Therapeutic Role of Music in Dementia

Listening to music and appreciating it forms a complex process in our minds, involving memory, learning and emotions.

Any musical input would consist of a selected pattern of sound vibrations, with its intermittent disappearance (silence) and which have an overall impact on our mind — often described variously as ‘pleasant’, ‘powerful’, ‘beautiful’, `exhilarating’, ‘soothing’, ‘aggressive’, ‘relaxing’, ‘stimulating’ etc.

Several components in music viz., pitch, rhythm, melody and timbre contribute towards its overall impact. A listener may thus find a particular melody or rhythm as pleasant or unpleasant, familiar or strange; he may even remain indifferent to some sometimes. The response to a particular music or the lack of it is often attributed to the listener’s mental status or mood, his or her cultural/regional milieu or up-bringing, and the past association with similar tunes and beats. 

Recent research would indicate that music could be made to play an important role in the prevention and treatment of dementia. It has come to light that some causes of dementia could be safely addressed with appropriate musical intervention. At the same time, it is also found that dementia caused by irreversible changes in the brain would hardly respond to music!

In spite of its definitive role on dementia and vagueness about the mechanism of its therapeutic impact, recent decades have witnessed music therapy gaining grounds – more particularly as a dependable intervention with the problems associated with ageing.

Considerable volumes of research, besides intimate experiments with music by contributors around the world, seem to promise a more definitive role for music therapy in ageing related problems, particularly dementia. What is significant about music is its unique characteristic that facilitates and enables communication (including self-communication) in its listeners.

Let us take recent research on music, as conducted at Beth Abraham Hospital, which found that Parkinson’s patients regained some ability to organize and perform movements that were otherwise lost due to the disease.

It is, however, necessary that the type of music selected in such cases should be able to evoke (or stimulate) response in the listener-patient. This author has found that it is the powerful and proactive rhythms in music that makes the difference. At times, it is the loudness (amplitude), tonal quality or timbre, manipulated variations in the beats (nadai) — all these contribute towards entrapping the listener’s attention or arousing certain interest in the otherwise disinterested persons. With appropriate rhythms one would be able to not only move his or her limbs and neck, but also commence walking!

Yet another essential point refers to familiarity in music.

While prescribing music, normally therapists go for such a genre, which is familiar to the patient’s age, musical taste, regional and cultural background.

However, some researchers at National Centre for Research and Care of Alzheimer’s disease, Bersica have come to a different inference. They found that people suffering from dementia sometimes do acquire new and even unexpected tastes (of course, which too may fall out eventually all of a sudden). They were found to like the very musical forms which they used to hate when they were young and healthy. 

Dr Frisoni, an expert, explains the reasons for such sudden change of behaviour. According to him, it could be due to a change in one’s attitude toward novelty. No doubt, for those who are above 60, pop music is novel.

In a 1998 study by some neurologists at the University of California-Los Angeles, it was found that dementia could bring out to the fore the hidden artistic talents. It was observed that patients developed artistic talents, including music and drawing, which flourished while dementia worsened. This study confirms the need to go for art and music as therapeutic interventions for the dementia-affected.

It is the conclusion based on the personal observations by this author that in working with people affected by dementia, a caution has to be exercised as certain types of music could even aggravate the situation. As music can bring out both positive and negative memories, it is necessary that a therapist has to be careful in selecting and playing only such music which brings out positive results in the target patients. In a therapeutic session with music, it was found that a musical session, which involved live bag-pipe music, instead of calming down the patient resulted in increased agitation and outbursts. The reason was that it retrieved war-time memories, which were cruel and excruciating to the listener. In another instance, as told by Beth Abraham researcher Connie Tomaino, when a waltz was played to a woman, she broke out in sobs. It was later found that the woman had a traumatic past, being a part of a concentration camp where she happened to listen to such music! However, in many cases, it was found that hymns and classical music have made the patients relaxed and peaceful in many therapeutic sessions. 

The Brain Research 

The brain researchers in recent times opine that there could be multiple areas of the brain, which have relevance to one’s musical experience. According to them, music is processed by the right hemisphere of the brain, which is generally associated with emotional, intuitive and creative aspects of human beings. Some of them also believe that the left hemisphere, associated with analysis and reasoning, also has a role to play in one’s musical experience. Thanks to the availability of sophisticated neuroimaging techniques, the brain scientists seem to have a clearer picture now as to how the various areas in the brain process the sound stimuli. It is found that both the right and left hemispheres of the brain respond to music. 

Music: How It Affects our Mind 

It is difficult to say how music affects us. The peculiar way music affects our mind has however, been brought out in the following words of Benjamin Britten:

`It is cruel, you know, that music should be so beautiful. It has the beauty of loneliness and of pain: of strength and freedom; the beauty of disappointment and never-satisfied love; the cruel beauty of nature, and everlasting beauty of monotony.’ 

The impact of pure tones and complex sounds, pure tones or single sounds emanate as we touch the string of a single-stringed instrument like ek tara or simple musical instruments used in meditation such as Tibetan singing bowl, cymbals, conch-shells and the like. 

Over time, these tones as we listen virtually become ‘monotonous’, thus uninteresting to explore, as our minds always look for a measure of intricacy to excite human curiosity. The reason is that single sounds are in most cases not sufficient to convey meaning. However, when put together in a sequence — like for example, imagine a necklace studded with a series of pearls – each representing the tone,  they try to exhibit certain emotive content or bhaava. There is a tendency in us that automatically prefers some sort of coherence, that is, a principle that connects the various sounds in order to make them comprehensible. 

Linguists are now aware that a main feature of human language, as opposed to oral communication in apes, is the importance of the temporal patterning of sounds, which pertains to time or tense.

This temporal patterning is equally important in music — if the tones are not in some way tied together sequentially, or are not rhythmical, people are unlikely to show appreciation. The temporal patterning is related to what the musical literature refers to as melody.

Further, it is conceivable that music requires similarities to language, such as complexity and melody, in order to be valued, because only then does it utilize the brain resources involved in processing the spoken words.

A student of Western classical music would know how much of the brain has gone into the making of a musical piece there, be it a sonata, concerto, fugue or whatnot! The complexity which evolved in harmony is the clear indicator of the mind inventing music and regulating its emotional content, which otherwise would have gone wild! Sounds that are too complex, however, tend to be overwhelming.

A certain complexity of sounds has also been involved with the growth —rather, an explosion of reasoning in the 18th and 19th centuries, which culminated into a material explosion – never witnessed by the human kind before!

Preference to Consonance (or `Purity’) in Music.

Several authors have, in the past, suggested that a preference for purity, and possibly for consonance, is innate in all human beings. (Roederer, 1995; Schellenberg and Trehub, 1996; Zentner and Kagan, 1996).

One reason why these qualities are favoured may be because they enhance oral communication.

The high level of communication in birds such as cuckoos, mynahs, koels and other songbirds and certain cetaceans could be due to their capacity to produce pure sounds. In these birds and animals, the auditory signals are the prominent form of communication.

A pure tone presumably carries further, and although language typically includes a mixture of relatively pure (vowels) and dissonant (consonant) sounds, purity and consonance are expected to reduce ambiguity. The brain centers involved in the production and processing of sounds are probably predisposed to prefer qualities that are most suitable for them. 

Continuous and Discontinuous Music 

One possible explanation for the relaxing effect of music is its being continuous and rhythmical.

In a natural environment, danger tends to be accompanied by sudden, unexpected sounds.

A background of constant sound, particularly one that is pre-judged to be safe, relaxes the mind. This sound can even be not much musical in its content. 

It could be even somewhat loud and harsh. Its repetition – again and again- however denotes certain security to the individual. In Indian music, continuous drone, emanating from tanpura and shruti boxes, which accompany the performers, creates an immense sense of security in the minds of listeners. 

Such a continuous drone is intuitively understood to be non-dangerous. 

The exception to this general rule could be those genres of music such as battlefield music: from war drums, bheris, bugles, brass etc. emanating powerful and erratic (at times arrhythmic) sounds, culturally associated with aggression and violence.

Discontinuous sounds, for example the dripping of a leaky tap on the other hand, demand more attention. Even if these sounds are soft, they can cause tremendous disturbance and affect one’s sleep by continuous nagging, 

Continuity of sounds 

The general appreciation of continuity of sounds could be a possible reason why we appreciate consonance. Concord creates continuity because the notes typically have overtones or harmonics that match the next notes in an audible way. 

By tying the notes together, consonance promotes a relaxing and consequently pleasing effect. 

Role of Rhythm 

We appreciate rhythm as it is a comforting feature, helping us in mentally organizing the sound we hear. 

The comfort can be related to the absence of danger associated with certain continuity or stability in rhythmic sounds. Yet another reason is that rhythms in music resemble one’s body rhythms: breathing cycle, heart-beat, baro-receptor cycle, blood flow, nervous pulsation etc. Thus, there is a close association between the body physiology and the external sound vibrations. 

Researchers DeCasper and Sigafoos (1983) believe that rhythms in music are intuitively equated to the recall of the pulse of the mother’s heart imprinted prenatally, in all of us.

Newborns are found to appreciate sound in the form of voices, vocal music or heartbeats, since they are able to quickly recollect those high frequencies of sounds which they received through the amniotic fluids nourishing them in their prenatal stages. (Butterfield and Siperstein, 1972).

Impact of Changes in the Expected Pattern of Sounds

 We know that the creation of expectancy implies a certain familiarity.

The changes in the expected pattern of sounds may be attractive because they stimulate our curiosity. 

In all musical compositions, we find that composers typically make striking themes and then repeat different variations several times in the composition to make the listener gain familiarity with the tune. It is an alternative arrangement, a familiar theme arising after every unfamiliar theme that keeps a balancing effect. This feeds the curiosity of the listeners as there is a tendency to investigate the unfamiliar terrains until they become familiar!

Good music has to, therefore, invariably offer a series of interesting surprises set against a firm back-ground of expectation. Take for example the structure of a kirtana, which is often composed of three parts: pallavi, anupallavi and charanam. By frequent repetition, pallavi provides a familiar base in the minds of the listeners, to be followed by the rest, which feeds their curiosity. 

Bibliography 

Bagchi, Kalyan. (Ed) 2007. Music Therapy: An Alternative Medicine, Mind and Mental Health New Delhi: Society for Gerontological Research 

Crandall, Joanne.1986. Self-Transformation through Music. First Indian edition: 2001, New Delhi: New Age books

Gaynor, Mitchell. L. 2002 The Healing Power of Sound: Recovery from Life-threatening Illness using Sound, Voice and Music. Boston & London: Shambhala

 Roederer, Jaun G 1995 The Physics and Psychophysics of Music. New York: Springer-Verlag

 Sairam, T.V. 2004 What is Music? Chennai: Nada Centre for Music 

Therapy Sairam, T.V. 2007 Self-Music Therapy: Musings on Music Therapy Chennai: Nada Centre for Music Therapy

Sairam, T V. ‘Music Therapy for Senile Dementia’ ayurveda-foryou.com/ music/m4demensia.html 

Schellenberg, E.G., & Trainor, L.J. (1996). ‘Sensory consonance and the perceptual similarity of com-plex-tone harmonic intervals: Tests of adult and infant listeners.’ Journal of the Acoustical Society of America, 100, 3321-3328

Shaw, Gina. 2006 ‘Sound Medicine’. Neurology Now. 2(5):26-29, September/October 2006. Zentner, M.R and J. Kagan, 1996 ‘Perception of music by infants’, Nature 383: 29. 

This article was published in ‘AYURVEDA AND ALL’  April 2008, Pages 31 to 34

Edited by Geeta Shreedar, July 19, 2021