Understanding the Continuum of Musical Experiences for People With Dementia

This chapter provides an overview of the music experiences of people living with dementia with a focus on their implementation by care providers. Music experiences exist on a continuum which spans recreational to therapeutic and passive to active participatory opportunities. For care providers, it is essential to become familiar with the various musical opportunities that can be implemented when providing holistic care, and to choose the most appropriate experiences for persons living with dementia. This chapter explores the potential benefits of these experiences, as well as the risks of using music in care. A list of implications for care providers are presented alongside a dialogue on musical considerations.

Musical Leisure Activities to Support Cognitive and Emotional Functioning in Aging and Dementia

The capacity of music to engage auditory, cognitive, motor, and emotional functions across cortical and subcortical brain regions and the relative preservation of music in the aging and degenerating brain makes music a promising tool both in supporting healthy neurocognitive aging and maintaining better emotional well-being, cognitive functioning, and communication and social interaction in different stages of dementia. As the incidence and prevalence of aging-related neurological illnesses is rapidly increasing, it is important to develop music-based interventions that make use of self- or caregiver-implemented musical leisure activities and that are enjoyable and effective in the everyday care of the persons with dementia. This chapter reviews recent experimental evidence on the emotional and cognitive effects of musical leisure activities in healthy older adults and in persons with dementia and their caregivers. The chapter also discusses which factors are crucial for the efficacy of music in different stages of dementia.

Therapeutic Music Interventions to Support People With Dementia Living at Home With Their Family Caregivers

Music can be used therapeutically in home and community settings throughout the trajectory of dementia. Communal singing experiences offer opportunities for music participation and social engagement that are accessible and enjoyable for people with dementia at any stage of severity. They also provide a means of communication and facilitate relationships between people with dementia and their carers through shared and meaningful musical interactions. In the early stages after a diagnosis of dementia, supported opportunities to sing together, along with the associated prospects for peer support and social interaction, may enable family carers to care for loved ones at home for as long as possible. In the later stages of dementia, singing may be the only way for the person with dementia to communicate and connect with others. Music processing capacities can be retained until the severe stage and music can stimulate memories and self-awareness for the person with dementia. Supported songwriting can be therapeutic for both people with dementia and their caregivers in facilitating emotional expression and acknowledging and validating feelings. This chapter explores the range of music participation opportunities available to people living with dementia at home with their caregivers at various stages of the disease. We also outline the differences in groups facilitated by music therapists and community musicians and highlight ways that caregivers can use music therapeutically in the home environment.

Approaches to Measuring the Impact of Music Therapy and Music Activities on People Living With Dementia

This chapter provides an introduction to the evaluation of music activities and music therapy for people with dementia. We outline some of the main challenges and considerations involved in choosing or using outcome measures. An overview of common outcome measures used in current research, including those for behavioral and psychological symptoms, quality of life, physiological changes, cognitive function, and music-related behaviors, is provided. Two music-therapy case studies are presented as real-life examples of how to select clinically relevant measures. Clinicians have long argued that some clinically meaningful changes may not always be measurable. We propose that when insights obtained from high-quality qualitative and mixed methods studies are added to the evidence base of quantitative research, it will lead to a deeper understanding of the benefits that music can have in the lives of people living with dementia.

Musical Playlists for Addressing Depression in People With Dementia

Depression is common in most forms of dementia. The relationship appears to be bi-directional, with depression being both a prodromal (or early) symptom and a risk factor for developing dementia. Depression and anxiety can also contribute to accelerated cognitive decline and reduced quality of life in people with dementia. This chapter will outline the relationship between depression and dementia and consider the use of personalized musical playlists to address depression in people with dementia. Although listening to music is a powerful means for improving mood among certain groups, people with depression and people with dementia appear to be vulnerable to music triggering negative thoughts or negative memories. Both the benefits and the risks to be considered in playlist selection will be discussed.

Melody, Memory, and Engagement in Alzheimer’s Disease

What are the personal and clinical implications of preserved memory for music in dementia? In light of this question, a framework is proposed for integrating basic and clinical research findings and for case formulation and theory building in music-based interventions. Elaborating on the Comprehensive Process Model of Engagement, a proposal is made for music engagement as an inclusive concept that encompasses the variety of ways in which individuals involve themselves with musical stimuli. It is argued that instances of music engagement arise through the combined influence of person, stimulus, and environment attributes. Preserved memory for melodies is discussed as an attribute of the person with particular relevance to music engagement. This approach orients naturally toward considering individual differences and, as such, lends itself well to case-based research and clinical case formulation.

Seven Capacities of Music That Underpin its Therapeutic Value in Dementia Care

Music is often employed as a therapeutic tool for individuals with dementia, facilitating memory recall, fluent speech and recovery of other cognitive and noncognitive abilities. There are several current discussions of the mechanisms that underlie these therapeutic effects, but no integrative model that can account for the benefits of music on multiple levels of analysis. Thompson and Schlaug (2015) proposed that seven capacities of music may be especially relevant to its therapeutic value for a range of neurological conditions; namely, that music is persuasive, engaging, emotional, personal, physical, and social, and that it encourages synchronization in rhythm and pitch. This chapter elaborates on this model by considering how each of these seven attributes of music has therapeutic benefits for people with dementia.

Music Interventions for Advanced Dementia

This chapter presents a review of the scientific literature published in English and Spanish concerning the use of music and music therapy with people in the advanced stages of all types of dementia. The aim of this review was to identify the needs of this client group, areas addressed in music therapy and music interventions, specific techniques which appear to be the most appropriate and effective, and other methodological issues that have arisen when working with this population. Based on the results of this literature review, a list of criteria and recommendations is provided to guide music therapists in the selection of appropriate music-therapy interventions and to assist caregivers to make informed choices on how to use appropriate music-based interventions with clients in the late stages of dementia.

Preserved Musical Instrument Playing in Dementia

The ability to play a musical instrument can remain in people with dementia, despite their cognitive impairment in other non-music domains. Case studies of people with Alzheimer’s Dementia (AD) or Behavioural variant Frontotemporal dementia (Bv-FTD) have reported preserved musical instrument playing even in the severe stage and, in some cases, the ability to learn a musical instrument after the onset of dementia. We propose that playing a musical instrument allows a unique form of access to two crucial domains, memory and the self. It enables the expression of preserved forms of memory, namely procedural, semantic, and episodic, including autobiographical memories. In doing so, it can provide access to one’s past and continuing self and can be considered a form of self-preservation and expression in musicians with dementia. Four new cases of preserved musical instrument playing in people with AD and Bv-FTD are described to illustrate our proposal.

Music Cognition in Frontotemporal Dementia and Non-Alzheimer’s Dementias

This chapter examines how music knowledge is affected in non-Alzheimer’s dementias, with a focus on frontotemporal dementia syndromes. It discusses the clinical and neurobiological rationale for studying music knowledge in non-Alzheimer’s dementia. It describes some of the ways in which music knowledge has been investigated in these patients, what musical abilities are lost or preserved in non-Alzheimer’s dementia, and how this information helps us improve our knowledge of how the brain processes music. The social role of music in evolution is briefly discussed. The chapter examines how emotions generated by and recognized in music are processed differently in frontotemporal dementia compared to healthy individuals and Alzheimer’s disease patients, including the phenomenon of musicophilia, the abnormally enhanced craving for music. Finally it explains how the differences in emotion processing between dementia diseases highlight the need for some selectivity in designing music-based therapies.