August 23, 2012 — The surprising popularity of a 6-minute video uploaded to YouTube last spring is bringing enthusiastic attention to music therapy programs as a possible way to improve symptoms in patients with Alzheimer's disease (AD) and dementia.
A program known as Music and Memory was created by former social worker Dan Cohen as a way to "awaken" memories in these patients through the use of personalized music selections played on mp3 players. A documentary about him and the program, entitled Alive Inside, is currently in production; it is a video clip from this documentary that garnered unbelievable attention.
With more than 6 million views, the clip features "Henry," an elderly man with dementia who is first shown slumped over in his chair, barely acknowledging those around him. But after headphones are slipped on him, he instantly lights up and becomes more animated, even humming along with the music.
More dramatically, after the headphones are taken off, he is shown being able to answer questions and even sings snippets of his favorite songs.
"This is not a cure, but we are increasing patients' level of engagement," Dan Cohen told Medscape Medical News. He reports that the program is currently being used in 50 nursing homes in 15 states and in Canada — although his goal is to eventually reach homes all across North America.
After screening a rough cut of the documentary for a group of senior hospital administrators and clinicians from the New York City Health and Hospitals Corporation (NYCHHC) in June, the organization made plans to pilot the program this fall, starting with a small group of residents from one of their long-term care facilities.
"Music and Memory is an example of how a brilliant, simple idea can have such a profound, positive impact on the lives of our elders and their families," Alan D. Aviles, president and CEO of NYCHHC, told Medscape Medical News.
"It is an emotionally powerful and inspiring phenomenon that we believe can touch long-term care residents and make extraordinary connections through music."
For a disorder that has no cure and few popular treatments, the Music and Memory program has sparked great enthusiasm, no doubt in large part because of the viral video.
But according to Cohen, it took a while to get to that point. The idea for the program came when he started wondering whether he would be able to take an mp3 player with his own music to a nursing home whenever his time came to enter a facility in the future.
"I found out there are 16,000 nursing homes in the US and at that time not 1 had an iPod program. So I called up my local 600-bed facility and said, 'I know music is already your number 1 recreational activity through live music and group music, but can we see if there's any added value in providing totally personalized music?' They said, 'Sure,' and it was an instant hit with the residents," recalled Cohen.
People don't really believe you when you talk about something extraordinary. It gets lost in translation. But the clip went viral, and the public really related to it.
When he began looking for funding to offer Music and Memory on a larger scale, he ran into difficulties in properly communicating the impact he had seen from the program. After meeting with a filmmaker, the clip of Henry was created.
"That did the trick. People don't really believe you when you talk about something extraordinary. It gets lost in translation. But the clip went viral, and the public really related to it," said Cohen.
He noted that the clip has had the most views of any dementia-related video ever posted on YouTube, and led to the making of the documentary. The hope is that the full film will be released next spring.
Oliver Sacks Weighs In
The philosopher Kant once called music 'the quickening art.' And Henry is being quickened. He's being brought to life.
"The philosopher [Immanuel] Kant once called music 'the quickening art.' And Henry is being quickened. He's being brought to life," said Oliver Sacks, MD, professor of neurology and psychiatry at Columbia University Medical Center in New York City, in the video clip.
"The effect of this doesn't stop when the headphones are taken off. In some sense, Henry is restored to himself. He has remembered who he is and he has reacquired his identity for a while through the power of music," added Dr. Sacks.
Cohen reported that 4 years after Henry first received his iPod, he still reacts the same way to the music.
"You can see the value of this program as being not just a casual activity but almost a necessity for daily care because of the promise and the potential it has for enhancing quality of life," said Concetta M. Tomaino, DA, MT-BC, LCAT, executive director of the Institute for Music and Neurologic Function in New York City, in a video posted on Music and Memory's Web site.
"One of the things I would say to agencies that think this has no real value other than that it's music and makes people feel good is that, based on research and our 30 years of experience, we know the impact that personalized music can make," said Dr. Tomaino.
She added that because it is so easy to record customized playlists and to set up these programs, "it should be available to everybody. This isn't something that should just be dismissed."
In April of this year, Medscape Medical News reported findings from a small study presented at the American Medical Student Association Annual Convention that showed that patients with AD who were given violin lessons demonstrated improvements in both mood and neuropsychiatric function.
For this and other music therapy programs, Beth Kallmyer, vice president of constituent services at the Alzheimer's Association, said that the most important aspect is that participants are being engaged.
"When you're doing music therapy in a residential facility or a nursing home, it's a social activity. And keeping them engaged and active during whatever activity you're doing remains important throughout all the stages of the disease," Kallmyer told Medscape Medical News.
As cognitive skills decline, there's something about the way the brain works and connects to music, especially when it's something they listened to when they were younger because those memories are really entrenched in the brain.
"As cognitive skills decline, there's something about the way the brain works and connects to music, especially when it's something they listened to when they were younger because those memories are really entrenched in the brain," she added.
Kallmyer noted that customized care should not include just medications directed toward a patient's specific situation. It could also include a patient's specific likes when it comes to music.
"This really supports person-centered care, which is really about asking the person (or the person's family): What's important? What do you like to listen to? Or like to do?"
Mechanism of Action
Angela Scicutella, MD, PhD, neuropsychiatrist and associate professor of psychiatry and behavioral sciences at North Shore–Long Island Jewish Health System of Hofstra University School of Medicine in Hempstead, New York, said that patients with dementia have problems with attention and with motivation.
"I think that novelty is very important for the Alzheimer's patient. When things are passive and they're not interactive in the environment, it's not a good thing for them. And the anterior cingulate part of the frontal lobe has a lot to do with motivation," Dr. Scicutella told Medscape Medical News.
"The inner drive that we all have to do specific tasks is lacking in these patients. I believe having the novelty of music, something different in the environment, triggers that to make them pay attention."
Dr. Scicutella noted that she attended the World Science Festival in New York City this year and was pleased to hear a presentation that included Dr. Sacks on the panel and clips from the Music and Memory program.
"I don't think you have to have memory per se, and I don't think that's what's going on in this kind of program. But maybe the music can trigger an old memory, something they can still pull up. We know that in Alzheimer's dementia, old memories stick around for a much longer time," she said.
Although Music and Memory concentrates on providing personalized music to trigger these memories, Dr. Scicutella said that any type of music may be fine to engage patients, especially during the later stages of the disease.
"I think just the concept of music itself, the rhythm, is important in the latter stages. It's not so important to know the lyrics of the song; I think they're responding to other aspects of music," she explained.
"I don't know that Henry [in the video clip] can directly relate when the first time he heard a song was but certainly there's something there that is triggering a good emotional memory for him. It's pleasant for him, and it's certainly grabbing his attention."
In Dr. Sacks' book Musicophilia: Tales of Music and the Brain, he writes that although music has the power to affect almost everyone, it may be an especially useful treatment for patients with neurological conditions, including stroke, AD, autism, and parkinsonism.
"We suggest that if playing music is important to a person or might calm them down, then people in a home should do that. Music therapy is something that can give people an improved quality of life regardless of where they are," said Kallmyer.
A study from Finnish researchers published last year in the British Journal of Psychiatry also showed that music therapy as an adjunct to antidepressant treatment could improve symptoms of depression.
I think that music, depending upon the type, should be used for patients with agitation. And I tell my family members: it's not all about medication. I think we should always try alternative methodologies.
"I think that music, depending upon the type, should be used for patients with agitation. And I tell my family members: it's not all about medication. I think we should always try alternative methodologies. So I encourage the use of music and think it can be a benefit," said Dr. Scicutella.
However, Kallmyer noted that, at least for some patients with dementia, being read to or being exposed to art or some other activity might be as effective or even more effective than music.
In fact, a recent TV report about the Music and Memory program in a nursing home in Lancaster County, Pennsylvania, showed that 1 participant's personalized playlist included episodes of old-time radio shows.
"With this, I'm a youngster again," the woman said, smiling.
"The important thing is to ask patients about themselves. Use those things that are specific to a person's life as a jumping off point," said Kallmyer.
"Beautiful New Technology"
Overall, Dr. Scicutella said that it is important to "be creative and think out of the box" when it comes to treating and engaging patients with dementia, and to tap into the family's knowledge of all aspects of the patient's life.
"What Dan Cohen is trying to do and his goal of getting iPods to nursing home patients is very noble. And I think it's certainly worth a shot," she said.
"When you think about all the nursing homes and agencies throughout the country and throughout the world that serve people with dementia — our agency alone serves 6000 people a day — the magnitude and the potential of this program to help so many millions of people is enormous," added Dr. Tomaino.
Dr. Sacks echoed these thoughts in the viral video clip.
"With this beautiful new technology, you can have all the music which is significant for you in something as big as a matchbox or whatever. And I think this may be very, very important in helping to animate, organize, and bring a sense of identity back to people who are out of it otherwise," he said.
Music will bring them back...into their own memories or their own autobiographies.
"Music will bring them back into it, into their own memories or their own autobiographies."
Cohen added that many people believe that those with AD and with advanced dementia do not have the ability to experience pleasure.
"As a result, these patients are left to do really nothing for the rest of their lives. But we have something that can be used at home or in a nursing home with no adverse effects. So this is a bit of good news for them," he said.
Information about donating iPods and other mp3 players to the program is available on Music and Memory's Web site.
Medscape Medical News © 2012 WebMD, LLC
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Cite this: Music Therapy Brings Dementia Patients 'Back to Life' - Medscape - Aug 23, 2012.