Through Music, Memories Return

Bret S. Stetka, MD


February 22, 2016

Editor's Note:
In 2014, a documentary called Alive Inside premiered at the Sundance Film Festival and picked up the audience award for best documentary. The film explores the idea that music can help reawaken memories and emotions in dementia patients and features the work of social worker Dan Cohen, MSW, whose nonprofit organization Music & Memory has improved the quality of life of thousands of patients through a very simple approach: giving them an iPod. Medscape recently spoke with Cohen about his rapidly growing initiative and about the therapeutic potential of personalized music in patients suffering from dementia.

Medscape: What is the mission of Music & Memory?

Mr Cohen: Music & Memory, Inc. is a nonprofit organization that promotes the use of personalized music to improve the quality of life of elders or anyone who has a cognitive or physical issue.

Medscape: What inspired you to start this nonprofit?

Mr Cohen: I'm a social worker but also have a long career with technology companies. In 2006 on the radio, I heard a journalist talk about how iPods were ubiquitous, and I thought, well, most young people have them, and many older adults do too. However, in a nursing home, it just didn't seem likely that people had these devices that the rest of us had. I Googled "iPods in nursing homes," and among 16,000 nursing homes, I could not find one that was using them. I called up a local facility and asked if we could try something. I knew the residents already had music, but I wanted to see if there was any added value to totally personalizing the music. They said yes, and it was an instant and definitive hit.

Medscape: How can music help patients with dementia and other cognitive problems?

Mr Cohen: Music has multiple benefits. People with dementia who have lost their short-term memory often retain their long-term memory, especially for music. If you play music from someone's youth that holds personal meaning, it will help them stay connected with themselves and be more alive, alert, communicative, social, attentive, and more engaged. There is abundant research focus on music's ability to reduce blood pressure, improve mood, enhance sleep, as well as reduce agitation and anxiety. Research has also shown that it reduces behavioral and psychological symptoms of dementia. Then there is research around how music helps reduce pain, as described by an article from the Journal of Advanced Nursing in the 1990s.[1] Music also helps to facilitate occupational therapy, physical therapy, and speech therapy.[2]

Music, speech, and movement are all interconnected in the brain. People fail rehabilitation because they're not getting up and walking. I remember this one gentleman who was not walking; he was given James Brown, and within a week he was walking 100 yards. There is no guarantee that music will generate hoped-for outcomes. Everyone is different. But the music that moves you now will probably move you the same regardless of cognitive impairment later in life. If you are unable to communicate what music you love, and no one else knows, you might end up listening to music you don't like. That's why people are beginning to integrate their list of favorites into their advance directives.

Medscape: How difficult was it to get nursing homes to embrace the program?

Mr Cohen: It's been a challenge. Change in any organization does not come easily or quickly. But we've now been successful in nearly every type of healthcare organization, whether it be a nursing home, assisted living facility, hospice, hospital, adult day care program, or homecare program. It self-perpetuates through word of mouth. We have no marketing budget, yet we are currently in more than 2400 of these facilities, in every state in the United States, most Canadian provinces, and another six countries globally.

In Toronto, they are currently giving out 10,000 iPods to 10,000 families. Anyone who is diagnosed with Alzheimer disease and who is a resident of Toronto gets a free iPod shuffle, $100 in music, and support. They've done research around it. Using scales such as the Cornell Scale for Depression in Dementia and the Caregiver Distress Scale, they have found statistically significant reductions in depression and caregiver stress.

Medscape: How has the program been received by doctors and other clinicians?

Mr Cohen: It varies, but overall the reception has been great. We have researchers, including Dr Peter Davies, the developer of Aricept® (donepezil), who has a cameo in the documentary Alive Inside. Also Dr Joshua Grill, associate director of the University of California at Irvine's Alzheimer's Disease Research Center, believes that researchers should not only be focused totally on the cure but also should really lend their voice and their support to modalities that improve care such as ours. He runs an iPod donation drive to support nursing homes that are running Music & Memory programs.

Dr Frederick Schaerf, who runs the Neuropsychiatric Institute of Southwest Florida, informs those who come to his facility who have some form of dementia that one thing they can do is get that playlist together, and that will help improve their quality of life; it will help their cognition going forward.

The Evidence

Medscape: Alive Inside portrays pretty striking results with music interventions in dementia, but are there supporting data out there too? Have people run studies?

Mr Cohen: Currently five Music & Memory-related studies are underway at four University of Wisconsin campuses. If you go to the New York State Department of Health website to the Electronic Dementia Guide for Excellence (EDGE), they recommend that all 650 nursing homes in New York State use individualized music to reduce agitation.[3] It's been up for 10 years, and basically nobody has paid any attention to it. There is no money behind it and no requirement to do it. But the recommendation is based on the evidence-based research from Linda Gerdner, RN, PhD, who in the 1990s did what is considered excellent research.[4] The foundational research is there. Also we have research studies going on in California, Texas, Ohio, and in different European countries. We're developing a Music & Memory, Inc. international research network because there are just so many requests to do research, and there is a need to really learn all we can about this.

Doctors often prescribe antipsychotics to dementia patients with agitation. We now know that you can often replace the antipsychotic medications with music, if you can figure out which music holds personal meaning for someone.

The federal government is encouraging doctors who are working with elders with neurocognitive dysfunction who don't have a psychiatric diagnosis—including those with Tourette syndrome and Huntington disease—to avoid prescribing an antipsychotic drug, which significantly increases mortality rates. Not only that, these drugs can really diminish whatever cognition, function, and personality they have left. We want to get them off of these drugs. And once we get them off of these drugs, we don't want them just sitting around doing nothing all day either. So, we use music as an accelerant to relationships.

When music is playing, people are more likely to be reminiscing. People avoid visiting someone with Alzheimer disease even if they are at home. Family and friends stop visiting. If that person goes from their home to an assisted living facility or nursing home, it is no fault of the facility itself, but people think that somebody else is taking care of them, and they don't need to visit. That's a recipe for decline.

Unfortunately, time-and-motion studies indicate that 90% of a resident's time is spent idle. Combine this with the fact that half of the people in nursing homes never—ever—get a visitor, and that makes for a bad combination even if your physical status is stable. It's a recipe for decline. Why live when nobody is visiting, and you have no meaningful relationships with anyone around you? We want to transform long-term care. How many of your readers are looking forward to going to long-term care? It's unlikely any would. Why is that? There are countries where people do look forward to it. What do we need to do? We need to make places that people enjoy being in where they will still have relationships and have a life. Music is one way to do this.

Working With Clinicians

Medscape: Practically speaking, how do you develop playlists for individuals?

Mr Cohen: If we can, we work with individuals to compile their personalized playlist. But if they're unable to recall what music they enjoyed or meant something to them, then we'll work with the family. We'll ask, "Did they play an instrument when they were young?" "Did they sing in a choir or a chorus?" "Did they like Broadway musicals or religious music?" We'll ask if they have any old LPs sitting in a closet somewhere and what their wedding or high school prom song was. All of these kinds of questions help us figure this out.

Aged care homes typically assume older patients want to listen to a popular music genre from their youth, such as big band. But unless that music holds personal meaning, perhaps associated to their senior prom, wedding song, or hanging with friends, it will probably just register as background noise.

That's why we say that everybody should have their elders create a playlist. We should have all of our playlists in place. Neuroscientists say that this stuff works. We should help others in the family get their playlist together so that when they enter the healthcare system at any point—they go to the hospital, they go to hospice, wherever they go—their music goes with them and will help transform their experience.

Medscape: You've had support from some big name musicians, right?

Mr Cohen: Yes. Kenny Chesney did a public service announcement. Paul McCartney has donated some of the music he owns, including blues, classical, and jazz music. Brian Wilson from the Beach Boys has also been helpful.

Medscape: What's next for Music & Memory?

Mr Cohen: There is a lot of research underway or that is about to be launched. We want to make this a standard of care. There are 60,000 healthcare entities in the United States. You have 46,000 long-term care facilities, 3700 hospices that handle a million people a year, 5000 hospitals, 10,000 adult day care programs, and many homecare programs. And beyond the United States, this is definitely becoming a global entity, one that we hope will keep expanding.

I think it's really incumbent upon the medical profession and everybody who serves elders to leverage what we now know works. And in many cases, music can have significant benefits, especially if we can figure out what music holds personal meaning for someone. If we figure this out, patients can have much greater chances of success.


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