Article Archive

Summer 2010

Unlocking Memory: Art and Music Serve as Keys
By Lindsey Getz
Aging Well
Vol. 3 No. 3 P. 12

Art and music therapy have proven successful in accessing deep-rooted memories and promoting communication in older adults with Alzheimer’s disease.

When older adults suffer from Alzheimer’s disease, it can often be challenging to find ways to stimulate their memory—or even to help them communicate. But creative forces such as music and art have been shown to make a dramatic difference for many with the disease.

Take, for instance, a patient whom Warachal Eileen Faison, MD, clinical services director at the Alzheimer’s Research & Clinical Programs department at the Medical University of South Carolina, recalls. This patient was suffering from severe Alzheimer’s. She exhibited very little voluntary movement and, for the most part, did not communicate verbally. “Her family was asked about music preferences, and they shared some of her favorite gospel singers and groups with the staff,” says Faison. “After a few minutes of playing the music, the resident was smiling, singing some of the words, and waving her hands with the music.”

Marc E. Agronin, MD, medical director for mental health and clinical research at the Miami Jewish Health System and an affiliate associate professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine, shares a similar story. “On the floor of patients with the most severe cases of Alzheimer’s, there was a woman who never spoke but made this repetitive clicking noise with her mouth. This is not uncommon, as many who are no longer verbal try to find other ways to express themselves, but unless you know them really well, you don’t know what they’re trying to say,” Agronin explains.

“Nobody was able to effectively communicate with this woman. So our music therapist brought her into a session one day. With his musical ear he picked up on the fact that there was a rhythm to the clicking, and he began playing it out on the keyboard. That’s when he realized it was the song ‘Let Me Call You Sweetheart.’ As he played it, suddenly the woman opened her eyes and began singing the words. Mind you, at our facility she had never spoken up until this point. It was as though she came out of a deep state. We later learned that this song had been from her wedding and was very special to her. It’s interesting how that deep and soothing memory was still there, but for so long it was inaccessible. Art and music are often able to tap into these memories in a way that nothing else can,” he says.

These are just two examples of many in which art or music helped an Alzheimer’s patient. Any professional using music or art therapy techniques has numerous anecdotes like these to share. There are also occasions such as taking older adults to art exhibits or giving them art supplies to work with have brought memories and skills back to life. “Instances like these happen every day with music and art,” says Agronin. “There’s something transformative about using artistic skills. It tells us that what’s deep in our soul isn’t necessarily lost through dementia; it’s just that the patient has lost one way of accessing it. For many, music and art can be a successful way to access those memories and abilities again.”

A Voice Through the Arts
What’s particularly extraordinary is the fact that music and art may give a “voice”—or at least some form of communication—back to older adults who had previously been uncommunicative. According to Faison, as Alzheimer’s disease progresses, elders gradually lose verbal skills. “But researchers have found that art may allow these patients to express themselves even when their verbal skills have failed,” she says. “And music therapy may assist in socialization, may enhance and recall language skills, may enhance movement, and may even decrease agitation. In addition, these activities may promote communication between people with Alzheimer’s and their caregivers.”

Barbara Bagan, PhD, ATR-BC, a registered and board-certified arts therapist, says that even though cognition may decrease in Alzheimer’s patients, creativity does not. Giving patients a means of expressing this creativity allows them to communicate in a different way. “Various art activities—painting, drawing, music, movement/dance, poetry, or drama—are offered for pleasure, relaxation, and socialization as well as a variety of treatment goals like reduced boredom, enhanced morale, and even improved cognition. Art and other expressive art activities serve as vital treatment modalities for older adults with dementias. Though these changes and events may be short-lived, they do, however, contribute to the overall quality of life in older adults. And some research does demonstrate that the effects are longer-lived than previously thought. In some cases, when patients are exposed to making or viewing art, the changes and memories can last hours or even days after the creative experience.”

Experts believe both art and music can tap into areas of the brain that were previously dormant as a result of Alzheimer’s disease. And music may be rooted in the brain even deeper than language. “Language appears to be a relatively new function of the brain in human history, whereas music is preverbal and pancultural,” says Kevin Kirkland, PhD, MTA, FAMI, an accredited music therapist and instructor of music therapy at Capilano University in North Vancouver, British Columbia. “Music is a preverbal and sometimes nonverbal brain function, predating the ability for language. Furthermore, music is processed by many different parts of the brain rather than just one center, as in language. The elements of music, such as rhythm, pitch, and melody, are all processed differently. The emotions are also tied in with music, thus activating the limbic system. Oliver Sacks, an advocate of music therapy, says that we listen to music with our muscles. The arousal is in the brain stem and the dynamic registers in the basal ganglia. With music being received and processed at the brain stem level, it shows how basic and primeval sound is to humans. This is why, as Sacks says, deeply demented people respond to music.”

And the research in these areas continues to grow. “A number of recent neuroimaging studies have investigated the neural correlates of music processing and perception in the brain,” says Faison. “Musical stimuli have been shown to activate specific pathways in several brain areas that are associated with emotional behaviors. Neurochemical studies have suggested that several biochemical mediators may play an integral role in the musical experience. And a number of recent small studies have also suggested that art and music therapy have short-term positive effects on cognition, depression, and anxiety.”

Reaching Your Patients
Music and art therapy are accessible to everyone. Music, particularly, is universal so even those who weren’t musically inclined may have personal connections to a particular song or genre of music. However, those individuals with a history of musical training may experience even more success with music therapy. “We used to think that music was a creative endeavor, specific to the right [creative] side of the brain,” says Kirkland, who also works and conducts research with cognitively impaired elders at the University of British Columbia Hospital. “Today we’re finding that music is a very complex phenomenon that is processed by many regions of the brain. Some of this ties into studies done with children that demonstrate how musical training is linked to better performance in other areas like math. Researchers at the University of British Columbia have marveled that someone who can easily score 0 out of 30 on the Mini Mental State Exam can exhibit memory for lyrics and melodies of songs they learned long ago.”

Though a trained music therapist can work more closely with patients through workshops and the use of various instruments, everyday caregivers and practitioners working with elders can also successfully incorporate elements of music therapy into their patients’ daily lives. The key to using music with Alzheimer’s patients is finding what kind of music the person enjoys, says Peter Rabins, MD, MPH, a professor of psychiatry and behavioral sciences at Johns Hopkins Hospital and the Richman Family Professor in Alzheimer’s disease at the Johns Hopkins School of Medicine. “Many times the family members would know this, but if it requires some investigative work, look into what types of music were popular when that patient was young,” he suggests. “If they were young in the 40s, for instance, they may respond well to Big Band music. Try playing a variety of music and see what they respond to. You’ll find that these patients may start brightening up, paying closer attention, and even singing, humming, and moving.”

Art can be a bit more challenging, says Rabins. “It usually requires some kind of hand/eye coordination, so it’s not always something that works with every patient,” he says. Though Bagan has worked with some later-stage Alzheimer’s disease patients, she adds that patients in the early to middle stages of Alzheimer’s may make the best candidates—particularly for caregivers who aren’t specially certified or trained. “Simple art activities may be led by professionals or caregivers who have some art background and are comfortable working with older adults with dementia,” she says.

However, Rabins also advises that as with any new activity, it should be handled appropriately. , Art may not be right for everyone. “You need to be aware of the fine line between making people feel like they’re being treated like children and giving them pleasure in an enjoyable activity such as painting,” he says. “I think it’s a very individual thing, and there’s no way to know in advance which patients are right for it. You have to be willing to try different things and see if it’s working for each patient. You never want to force an activity on a patient or do something that makes them feel insulted or belittled.”

Faison adds that when incorporating any sort of hands-on art activity, it’s important to remember that safe, nontoxic art supplies should be used. However, she points out that effective art therapy doesn’t have to involve participation in an actual hands-on project. “There are a number of museums encouraging people with Alzheimer’s to visit on group tours during special hours,” she says. “I recall people with Alzheimer’s disease who have participated in these group tours and appear to exhibit decreased word-finding difficulty and decreased repetitive language.”

For these types of treatments to be the most effective, it’s important for caregivers to provide one-on-one attention. “It’s important to be cognizant that every single person with Alzheimer’s disease is an individual,” says Faison. “Yes, activities may be tailored to a group, but individual needs must be considered as well.”

Caregivers and practitioners working with elders should also keep in mind that music and art don’t have to be the only memory and communication triggers. “Everyone has something different that was important to them in their earlier years,” says Agronin. “For some, deep faith may play a role. We have men and women who grew up in very religious Jewish households that have severe memory impairment but can still recite prayers. Other times it’s language that can play a role. I was working with a patient who couldn’t recall much of anything because his memory was so poor, but as we were crossing campus, we bumped into a staff member he knew, and the patient began speaking Polish and singing a song. It’s just another example of how there are always other avenues to reach someone—even in the shadows of dementia.”

Agronin says his No. 1 suggestion to those who care for Alzheimer’s patients is to keep an open mind about the elder’s capacity. Remember there may be ways to help evoke memories and communication but they often require patience and a willingness to try various pursuits. “It’s important to have a team of individuals for these patients who can provide a variety of meaningful activities and involvement— whether it’s the arts, music, or other types of therapy,” he says. “You have to be willing to explore the specific needs of each patient. There are too many patients out there who are sitting in a room alone and are not being afforded these types of opportunities. You never know what a patient with Alzheimer’s is capable of until you start putting the time and effort in.”

The bottom line, according to Kirkland, is that even elders with the most severe forms of Alzheimer’s can find joy and ways of better communicating with therapy. He says, “The days of believing that persons with Alzheimer’s disease are not capable of living better—of learning, growing, engaging in creativity and fun—need to be challenged.”

— Lindsey Getz is a freelance writer based in Royersford, Pa.


Old Man’s Fear Song

By Jerry Bloedow

I fell.
I went outside without my pants.
I smell.
I forget my son’s name.
I’m a shame.
Please don’t put me away.
Gimme one more chance.
I’ll be better next time.
Being old shouldn’t be a crime.
I know, I know, so?
I forget to pay my bills.
But I made out twenty wills.
If only I could find them.
Again the nightmares.
Never mind them.
I keep forgetting my phone number, my address.
Oh please, I’m so embarrassed I made a mess.
I’ll clean it up, where’d I put that rag.
Is this something to eat or my laundry bag?
So what if I fell
Look, you never can tell.
I know one doesn’t get no younger
But being old don’t stop the yearning or the hunger
So just let me do my things my way a little bit more.
And when it’s time, I’ll be out the door.
And then you’ll never find me.

— Jerry Bloedow, diagnosed with Alzheimer’s disease about 10 years ago, worked for more than 35 years in various areas of film making as an actor, director, producer, and editor. The winner of many awards, he served as an adjunct professor of film and video in the School of Continuing and Professional Services at New York University until retiring in 1999. He has written poems and plays throughout his lifetime. This poem was written about seven years ago when he was 75, according to his wife and caregiver, Maria Neuda.


Provider Perspective
• Incorporate elements of familiar music into elders’ daily routines.

• Determine the genre of music that evokes responses from Alzheimer’s patients.

• Offer a variety of hands-on activities to Alzheimer’s patients to elicit artistic abilities and positive responses.

• Plan opportunities for passive art and music experiences such as museum visits and concert attendance.