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Comment: Music, a powerful medium that can move the memory of people with dementia

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SINGAPORE: In the movie The Father, Oscar winner Anthony Hopkins plays a man who slowly loses control of reality as he grows in memory.

In history, music plays an important role in its rapidly deteriorating condition. In one scene, he comes to life by singing and tap dancing.

While Sir Hopkins is a role-playing actor, I see patients as the character he played. Amil * is a loving and cheerful patient of mine, but during her depressed times she cried for her daughter.

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But one thing would cheer her up: When she attends music therapy sessions at Dover Park Hospice, familiar songs like Burung Kakak Tua make her smile.

For Amil, such songs take her back to her youth where she remembers participating in dance competitions. As the song plays, her body and hands move in time with the music.

It’s almost like a reflex muscle memory response triggered by music. As his condition deteriorated, Amil began to speak less. But the moment a familiar song came along, it would light up and sing along.

MUSIC HELPS MOOD AND MEMORY

Music is a natural, non-pharmaceutical approach for people with dementia. As cognitive and verbal skills decline with the progression of dementia, people with dementia may not be able to communicate their needs effectively.

Due to the difficulty in expressing their unmet needs, patients may become agitated and make repeated requests. To deal with it, drugs are sometimes given in nursing homes for the elderly, but there are possible side effects.

Psychotropic drugs such as administered antipsychotics can often cause drowsiness and affect quality of life.

Researchers have found that melody, even lyrics, can stay in our memory for a long time because the part of our brain that stores musical memory is preserved. (Photo: iStock / Cécilie_Arcurs)

But increasingly, studies show that non-pharmaceutical approaches such as music therapy, art therapy can benefit patients with dementia.

The results of a 2013 study by Scandinavian researchers showed that the six-week intervention in music therapy reduced disturbances in agitation and prevented the increase in medication in people with dementia.

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In another study of patients with severe dementia in Japan, music was found to reduce stress in patients and improve quality of life. The interventions used were based on individualized music, selected to elicit pleasant memories and evoke positive emotions.

In our profession, we see that music can bring comfort to patients.

Researchers have found that melody, even lyrics, can stay in our memory for a long time because the part of our brain that stores musical memory is preserved despite illnesses like Alzheimer’s disease. In other words, our long-term “autobiographical” memory is less affected by such neurological diseases.

Autobiographical memory includes self-referential memories such as the location of the house and episodic memories of events such as a wedding day.

This is also why we remember our favorite songs and can sing them by heart, no matter how old we are.

It also works in dementia patients – songs from their early years remind them of their loved ones.

In our patients, it triggers memory. Although they may forget where they are or not recognize the people in their life, they can remember the lyrics of a song they know. And in doing so, it gives them meaning and the assurance that they are safe.

THERAPEUTIC BENEFITS

Singing and playing percussion is an experience that people with dementia can easily share with others. It is not physically demanding. It also taps into individuals’ resources such as their long-term memory.

A caregiver touching the hand of an old man who is holding a stress ball

Researchers followed participants in nursing homes and specialty memory clinics for 20 years to see who developed dementia and whether fitness affected their risk of contracting the disease. (Photo: Pexels / Matthias Zomer)

More importantly, it is the act of doing something that fosters a sense of belonging.

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I remember a patient who barely spoke, and due to COVID-19, her family based abroad was unable to visit her.

During a video call with his family, his young grandchildren chose the song Twinkle Twinkle Little Star to sing for him.

While playing the guitar for them, I saw this patient light up in response to their voices. Soon she began to sing and raised her hands, opening and closing her palms like a star.

For people with dementia, music is a powerful motivator that also encourages movement.

Music can be a way for them to channel and expend their energy in a natural way, giving them the opportunity to be creative and to be themselves. Music can also maintain muscle memory to some extent.

I remember cases of patients retaining the ability to play instruments, or even doing “aerial guitar” to the sound of the guitar.

This is because there is an automatic synchronization of neural activity, physical movement, as well as heart and respiratory rates with the rhythmic signals of music.

Most of the time, music is a great mood lift. In music therapy, we encourage patients to choose the type of music they would like to hear.

A common principle is to respond to the mood of the person at the time. For example, while slow, soothing music is usually chosen for relaxation, there has been one case in music therapy where a patient has chosen loud, fast piano music instead. This music for him was cathartic.

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He spoke of feeling relaxed and happy after listening to him. Likewise, a song that sounds happy may or may not be suitable for someone who is feeling down. This is why making a personalized playlist can be useful in the management of patients with dementia. We all have personal tastes in music.

SELF-REGULATION AND PAIN RELIEF

We have also found that music is an effective distraction from physical or subjective ailments.

I remember a patient who used music to regulate her discomfort. She would ring the bell to get my attention, choose the music wisely and explain her choices. Sometimes she wanted me to play quick songs to combat the drowsiness caused by the drugs.

At other times, she would ask for slow instrumentals that helped her relax.

Music can therefore be helpful for psychosomatic pain. It is also an illustration of total pain in palliative care, a concept where pain is not only due to physical reasons, but also psychological, emotional and spiritual distress.

We all have musical stories. Music reminds us of important memories and our identity such as religious faith or nationality. People with dementia are mothers, fathers, sisters; a person with a story. Sometimes you can forget about it and focus on their illness.

Dementia causes profound losses, and the path can be difficult for both patients and their families. But in taking care of our loved ones, it is important to see the personality that is always present.

Music is a way to unlock memories, helping people with dementia remember who they are. We also remember who they are and who we are to each other. And that’s what matters most in the end.

* Pseudonyms have been used in this comment.

Camellia Soon is a music therapist at Dover Park Hospice.