Music and the Brain
Music & Memory started with the understanding that music is deeply rooted in our conscious and unconscious brains. As powerful as that idea is, it becomes even more important if the functioning of the brain is deteriorating, as occurs in dementia and other types of cognitive and physical loss. But music can awaken the brain and with it, the rich trove of memories that are associated with familiar songs or beloved pieces.
Oliver Sacks on Music, Memory and Emotion
Oliver Sacks, M.D., noted neurologist and best-selling author of Musicophilia, discusses the impact of personalized music on people suffering from Alzheimer’s and severe memory loss.
Dr. Sacks died on August 30, 2015. He was a wonderful friend to Music & Memory who made important contributions to the conversation around Alzheimer’s and other forms of dementia through a lifetime of work and research. Rest in peace.
"The past which is not recoverable in any other way is embedded, as if in amber, in the music, and people can regain a sense of identity. . . " — Oliver Sacks
Featured Research
The Impact of Music & Memory on Resident Level Outcomes in California Nursing Homes
In 2020, researchers from the Betty Irene Moore School of Nursing at UC Davis completed the most comprehensive study of its kind on the effects of the Music & Memory program, which found that personalized music is associated with a reduction in the amount of antipsychotic medication taken by nursing home residents and fewer distressed behaviors. The three-year study of 4,107 residents in 265 California nursing homes found the use of antipsychotic drugs declined by 13% and anti-anxiety medications declined by 17% each quarter for residents with dementia using the music program. The odds of depressive symptoms decreased 16% per quarter and the odds of reported pain decreased 17% per quarter. In addition, the number of days on medications declined by 30% and aggressive behaviors reduced by 20%. The results are published in the Journal for Post-acute and Long-term Care Medicine (JAMDA).
Music Activates Regions of the Brain Spared by Alzheimer’s
An April 2018 study reports that “objective evidence from brain imaging shows personally meaningful music is an alternative route for communicating with patients who have Alzheimer’s disease.” The research, published by a team at University of Utah Health in Salt Lake City in The Journal of Prevention of Alzheimer’s Disease, demonstrates that familiar music may facilitate attention, reward and motivation, which in turn makes it more possible to manage emotional distress in Alzheimer’s. While the study’s small sample size and single imaging sessions leave room for more research to be done, the findings mark a significant step toward demonstrating how Music & Memory’s personalized music program is a therapeutic mechanism to address measurable improvement in mood, awareness and quality of life for people with dementia. Read more.
Music & Memory and Improved Swallowing in Patients with Advanced Dementia
Swallowing, self-feeding and choking issues affect many people with advanced dementia, leading to serious health consequences such as dehydration, malnutrition and weight loss (change of status). This 2018 study, published in conjunction with Dr. Stephen Post of Stony Brook University in Dementia: The International Journal of Social Research and Practice presents data indicating Music & Memory’s personal music intervention improves swallowing in individuals with advanced dementia, making eating easier and potentially diminishing reliance on feeding tubes and PEG intervention. This is a significant finding at a pilot level and is strong enough to warrant further replication. Read more.
An Individualized Music-Based Intervention for Acute Neuropsychiatric Symptoms in Adults with Cognitive Impairment
Neuropsychiatric symptoms are common features of dementia, and these occur in three fourths of patients on psychogeriatric inpatient units. These symptoms have traditionally been treated with pharmacological agents, but many medications are as likely to harm patients with dementia as to help them. As a result, nonpharmacological interventions are increasingly being investigated as ways to reduce these symptoms. This 2018 study, published by the University of Kansas School of Medicine, concludes that agitation, negative mood, and positive mood all benefited from the music-based intervention, with resulting large effect sizes. Read more.
Music Intervention to Prevent Delirium Among Older Patients Admitted to a Trauma Intensive Care Unit and a Trauma Orthopedic Unit
Delirium onset as a result of hospitalization poses a serious health risk to older patients. In a randomized, controlled study of 40 patients aged 55 and older, Dr. Kari Johnson, PhD, RN, ACS-BC with Honor Health in Scottsdale, Arizona, tested the effect of pre-recorded self-selected music playlists on trauma patients’ vital signs and assessed confusion. In the music intervention group, there was a statistically significant reduction in heart rate and systolic blood pressure, versus no change for the control group, indicating that the intervention had helped to reduce patient anxiety—a major precursor to onset of delirium. The study was published in the August 2018 issue of Intensive and Critical Care Nursing. Read more
Individualized Music Program is Associated with Improved Outcomes for U.S. Nursing Home Residents with Dementia
A 2017 study by Brown University, published in The American Journal of Geriatric Psychiatry, compares behavioral and psychological resident outcomes before and after implementation of the Music & Memory program. Ninety-eight nursing homes trained in Music & Memory were studied along with 98 matched-pair comparisons for the year 2012-2013. The results show that discontinuation of antipsychotic medications increased in Music & Memory facilities (23.5% to 24.4%), while decreasing among comparison facilities (24.8% to 20.0%). Facilities using Music & Memory also demonstrated increased rates of reduction in behavioral problems (50.9% to 56.5%) versus comparison facilities (55.8% to 55.9%). Implication for practice concluded that “effective, non-medicalized, low-cost interventions such as Music & Memory, are critical to address the needs of the growing ADRD population.” Read more.
Music and Memory in Dementia Care
A 2017 study in the International Journal of Neurorehabilitation led by Deepa Vinoo at New York City Health + Hospitals examined the impact of personal music on 108 residents of four Memory Care units at an 815-bed long-term nursing care facility. All residents of the four units were assessed over a two-year period for use of Music & Memory, antipsychotic usage, physical altercations and falls. The Music & Memory program was part of a mix of improvements in memory care at the facility. At the end of the study period, there was a significant reduction in the transfer of residents to psychiatric ERs for behavioral and psychological symptoms of dementia (BPSD), as well as a significant reduction in falls and physical altercations and resulting drop in transfers to acute hospitals for further management. One-to-one observations decreased from five to one during the same period. Read more.
Repeated Exposure to Familiar Music Alters Functional Connectivity in Alzheimer’s Disease
Alzheimer’s Disease is characterized by the disruption of resting-state networks, particularly decreased functional connectivity within the Default Mode Network (DMN) of the brain. Neuroimaging studies in healthy controls suggest music exposure elicits functional connectivity changes in areas involved in cognition, including the DMN. A July 2018 study published in Alzheimer’s & Dementia used neuroimaging to determine whether daily exposure to long-known music can alter functional brain connectivity (FC) and improve cognitive outcomes in persons with mild cognitive impairment and early Alzheimer’s. A research team led by Melissa Leggieri found whole-brain significant differences in FC for subjects who had participated in a three-week, home-based music intervention program. Read more.
Longitudinal changes in auditory and reward systems following receptive music‐based intervention in older adults
Listening to pleasurable music is known to engage the brain’s reward system. This has motivated many cognitive-behavioral interventions for healthy aging, but little is known about the effects of music-based intervention (MBI) on activity and connectivity of the brain’s auditory and reward systems. Here we show preliminary evidence that brain network connectivity can change after receptive MBI in cognitively unimpaired older adults. Using a combination of whole-brain regression, seed-based connectivity analysis, and representational similarity analysis (RSA), we examined fMRI responses during music listening in older adults before and after an 8-week personalized MBI. Participants rated self-selected and researcher-selected musical excerpts on liking and familiarity.
Parametric effects of liking, familiarity, and selection showed simultaneous activation in auditory, reward, and default mode network (DMN) areas. Functional connectivity within and between auditory and reward networks was modulated by participant liking and familiarity ratings. RSA showed significant representations of selection and novelty at both time-points, and an increase in striatal representation of musical stimuli following intervention. An exploratory seed-based connectivity analysis comparing pre- and post-intervention showed significant increase in functional connectivity between auditory regions and medial prefrontal cortex (mPFC). Taken together, results show how regular music listening can provide an auditory channel towards the mPFC, thus offering a potential neural mechanism for MBI supporting healthy aging. Read more.
Research by Topic
(Compiled by Nina S. Parikh, PhD, MPH, Brookdale Center for Healthy Aging of Hunter College, CUNY)
Gerdner, L.A. (2005). Use of individualized music by trained staff and family: translating research into practice. Journal of Gerontological Nursing, 31(6), 22-30.
Gerdner, L.A. (2000). Effects of individualized versus classical ‘relaxation’ music on the frequency of agitation in elderly persons with Alzheimer’s disease and related disorders. International Psychogeriatrics, 12(1), 49–65.
Gerdner, L.A. (1999). Individualized music intervention protocol. Journal of Gerontological Nursing, 25(10), 10-16.
Gerdner, L.A. (1997). An individualized music intervention for agitation. Journal of the American Psychiatric Nurses Association, 3(6), 177-184.
Gerdner, L.A., & Schoenfelder, D.P. (2010). Evidence-based guideline. Individualized music for elders with dementia. Journal of Gerontological Nursing, 36(6), 7-15. doi: 10.3928/00989134-20100504-01.
Ragneskog, H., Asplund, K., Kihlgren, M., & Norberg, A. (2001). Individualized music played for agitated patients with dementia: analysis of video-recorded sessions. International Journal of Nursing Practice, 7(3), 146–155.
Sung, H.C., & Chang, A.M. (2005). Use of preferred music to decrease agitated behaviours in older people with dementia: a review of the literature. Journal of Clinical Nursing, 14(9), 1133-1140.
Sung, H.C., Chang, A.M., & Abbey, J. (2006). The effects of preferred music on agitation of older people with dementia in Taiwan. International Journal of Geriatric Psychiatry, 21(10), 999-1000.
Sung, H.C., Chang, A.M., & Lee, W.L. (2010). A preferred music listening intervention to reduce anxiety in older adults with dementia in nursing homes. Journal of Clinical Nursing 19(7-8), 1056–1064. doi: 10.1002/gps.2761
Brotons, M., Koger, S.M., & Pickett-Cooper, P. (1997). Music and dementias: A review of literature. The Journal of Music Therapy, 34(4), 204–245.
Choi, A.N., Lee, M.S., Cheong, K.J., & Lee, J.S. (2009). Effects of group music intervention on behavioral and psychological symptoms in patients with dementia: a pilot-controlled trial. International Journal of Neuroscience, 119(4), 471–481.
Clair, A.A. (1996). The effect of singing on alert responses in persons with late stage dementia. The Journal of Music Therapy, 33, 234-47.
Clark, M.E., Lipe, A.W., & Bilbrey, M. (1998). Use of music to decrease aggressive behaviours in people with dementia. Journal of Gerontological Nursing, 24(7), 10–17.
Cooke, M.L., Moyle, W., Shum, D.H., Harrison, S.D., & Murfield, J.E. (2010). A randomized controlled trial exploring the effect of music on agitated behaviours and anxiety in older people with dementia. Aging & Mental Health, 14(8), 905-16.
Crystal, H., Grober, E., & Masur, D. (1989). Preservation of musical memory in Alzheimer’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 52(12), 1415–1416.
Evans, D. (2002). The effectiveness of music as an intervention for hospital patients: a systematic review. Journal of Advanced Nursing, 37(1), 8–18.
Gibbons, A.C. (1977). Popular music preferences of elderly people. The Journal of Music Therapy, 14(4), 180–189.
Goodall, D., & Etters, L. (2005). The therapeutic use of music on agitated behavior in those with dementia. Holistic Nursing Practice, 19(6), 258–262.
Götell, E., Brown, S., & Ekman, S.L. (2002). Caregiver singing and background music in dementia care. Western Journal of Nursing Research, 24(2), 195–216. doi: 10.1177/ 019394590202400208.
Guétin, S., Portet, F., Picot, M.C., Pommié, C., Messaoudi, M., Djabelkir, L., Olsen, A.L., Cano, M.M., Lecourt, E., & Touchon, J. (2009). Effect of music therapy on anxiety and depression in patients with Alzheimer’s type dementia: randomized, controlled study. Dementia and Geriatric Cognitive Disorders, 28(1), 36–46.
Koger, S.M., Chapin, K., & Brotons, M. (1999). Is music therapy an effective intervention for dementia? A meta-analytic review of literature. The Journal of Music Therapy, 36(1), 2-15.
Munro, S., & Mount, B. (1978). Music therapy in palliative care. Canadian Medical Association Journal, 119, 1029–1034.
Snyder, M., & Chlan, L. (1999). Music therapy. Annual Review of Nursing Research, 17, 3–25.
Sung, H.C., Lee, W.L., Chang, S.M., & Smith, G.D. (2011). Exploring nursing staff’s attitudes and use of music for older people with dementia in long term-care facilities. Journal of Clinical Nursing, 20 (11-12), 1776-1783.
Svansdottir, H.B., & Snaedal, J. (2006). Music therapy in moderate and severe dementia of Alzheimer’s type: a case-control study. International Psychogeriatric Association, 18(4), 613-21.
Raglio, A., Bellelli, G., Traficante, D., Gianotti, M., Ubezio, M.C., Villani, D., & Trabucchi, M. (2008). Efficacy of music therapy in the treatment of behavioral and psychiatric symptoms of dementia. Alzheimer disease and associated disorders, 22(2), 158–162.
Burgio, L.D., Butler, F.R., Roth, D.L., Hardin, J.M., Hsu, C.C. & Ung, K. (2000). Agitation in nursing home residents: The role of gender and social context. International Psychogeriatrics, 12(4), 495-511.
Cohen-Mansfield, J. (2003). Agitation definitional and theoretical conceptualization. In D.P. Hay, D.T. Klein, L.K. Hay, G.T. Grossberg, & J.S. Kennedy (Eds.), Agitation in patients with dementia: A practical guide to diagnosis and management. American Psychiatric Publishing, 1-21.
Cohen-Mansfield, J., & Billig, N. (1986). Agitated behaviours in the elderly: a conceptual review. Journal of the American Geriatrics Society, 34(10), 711-721.
Cohen-Mansfield, J., Marx, M.S., & Rosenthal, A.S. (1989). A description of agitation in a nursing home. Journal of Gerontology: Medical Sciences, 44(3), M77-M84.
Cohen-Mansfield, J., & Mintzer, J. (2005). Time for change: the role of nonpharmacological interventions in treating behavior problems in nursing home residents with dementia. Alzheimer Disease & Associated Disorders, 19(1), 37-40.
Cohen-Mansfield, J., Werner, P., & Freeman, L. (1995). Sleep and agitation in agitated nursing home residents: An observational study. Sleep, 18(8), 674-680.
Cohen-Mansfield, J., Werner, P., Watson, V., & Pasis, S. (1995). Agitation among elderly persons at adult day-care centers: The experiences of relatives and staff members. International Psychogeriatrics, 7(3), 447-458.
Forbes, D.A., Peacock, S., & Morgan, D. (2005). Nonpharmacological management of agitated behaviours associated with dementia. Geriatrics & Aging, 8(4), 26–30.
Hall, G.R., & Buckwalter, K.C. (1987). Progressively lowered stress threshold: a conceptual model for care of adults with Alzheimer’s disease. Archives of psychiatric nursing, 1(6), 399-406.
Moretti, R., Torre, P., Antonello, R.M., & Pizzolato, G. (2006) Atypical neuroleptics as a treatment of agitation and anxiety in Alzheimer’s disease: risks or benefits. Expert Review of Neurotherapeutics, 6(5), 705–710.
Sourial, R., McCusker, J., Cole, M., & Abrahamowicz, M. (2001). Agitation in demented patients in an acute care hospital: prevalence, disruptiveness, and staff burden. International Psychogeriatrics, 13(2), 183-197.
Werner, P., Cohen-Mansfield, J., Koroknay, V., & Braun J. (1994). The impact of a restraint reduction program on nursing home residents. Geriatric Nursing, 15(3), 142-146.
Ballard, C., Neill, D., O’Brien, J., McKeith, I.G., Ince, P., & Perry, R. (2000). Anxiety, depression and psychosis in vascular dementia: Prevalence and associations. Journal of Affective Disorders, 59(2), 97−106.
Chemerinski, E., Petracca, G., Manes, F., Leiguarda, R., & Starkstein, S.E. (1998). Prevalence and correlates of anxiety in Alzheimer’s disease. Depression and Anxiety, 7(4), 166−170.
Gibbons, L.E., Teri, L., Logsdon, R.G., & McCurry, S.M. (2006). Assessment of anxiety in dementia: An investigation into the association of different methods of measurement. Journal of Geriatric Psychiatry and Neurology, 19(4), 202−208.
Gibbons, L.E., Teri, L., Logsdon, R., McCurry, S.M., Kukull, W., Bowen, J., McCormick, W., & Larson, E. (2002). Anxiety symptoms as predictors of nursing home placement in patients with Alzheimer’s disease. Journal of Clinical Geropsychology, 8(4), 335-342. doi: 1079-9362/02/1000-0335/0
McClive-Reed, K.P., & Gellis, Z.D. (2011). Anxiety and Related Symptoms in Older Persons with Dementia: Directions for Practice. Journal of Gerontological Social Work, 54(1), 6–28.
Seignourel, P.J., Kunik, M.E., Snow, L., Wilson, N., & Stanley, M. (2008). Anxiety in dementia: A critical review. Clinical Psychology Review, 28(7), 1071–1082.
Teri, L., Ferretti, L.E., Gibbons, L.E., Logsdon, R.G., McCurry, S.M., Kukull, W.A., McCormick, W.C., Bowen, .JD., & Larson, E.B. (1999). Anxiety in Alzheimer’s disease: Prevalence and comorbidity. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 54(7), M348−M352.
Alzheimer’s Association, 2011 Alzheimer’s Disease Facts and Figures. (2011). Alzheimer’s & Dementia, 7(2). Available at: http://www.alz.org/downloads/Facts_Figures_2011.pdf. Accessed October 2011.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association.
DePaulo, J.R.Jr., & Folstein, M.F. (1978). Psychiatric disturbances in neurological patients: Detection, recognition, and hospital course. American Neurological Association, 4(3), 225–228.
Finkel, S.I. (2001). Behavioral and psychological symptoms of dementia: a current focus of clinicians, researchers, and caregivers. Journal of Clinical Psychiatry, 62(Suppl 21), 3–6.
Hoe, J., Hancock, G., Livingston, G., & Orrell, M. (2006). Quality of life of people with dementia in residential care homes. British Journal of Psychiatry, 188, 460−464.
Lyketsos, C.G., Lopez, O., Jones, B., Fitzpatrick, A.L., Breitner, J., & DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. Journal of the American Medical Association, 288(12), 1475-1483.
Plassman, B.L., Langa, K.M., Fisher, G.G., Heeringa, S.G., Weir, D.R., Ofstedal, M.B., Burke, J.R., Hurd, M.D., Potter, G.G., Rodgers, W.L., Steffens, D.C., Willis, R.J., & Wallace, R.B. (2007). Prevalence of Dementia in the United States: The Aging, Demographics and Memory Study. Neuroepidemiology, 29(1-2), 125–132. doi: 10.1159/000109998
Starr, J.M., & Lonie, J. (2007). Relationship between behavioral and psychological symptoms of dementia and cognition in Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 24(5), 343–347.
Free Guides
Visit our Get Involved page to learn more about the use of these guides. If you have questions, please contact us via email, info@musicandmemory.org
How to Make a Personalized Music Playlist for a Loved One at Home
Is there someone in your care that would benefit from the power of personalized music? We recommend creating a 20-30 song playlist from their youth and offering it for 30 minutes at a time as often as is needed or enjoyed. To ensure it’s highly personalized for greatest impact, try to find top songs from when they were 15-25 years old. We also suggest offering it proactively before medical appointments or social occasions.
For more detailed guidance, please refer to our free guide: How to Make a Personalized Playlist for a Loved One at Home. Feel free to contact us if you have any questions.
