Podcast | Singing in the brain; music for dementia

NASGP

London’s Wigmore Hall is a temple of high culture. The audience is packed with musicians. Sometimes I feel I’m the only person who couldn’t be up there performing the work. But recently I joined forty people, some able, some less able, in mind and body, for a ‘Big Sing’. Everyone seemed to feel at home. In the morning we learned to sing simple songs in four parts, and in the afternoon we went up on stage and sang them. I’m no singer but the opportunity was fun and boosted my morale. So how much more it must have done for the participants with dementia. Everyone, everywhere, responds to music. We hear it in the womb, it accompanies the important events in our lives, it modulates our emotions. Hearing is the last sense we lose as we die. People with advanced dementia who haven’t spoken for months may perk up when they hear Vera Lynn singing The White Cliffs of Dover. They may even venture into a solo, or go to the piano and play with an ability no-one knew they had. Thinking skills may have atrophied, but musical skills remain. Given the right stimulus, they surface from the depths of a failing brain. * CPD | Management of dementia There is currently no prospect of effective medication for dementia. Reluctantly, we prescribe agitated patients chemical coshes. But does music sooth agitation – and more? Neuroimaging shows that, unlike speech, music lights up lots of different areas of the brain. It finds a back door into even a ramshackle brain. Music may even help to keep neural pathways in the brain open. So far, studies of the effect of music on people with dementia, though small and short-term, are encouraging. But research projects are seeking robust evidence. Can biochemical changes be linked to our responses to music? What psychological measures can be used to assess benefit? How can music most effectively be used? What opportunities does it offer for carers, care homes, musicians and institutions? Music therapy is a well established profession, although few care homes can afford a therapist. But graduate courses in using performance arts to help people with brain failure are burgeoning, and charities, local authorities, music schools, music groups, orchestras, arts and religious venues are trying out different interventions. With phone calls and a few visits, I discovered how much there is on offer. "Through music, families can glimpse the individual their relative once was: the loving partner, the caring parent, the delightful aunt, the indulgent gran. Once again they can share pleasant experiences." Residents of care homes respond when amateur choirs come to sing. They may join in, although perhaps not singing the same song as the performers. They may rattle a teaspoon throughout the concert, or stand behind the conductor waving their arms. The benefits are fleeting, but any enrichment of barren lives, however temporary, is worthwhile. Repetition helps. And not surprisingly, participation increases the benefits, too. So a musician, squatting down in front of a wheelchair to encourage someone to make simple music, singing or playing instruments may stir her from apathy for longer. She may start chatting. And so change the atmosphere of the home. For people with dementia still living in the community there are ‘relaxed concerts’ where no-one minds if you are restless. Other events encourage people to take part. Alzheimer’s Society’s Singing for the Brain is a model: experienced singing leaders run weekly sessions. Volunteer helpers ensure that carers also have some fun and a break – a crucial benefit of community events. There’s a welcome, action songs, familiar numbers and new ones, opportunities to shake a tambourine,