The magic of melody in dementia care

Written on the 4 July 2022 by Dr Kailas Roberts

One of the most remarkable things I have ever seen happened in a nursing home in Western Brisbane. I had been asked to see an elderly gentleman - let's call him Hans - with advanced dementia. He was a lovely fellow but could become irascible when staff approached as he did not understand who they were. In fact, he did not even know where he was or why he was there. He was frail, stooped and moved slowly. Staff needed to help him eat his food as he could not manipulate his knife and fork to bring food to his mouth.  

I spoke to Hans in his room. He sat on his bed looking bewildered and lost. It was a rather one-sided conversation. English was his second language (and my only one) and his dementia had further eroded his ability to communicate with me. I did notice, however, that he had a lot of records in his room, and up on a shelf there was a black and white photo of a young man sitting at a grand piano in a concert hall. I realised it was him and experienced a touch of sadness at the contrast - no one, whatever talents life may have bestowed on them, is immune from the ravages of Alzheimer's disease.

To engage him more, I took him over to the old piano that sat unoccupied in the common room. He sat down and the change was instant: he sat upright and placed his fingers lightly on the keys before launching into a complicated piece by Debussy. He played it almost perfectly, the hands that before had struggled to hold cutlery now caressing the keys in expert synchrony. As he finished, he received an enthusiastic round of applause, not just from me but from many other residents with dementia that previously had appeared inert and disengaged. He smiled and bowed.

Music is the most wonderful of stimulants and similar scenes to mine can be found online: Ballet dancers that come alive when they hear Swan Lake; others that have lost the power to speak bursting into song as they hear familiar music. Many of you may have seen the final public concert of legendary singer Tony Bennett who comes alive doing what he loves despite having dementia.

It seems that musical memories are stored in parts of the brain that are not typically affected in common forms of dementia. They are less reliant on the hippocampus, a small structure that is hit early in Alzheimer's Disease, and perhaps shaped more by the perceptual parts of our brain - those which perceive and interpret signals - than by the parts that remember and store facts.

Music also often has an emotional quality, and we know that strong emotions cement memory - we are much more likely to remember something that stirs us in some way.

For those who are practised musicians, some of the ability to play is also stored in the deep parts of the brain - those responsible for unconscious movement. These are the same areas that allow some individuals with dementia to drive a car efficiently even though their memory is impaired. They are procedural or 'autopilot' memories.

There is also evidence that music can also settle distressed or agitated individuals with dementia. So-called music therapy can take many forms but has been shown in many studies to be helpful. Being part of a group - just listening to music or perhaps singing along, - has multiple benefits and can carry people away from the immediate difficulties they face. There are even apps such as Vera dedicated to providing personalised playlists for those with dementia. Clearly, music is a very powerful part of the human experience and recognising this can help us greatly enrich the lives of those with the condition.

*As published in Inside Ageing 28 Jun 22