Music Therapy Used to Stimulate the Brain in Alzheimer Patients
Wendy J Rodke
Wisconsin Indianhead Technical College
Music therapy is being used to stimulate the brain in Alzheimer patients. Studies are finding that music releases neurotransmitters from the brain that can calm and relax agitated patients. It awakens their long-term memories bringing some joy into a lonely world.
Alzheimer’s is a brain disease that slowly takes away the patient’s memory, leading them to eventually lose the ability to communicate with others. It is a neurodegenerative disease, which in the daily lives of the patients, can have a profound effect on their emotional and social function. There is no apparent cure for the disease, but certain medications can help slow down the process. It is feared nearly 5 million people are experiencing forgetfulness that could eventually lead to Alzheimer’s disease(AD). We have all forgotten a few things, like where we parked our car or left the car keys, as this is part of the normal aging process. Alzheimer patients slowly lose their memory, the ability to speak, their personality disappears, and it eventually destroys most bodily functions. There have been some recent studies on how music can reach deep into their souls, allowing patients to relive their past in a small way, bringing comfort to them.
My mother had AD for nearly ten years before passing away. It was one of the hardest and most heartbreaking parts of my life. Years earlier, the physician had told her that her cholesterol was high and placed her on medication. From that point, she was on a mission to never eat anything with fat in it. She only ate certain foods and watched every bit of fat intake daily. We asked the doctor if a genetic factor caused this. He said he could test for that, be he did not think so in her case. He said that the E4 variant of Apolipoprotein E (APOE) could be done but did not think that it was worth the expense as it would not change the outcome of her illness. He did state that while this could factor a larger risk for us, he thought her case was more related to her high cholesterol. The brain needs a layer of fat to protect it and function properly. He said this was called the myelin sheath, which is a fatty layer that is in the brain to protect the nerve cells. Myelin aids in accelerating the speed at which some impulse travels along a nerve by causing the impulse to jump from one node of Ranvier to the next. Damage to the myelin sheath, called demyelination, compromises the nerve’s ability to conduct impulses. CITATION Gre15 l 1033 (Grey, 2019) When she decided to cut her fat intake to nearly nothing, she forced her body to use the fat that was there, resulting in the start of dementia and eventually AD.
I remember the doctor trying to explain how the disconnection in the brain works, and the role played by plaques and tangles. Plaques are clusters of protein that build up between the nerve cells. Tangles are a protein called tau, sort of twisted protein fibers. Small clumps of plaque can block the signal from cell-to-cell. Beta-amyloid is thought to be one of the worst forms that can cause damage. It can set off the immune system and cells can become inflamed and then eat away at the disabled cells. This then can enable the tangles to form inside these cells that begin to die. If the tau is healthy, it keeps the transportation of signals going in the right direction, but if they are twisted it prohibits the transportation of nutrients and other essential supplies and eventually disintegrate the whole transport system. As we get older we tend to develop plaque and tangles, but people with Alzheimer’s tend to develop more of them, targeting the memory and learning areas first. CITATION Alz18 l 1033 (Association, 2018)Studies show that serotonin, dopamine, acetylcholine, and glutamate are necessary for the brain to function and in with AD there is an imbalance of these neurotransmitters that interrupts the signals that should transmit to the memory and learning areas of the brain. This is an interesting information:
We tested this hypothesis by examining protein and mRNA levels of these transporters in postmortem prefrontal cortex from 10 AD patients and 10 matched non-AD controls. Compared with controls, protein and mRNA levels of VGLUTs, EAAT1-3, VAChT, and SERT were reduced significantly in AD. Expression of DAT and catechol O-methyltransferase was unchanged. Reduced VGLUTs and EAATs may contribute to an alteration in glutamatergic recycling, and reduced SERT could exacerbate depressive symptoms in AD. The reduced VAChT expression could contribute to the recognized cholinergic deficit in AD. Altered neurotransmitter transporters could contribute to the pathophysiology of AD and are potential targets for therapy. CITATION Che11 l 1033 (Chen, 2011) As most information is transmitted to our brain through electrical pulses, you can see that if there is an interruption due to the build up of plaque and tangles or the alteration of certain neurotransmitters, the deterioration of the cells begins and thus the beginning of AD. Studies has shown that Acetylcholine and Glutamate when decreased or increased can play a part in the beginning of AD. To much Glutamate can cause cell death and it is involved in the learning, memory, and sensory processes of your brain, while a deficiency in Acetylcholine appears that it leads to the deterioration of the intellectual function of your brain. CITATION Hoc16 l 1033 (Hockenbury S, 2016)Emotional Healing thru Music Therapy
Studies have been to measure the effects that music has with Alzheimer patients, and the results show that it shows positive changes in their demeanor. With this disease, the short-term memory is the first to go, first just bothersome forgetfulness and then it progresses in to more than just wondering what you came into the room for or where your keys are. They forget to do their daily routine, forgetting meals, medications, how to get home from a walk and so on. Eventually they do not recognize friends and families, at first, they look familiar and upon reminders they can recall you if you have been in their lives for a long while, their long-term memory still is active but fades in and out. You will see them just sitting and staring off into nowhere, not aware of their surroundings.
There was a study done on male patients that had been diagnosed with AD. Men ages 68-90 participated in the study. They were experiencing difficulties with agitated behaviors, repetitive body movements and verbal outbursts. They were not taking medications like antidepressants or any other medications that would affect serotonergic, noradrenergic, adrenergic, or melatonin systems. In this study they included all types singing, instruments playing, singing along and drums. Patients were encouraged to sing and play along. All genres of music were played, and they could detect which person liked different types of music. This therapy was monitored off a baseline that was set up for each patient and then carried out music sessions 30-40 minutes daily. This study ran about 4 weeks and the levels were checked against their baseline. Many test results were recorded and documented some patients showed an increase in melatonin levels, and plasma levels including norepinephrine and epinephrine changed from the beginning statistics. There was no remarkable change in serotonin and prolactin. CITATION Nai86 l 1033 (Nair NPv, 1986)
Research shows that background music can help with social behavior in a positive way. I can reach down and stir their long-term memories to when they remember their old favorite tunes. There was great progress in music increasing good behavioral patterns in patients that are agitated and have negative behavior. CITATION Cas94 l 1033 (Casby.J. A, 1994) One activity we did with my mother was with music. She loved the old hymns we played on the CD player for her. When possible, as many of us girls as possible would gather around the piano with her and sing. She would look very nervous at first, wringing her hands and not quite knowing what to do. As we sang, soon she would start to hum along. Eventually, very softly she would start to sing the words. CITATION Vic12 l 1033 (Peterson, 2012). My father also plays the piano and would play for hours so other patients could enjoy the music. Music can be an effective tool in decreasing their agitation and help calm them. Another effective method of stimulating their senses was a stuffed puppy dog. Mom did not realize that it was not real, and would remember at times, that she needed to feed the dog and take it outside. The puppy also had a little music box in it and when you pressed the paw, it would play little pre-programmed tunes for my mom. She still would press the paw and her face would light up with joy, right up until a few weeks before she passed away. Having background music in their room and in other areas of the facility seemed quite welcoming to her and other dementia patients. Music therapy can be used to increase the wellness of patients by reaching their cognitive simulation and their social interaction. Group therapy can work with all stages of dementia, using familiar music and repeating the therapy several times a week. CITATION Cra l 1033 (Craig, 2014)This can decrease their agitation and calm them down. As Alzheimer patients have lost their ability to communicate verbally, they may still use some non-verbal communication while interacting with music. Sometimes just a smile, nodding their head or perhaps keeping the beat with their hand or fingers on the table. This taps into their long-termed memory and encourages them to remember the words of songs, increases their listening skills and even can get them to move a bit. CITATION Cra l 1033 (Craig, 2014) According to Cuddy and Duffin:
Some individuals with dementia remember music and old songs and sing and dance to them for longer than they remember and respond to other information these observations are surprising: the memory of music is a complex skill. According to Cuddy and Duffin, it requires the integration of various components, including pitch, rhythm, and timbre, dynamic, linguistic, visual kinesthetic, and emotional ones. The explanation of these observations by the way of the relationship between behavioral observations and neurological processes is multifaceted. However, according to Cuddy and Duffin ‘at early stages of auditory processing, hemispheric specialization may operate; the right auditory cortex, for example, is thought to be specialized for spectral (pitch) analyses, while the left auditory cortex is thought to be specialized for rapid temporal resolution.’ CITATION Cud05 l 1033 (Cuddy, 2010)It seemed that the only way to connect with mom was through music towards the end. About a year before she passed away, we took her to a SELAH concert. This was one of her favorite Christian groups she had listened to quite a bit and had been to their concerts before. Now keep in mind she did not know any of us by name, only that we were familiar to her. She seemed to be a little agitated and nervous when we first arrived there, but from the moment the concert started, she was fully entertained. She started to smile, was clapping along and even tried dancing. She had totally forgotten that she did not dance, she was like a child without a care in the world. She sang along with what words she could remember, and she was having the time of her life. We had not seen that kind of joy in her for a long time. It had reached down into her soul and managed to kick in her long-term memory and she was happy. Music brought so much joy to her that night. She had amazing volunteers while on hospice care and they were older ladies that had much love to give and they would show up every day and play her music. Some of the ladies would sing to her and she responded by smiling and humming along. When visiting mom most times you would find us gathered around the piano in the activity room to sing old hymns with her. She would sit and listen, would appear nervous and wring her hand, and then start to hum. This was amazing to us as she did not know us, never spoke a word except yes or no, and had gotten a little confused as to why we were there. We took a video of this just weeks before she passed away. I will send you the video via email. (Peterson, 2012)
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