentation here at the American Medical Student Association 62nd Annual Convention.

The research was a small study involving 15 patients, but it represents an intriguing addition to the body of evidence on the potential benefits of music therapy for people with Alzheimer's disease.

For the study, William Kang, a third-year medical student at the University of Central Florida in Orlando, divided a cohort of 15 patients with Alzheimer's disease into 2 groups: a control group of 7 patients who received biweekly sessions of "passive" music therapy, involving only listening to violin music; and an intervention group of 8 patients who received biweekly sessions of instructional violin lessons in addition to the passive music therapy.

None of the patients had played the violin before. The lessons were taught by Kang, who is himself a former professional violinist. "I played at nursing homes occasionally and enjoyed it a lot, so I am used to this audience," he said.

Four of the patients, with Mini-Mental State Exam (MMSE) scores ranging from 7 (severe impairment) to 28 (mild impairment), were able to learn skills including plucking strings and holding the bow with assistance, 2 were able to produce sound, and 1, with an MMSE score of 22, was able to learn to play the song Twinkle, Twinkle, Little Star.

Although qualitative results between the 2 groups after 8 weeks were not statistically significant, Kang said several observations were striking.

For one thing, the results indicated that patients in the intervention group were capable of learning the violin. "We learned that Alzheimer's disease patients can learn to play the violin," he told Medscape Medical News. "Even someone with the [MMSE] score of less than 15 was able to it learn it to a certain extent."

Second, those learning the violin demonstrated improved abilities in relation to everyday tasks such as remembering names and faces. In the most dramatic example, one patient recalled the name of a nurse she'd long forgotten.

"She'd had the same nurse for 10 years but could never remember the nurse's name, but after just 3 weeks of learning to play the violin, she greeted the nurse one morning by her name," Kang said.

Third, the patients who received violin lessons showed observable improvements in mood, memory, and cognition.

"The nurses, families, physicians, and I observed improvements in mood and energy and decreases in agitation," Kang said.

"Patients who had sundowners syndrome and were out of control, for instance, were able to calm down and improve cognitively after just 8 weeks, which is a relatively short time."

Kang noted that previous studies involving music therapy with Alzheimer's patients have involved more basic responses, such as listening, clapping, and following a rhythm, but he is not aware of any other research evaluating the effects of learning to play a complex musical instrument.

He speculated that the nature of the violin itself could be an important part of the equation, providing different challenges than, perhaps, learning to play a saxophone.

"I think the difficulty of the violin is the most important asset," Kang said. "If you think of the violin, you're using aural, visual, vibration sense, pain and temperature sense, proprioperception, and an emotional sense."

"Every song they play has an emotional quality. Previous studies have even shown increases in the corpus callosum, connecting the left and right cerebral hemispheres, in relation to music," he explained.

Famed neurologist and author Oliver Sacks, MD, has written extensively on the profound and fascinating way that music resonates with dementia and Alzheimer's patients.

In a 2007 interview with National Public Radio about his book Musicophilia, Dr. Sacks described an Alzheimer's patient who "has no idea what he did for a living or what he did 10 minutes ago," but who "remembers the baritone part to almost every song he has ever sung.... Music is one of the only things that keeps him grounded in the world."

According to psychiatrist Angela Scicutella, MD, PhD, associate professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine, in the Bronx, New York, and a member of the American Academy of Neurology, one reason Alzheimer's patients respond to music might be that the part of the brain that understands music is not the first target of the disease.

"The processing of music is thought to involve frontal subcortical circuits," said Dr. Scicutella.

"The orbitofrontal cortex is important in social interactions, and the medial prefrontal cortex is important in attention and motivation of human behavior."

"These areas, which are more involved in the emotional aspects of human behavior, are usually preserved until later in the course of Alzheimer's dementia, as opposed to the hippocampus and entorhinal cortex, which are involved in factual memory and are the first areas to be affected by the pathology of Alzheimer's disease."

"Therefore, these cortical/subcortical circuits, which tap into brain areas that are relatively preserved, can serve as another route for learning."

Music has a unique ability to engage patients on multiple levels, which makes it highly useful on a therapeutic level, she added.

"Music may be able to benefit Alzheimer's patients because it increases arousal and attention, which may help them to encode information and improve their recall of that information."

Dr. Scicutella explained that using music as a participatory exercise is often beneficial, whether it's learning to play an instrument or just singing some favorite old songs.

"I would suggest engaging the patient in whatever music that the person liked prior to the diagnosis of dementia or music that was popular in their youth/teenage years/early 20s," she said.

"Engaging patients in active participation, such as a sing-a-long or playing a simple instrument like cymbals or drums is preferable to passive activities, where they are just sitting in an audience listening to music."

Mr. Kang and Dr. Scicutella have disclosed no relevant financial relationships.

American Medical Student Association (AMSA) 62nd Annual Convention: Abstract 20. Presented March 9, 2012.


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