Alzheimer’s Disease: The Role of Music Therapy in Symptom Palliation

Alzheimer's disease (AD) is the most common cause of dementia, and an important secondary cause of death in many industrialized nations. In the United States, it is estimated that 2.4 million to 4.5 million people currently have AD (Alzheimer's Disease: Unraveling the Mystery). Although AD is still incurable, within the past decade, researchers have focused on music therapy as a beneficial palliative treatment for geriatric patients who have AD, as well as a variety of other neurologic disorders.

AD appears to be caused by an accumulation of neuronotoxic proteins in the cerebrum, the part of the brain involved in speech, memory and hearing. In postmortem brain cutting, AD patients usually have severe atrophy that results from extensive neuronal damage. Pathophysiologically, the abnormal neurofibrillary tangles seen in AD impair neuronal transmission, and after years of neuronal loss and synaptic degeneration, patients demonstrate profound cognitive and behavioral impairment. While the FDA has not approved disease-modifying therapies for AD, the standard treatment includes symptomatic therapy.

Although many patients with advanced AD are unable to communicate with language, music therapy has shown promise as a way for patients to express themselves, and such sensory stimulation might even slow the decline of physical, psychological, and cognitive processes. Jiska Cohen-Mansfied, a psychologist of the Research Institute of the Hebrew Home of Greater Washington, has studied the manifestations of AD and reported her results in Science (1031).  She observed that the violent behaviors of patients with AD occurred when their room was dark and they were alone. The results of her investigation found that one-third of her patients decreased their violent behavior in response to music, a greater response than with psychotropic drugs, restraint, or passive neglect. Cohen-Mansfied believes that music is an effective therapy because it reduces the social isolation experienced by demented patients. While not offering a cure for AD, music therapy can clearly decrease the agitation some patients manifest. In the past, such behaviors were thought to be the result of psychosis (Barinaga 1031), but are now considered to stem from the social isolation caused by the dementia, something that music therapy is designed to target.

Many physicians and caregivers observe that even without speech, musical abilities appear to be relatively unaffected by the cognitive processing difficulties associated with AD. Dr. Oliver Sacks, a neurobiologist and author, described the influence of music therapy with another neurologic disorder in Musicophilia (2007):

Cuban composer Leo Brouwer stated that music is like telling stories (Degmečić 288), and Carl Leichter, the Esonian semiotic, claimed that music and musical expression originates in inner psychic tensions, which search for relaxation through music.

The association of pieces of music with certain memories, and the ability for music to stimulate the recollection of these past events, might be an additional benefit of music therapy. New York University psychiatrist Barry Reisberg explained that wealthy women with late-stage AD, whose caregivers paid for professional attention and care for them, continue to go to social events and seem to enjoy life (Barinaga 1032). This is contrasted with other women that are bed-bound and withdrawn because they did not maintain their previous social life.  

To be effective, music therapy must be tailored to the functional capacity of each individual patient.  Derek Prinsley, director of the National Ageing Research Institute (1976-1986) in Melbourne, Australia, has advised that music therapy should be based on treatment objectives including social interaction, mood improvement, speech stimulation, mental process organization, sensory stimulation and motor integration ("Music and Alzheimer's disease-assessment and therapy: discussion paper" 95). With these goals, a music therapist must develop a specific treatment plan.  This might include composing music with patients, leading a group music session, or assembling a playlist of songs.

Music might even have a role in the evaluation of patients for cognitive impairment, since it can discriminate between minor language deficits in a way that more standard verbal examinations (such as the Mini-Mental State Examination) cannot. ("Music and Alzheimer's disease-assessment and therapy: discussion paper" 93). This might be because most language processing is dominant in one hemisphere of the brain, while playing and listening to music involves the interaction of more areas in both cerebral hemispheres ("Music and Alzheimer's disease-assessment and therapy: discussion paper" 93).

Although effective treatment has lagged behind our understanding of the pathophysiology of AD, music therapy has been shown to improve the quality of life for many patients. Furthermore, music may also assume a role alongside verbal examinations in testing for subtle language disorders. 

Aldridge, David. "Music and Alzheimer's disease-assessment and therapy: discussion paper." Journal of the Royal Society of Medicine 86 (1993): 93-95.

Aldridge, David. "The Music of the Body: Music Therapy in Medical Settings." The Journal of Mind-Body Health. 9.1 (1993): 17-35.

Barinaga, Marcia. "Alzheimer's Treatments that Work Now." Science. 282.5391 (1998): 1030-1032.

Degmečić, Dunja, Ivan Požgain, and Pavo Filaković. "Music as Therapy / Glazba kao terapija." International Review of the Aesthetics and Sociology of Music. 36.2 (2005): 287-300.

Plassman, B.L., et al. "Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study." Neuroepidemiology. 29 (2007): 125-132.

U.S. Department of Health and Human Services. Alzheimer's Disease: Unraveling the Mystery. Bethesda: NIH Publication, 2008.  

Sacks, Oliver. Interview. All Things Considered. NPR. 21 Nov. 2007.