The Effects of Music Therapy on Alzheimer's Patients

Abstract

Alzheimer's disease (AD) is a neurodegenerative disorder that impacts more than 6.9 million people in the United States age 65 and older, causing significant cognitive impairment, memory loss, and the decline of basic motor and social skills. Current treatment options offer minimal relief; thus research has focused on non-pharmacological alternatives, including music therapy (MT). This literature review focuses on the effects of MT on individuals with AD in the United States, including the medical, emotional, social, and neurological effects of MT. Several studies indicate that MT can help to alleviate common psychological symptoms of AD, such as anxiety and depression, by reducing anxiety levels, increasing sense of wellbeing, and providing a sense of purpose. Svansdottir and Snaedal found that MT served to lift mood, while Soufineyestani et al. found that MT served to stabilize vital signs, diminish aggression, promote self-esteem, and build communication skills. Moreover, Matziorinis and Koelsch established a connection between MT and neurogenesis and neuroplasticity, suggesting that MT may actually promote new neural connections and partly counteract the decline of brain function associated with AD. Additionally, MT fosters social interactions, giving patients engagement and opportunities to connect with others and express emotion through structure and, perhaps, cooperation, and it may alleviate loneliness, a well-documented risk factor for cognitive decline. MT is not a cure; however, the wealth of potential benefits is appealing as a supportive treatment for Alzheimer's disease (AD). This review highlights the potential for MT to enrich the quality of life and potentially slow the progression of symptoms for persons with dementia associated with AD, and support MT as a treatment modality in a holistic care plan, always keeping in mind the continuing needs for research regarding the longer term implications of the treatment and the patient's approach to, and response to, that treatment.

Introduction

Most people can’t imagine forgetting how to walk or swallow. However, these are things that many people take for granted, come true for the millions who are diagnosed with Alzheimer's every year worldwide. And without a tangible solution, this is the reality for millions of people worldwide who are diagnosed with Alzheimer's. In the United States alone, over 6.9 million people over the age of 65 are diagnosed with Alzheimer's disease (AD), according to the 2024 Alzheimer’s Disease Facts and Figures published by the Alzheimer's Association, a peer-reviewed Alzheimer’s study. AD causes complications such as memory loss, depression, and increased blood pressure that can be fatal. This is according to Soufineyestani, Mahsa et al., published in a peer-reviewed journal that publishes high-quality research in the field of neurology. Alzheimer's can occur to anyone, but it mainly affects those who are 65 or older, with an ongoing debate about the best type of therapy.

On the other hand, music therapy has been showing promising results on many occasions. According to Deborah Paredez, the current chair of the School of the Arts Writing Program at Columbia, music has always helped people such as Selena, who, after her tragic death, became popular, and helped many people find their lost identities. Selena’s music helped people find their sense of themselves, as it has helped many AD patients with the power of music. While numerous other types of therapy have been suggested for AD patients, no therapy resonates as deeply with patients as music does. Marta Cinta González Saldaña, a former ballet dancer later diagnosed with AD, has shown the true effects of music after 50 years. When the song “Swan Lake” was played, she reacted to it by dancing the same graceful movements that she performed on stage. This shows the impact that music has on people, according to a study done by Shankar, a neurology resident at UNC. This debate about the best type of therapy begs the question: Does music therapy help to alleviate dementia caused by Alzheimer's disease, and does patient responsiveness influence its effectiveness in the United States? This review will examine the scientific literature on MT’s effects on Alzheimer’s patients in the United States, exploring its medical, emotional, social, and neurological benefits, while also addressing potential limitations.

Literature Review: Benefits of Music Therapy

When talking about Alzheimer's, it’s important to talk about the medical effects that it has on a patient, both emotionally and physiologically. Alzheimer's causes many patients to have mental disorders such as depression, which is common in the early stages of Alzheimer's, when patients know that they are deteriorating mentally. Alzheimer's is also known for frequently causing anxiety with a feeling of insecurity, caused by the disorientation that is caused when the patient is there and how they got there. Nonetheless, according to a study done by Svansdottir and Snaedal, published in the Cambridge University Press, the true effects that music therapy has on AD patients are examined. Svansdottir and Snaedal found that MT can help with mood and anxiety, common side effects of being diagnosed with AD. It helped to give Alzheimer's patients a purpose. As Alzheimer’s disease progresses, many patients lose their sense of purpose. Music therapy helps restore this by offering engaging, meaningful activities, and research suggests that this increased engagement can slow the progression of symptoms. This can also be supported in the study by Soufineyestani, Mahsa, et al. found the physiological, cognitive, and psychological effects that MT had on a patient. Not only does MT have positive psychological effects, as Svansdottir and Snaedal have shown, but Soufineyestani, Mahsa, et al have also found physiological, cognitive, and behavioral effects. When patients heard music that they hadn’t heard in a while, it showed a balance of vital signs. It also reduced mood fluctuations while simultaneously helping with aggression and depression. Their study also showed that the emotional benefits of music therapy help patients with communication and improve their self-esteem, leading to improvement in behavior and self-esteem, ultimately leading to a refinement of behavior. Music therapy has also shown positive effects on the brain by complementing the growth of neurogenesis and neuroplasticity. For example, a study done by Matziorinis, A. M., & Koelsch, both with strong interests in healthy mental aging, found that music therapy helped with the generation of new neurons, neurogenesis, and with the formation of new synapses, and axonal sprouting, also known as neuroplasticity. Music therapy acts as a reverse mechanism because it can reverse damage caused by AD. Also seen in the article of Matziorinis, A. M., & Koelsch, they found that not only does it increase the formation of neurogenesis and neuroplasticity music also helps to release dopamine, which activates the brain's reward network, leading to improved mood and better cognitive functions. 

Music therapy also helps with the social interactions of Alzheimer's patients, as many patients with AD suffer from being alone. Having social interactions is a vital part of human life. Regardless of personality type, social interaction is essential for well-being. According to Ren, Yi, et al., who all have a background in psychology or medicine, they found that those who have limited human interactions, especially at an older age, are at a higher risk of getting AD. Especially the elderly without close family feel a sense of discomfort and loneliness, and Ren, Yi, et al. have found that 12% to 40% of those who are 65 years old or older struggle with feeling lonely every day. This feeling of loneliness increases the likelihood of developing Alzheimer's. However, with the help of MT, this number can be reduced, as according to Grasel, Elmer, et al, all authors with multiple neurological publications, MT facilitated the development of social skills and mood in Alzheimer's Disease (AD) patients by providing structured opportunities to interact with others, express their feelings, and participate in shared activities ultimately restricting the number of elderly people feeling lonely. Singing a song together and playing an instrument in group sessions can facilitate communication, cooperation, and belonging in a community, and familiar songs can produce comfort and connection. Introducing MT as a routine intervention for people with AD could greatly reduce loneliness and provide patients with belongingness and worth in this world, which is crucial as over 10% of Alzheimer's patients experience suicidal ideation every day (Draper & Brodaty). However, among the many positive effects that MT has on a patient, one that stands out is their improved communication skills, where in the studies of Soufineyestani, Mahsa, et al, they found that music therapy helped improve communication skills for patients, increasing their social awareness. As shown in the previous study by Svansdottir and Snaedal, it shows a clear connection between MT and helping AD patients overcome depression and find their purpose in life. These patients are at their lowest, and many of them don’t have families or caregivers who take care of them, so having access to music therapy when they can listen to familiar things in a world where they are constantly confused can give these Alzheimer's patients a break from the confusion of the world. A study done by Popa et al, published in a peer-reviewed international journal, has also found the positive effects that MT had on patients who are living in constant fear of everything around them. They found that the implementation of music therapy helped patients express themselves, and it allowed them to depict their thoughts and emotions. Allowing them to share their feelings in a clearer way allowed those around them to feel less burdened and stressed by what they were saying. It was also found in the studies of Popa et al. that the improvement of mood created a better environment for Alzheimer's patients, which can be especially important for caretakers. Many caretakers are often overlooked when studying Alzheimer's, despite the critical role that they play. Caretakers are often family members who have quit their jobs to take care of a loved one. According to the Alzheimer’s Association, it found that 59% of caregivers have emotional stress and 38% have physical stress from caregiving. Not only is there stress that comes along with caregiving, but it should also be noted that many of these caregivers had to give up their jobs to care for their family members. With the number of those suffering from Alzheimer's growing, the unpaid care is also growing. In the US alone, the amount of money lost by the unemployment accounts for around $346,585 (in millions) for over 11,457 caregivers (in thousands). While there isn’t a cure for AD yet, there is a cure to help the thousands of caregivers who feel the stress and the burden of caring for a patient with Alzheimer's. As mentioned previously in the studies by Popa et al. implementation of music therapy will help to reduce the amount of stress that caregivers face every day; music therapy gives them a time to not only the patients but also gives a chance for caregivers to clear their minds and helps them to catch up to the environment around them that changes constantly. 

Limitations

When thinking about the potential benefits of a solution to a problem as big as Alzheimer's, it is important to think about the future effects that the solution brings. Though music therapy is often non-risky and well-tolerated, there have been some reported potential risks. It is recommended that the patient has been exposed to music in their life before the onset of music therapy. Moreover, although music therapy is mostly safe, it is possible for certain types of music, or loud music therapy sessions, to create overstimulation or anxiety; other pieces of music may create negative responses or bad memories. That said, potential individualized music selection typically reduces risks for patients. Individualization can be implemented by pulling music that is based on personal history and preference, considering the length and loudness of the music therapy session to avoid overstimulation and minimize other triggering stimuli, and by conversing with the care staff. Music therapy is still a non-risky, useful, and flexible intervention relative to other interventions that often have undesired side effects. The long-term effects of music therapy for people with Alzheimer's remain to be seen, but two important considerations would suggest that music therapy is a key and meaningful therapeutic option for individuals living with Alzheimer's disease. When many Alzheimer's patients aren't able to recall simple things like their own son or daughter, they can encode and learn new songs and can emotionally connect with the songs, showing that there is still hope in the dark of the night. Shown in the studies of Cuddy, Lola L., and Jacalyn Duffin, both with PhDs and professors at Queen's University, they found that music therapy helped a patient named EN with severe dementia. An elderly lady known as EN was selected for this study as she was suffering from severe AD, and she was deteriorating rapidly. Her scores on the Mini‐Mental State Examination (MMSE) were around 20-25 at the time of the initial diagnosis of Alzheimer's, but only in a few short years, they declined to 8, with most of the drop occurring in a few years. At this stage in the course of her Alzheimer's, EN was reliant on a wheelchair and could not remember any of her family members' names or even the date. Nonetheless, she could respond to songs that were known to her, like 'Happy Birthday', illustrating the genuine effects that MT has on people with AD. Although she had significant difficulties responding to basic questions, she could still hum or sing lyrics from memory, maintaining her music recognition and memory from a long time prior. Although many people have doubts about this study because it might just be a coincidence that she was able to know these songs, it turns out that the songs that she didn’t recognize, she never responded to, showing that music therapy improves the cognitive functions of those with Alzheimer's, even for those who have severe Alzheimer's. 

Conclusion

Ultimately, after examining a wide range of studies and practical applications of music therapy (MT), it’s clear that MT is a very effective intervention for Alzheimer's patients. As it allows patients to feel less isolated, allows expression, feel meaningful, and be fully emotionally engaged, all with beneficial long-term improving effects on cognition. In this sense, music therapy is also supportive to caregivers, reducing burden and the stress, uncertainty, and anxiety that come with helping out patients with Alzheimer's. This is because MT supports emotional expression/disclosure, social and interpersonal engagement, and cognitive stimulation. Music therapy collectively stimulates areas of life and support where caregivers use engagement of their loved one, but also connection and family response. Music therapy is more than a treatment; music therapy can build a bridge to link identity and relationship, and be another way to bridge narrative experiences with their loved ones. Even with a diagnosis of Alzheimer’s, music therapy offers moments of joy, dignity, and family harmony together.

References 

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