Last Updated: November 2, 2014
The man had not spoken in three or four years. An older man in
the late stages of Alzheimer's, he could no longer care for himself
and required a high level of assistance in his daily activities of
But on one particular day, Concetta Tomaino, DA, a certified
music therapist, offered a different kind of dementia therapy-she
sang an old Yiddish song to him and some of her other patients.
"You could tell by his face that he was watching," recalls Tomaino.
From a man in his condition, attention was a lot to ask for.
"Whenever I got a chance I played this song to him and sang to him.
Within a month of doing this, he was making an attempt to speak,
and he eventually started singing the song himself. He also started
talking again. He continued talking and lived for many years after
The Brain and Music
Just how the brain and body process music remains mysterious.
Tomaino, director of the Institute for Music and Neurologic
Function at Beth Abraham Family of Health Services in New York,
says we at least know music is processed on many levels at
"Why it's so positive is that we process music with almost every
part of our brain," she says. "Music that has personal significance
to someone or is connected with historical events is a strong
stimulus to engage responses in people, even in late stages of dementia.
Even if they're not necessarily able to tell you what the song is,
they are able to be moved and feel the associations."
Tomaino and other researchers have found a strong connection
between the human brain's auditory cortex and its limbic system,
where emotions are processed. "This biological link makes it
possible for sound to be processed almost immediately by the areas
of the brain that are associated with long-term memory and the
emotions," she says.
The Institute for Music and Neurologic Function was founded on
Tomaino's observations, together with those of noted neurologist
and colleague Dr. Oliver Sacks and others, that many people with
neurological damage learned to move better, remember more, and even
regain speech through listening to and playing music. In numerous
clinical studies of older adults with Alzheimer's and other forms
of dementia, familiar and likable music, not medication, has
reduced depression; lessened agitation
increased sociability, movement, and cognitive ability; and
decreased problem behaviors.
In a small 1986 study, only music elicited a physical response
from those with final-stage Alzheimer's as measured in heart rate,
breathing, eye blinking, and mouth movement. A later study that
used music in palliative care found the combination of language,
which is processed by one part of the brain, and music, processed
by many parts of the brain, increases the chance of activating
neurological pathways that language alone cannot.
"There are certain areas of the brain that are still relatively
intact even as a progressive disease like Alzheimer's takes
effect," says Suzanne Hanser, PhD, department chair of music
therapy at Berklee College of Music in Boston and former program
director of San Francisco's Alzheimer's Association. "In
particular, the limbic system. And specifically, the hippocampus,
which retains long-term memory and has retained emotional impact.
Music triggers these long-term memories. So we see people who have
not spoken in years begin to sing songs that they knew in their
early teens and early adulthood."
Hanser says that when we actively make music, as opposed to
passively listening to it, we activate another part of the brain
that controls balance and movement-the cerebellum-in addition to
cognitive and limbic areas. "Music therapists may begin with
passive listening but soon we engage the person so there's more
parts of the body involved," she says.
According to the Alzheimer's Association, Alzheimer's now
affects more than 5 million Americans. For those who suffer from
its progression, a number that doubles every fives years among
seniors according to The National Institute on Aging, music can not
only be a pleasant link to the past, but a nourishing connection to
"Family members who every day see losses and degeneration first
hand need some kind of hope, need to see there are ways to access
the human being they loved," says Hanser. "For a caregiver or
family member to dance or sing with that person brings them much
more a sense that there is [someone] within the shell the disease
A Cross-Cultural Language
I think music in itself is healing. It's an explosive
expression of humanity. It's something we are all touched by. No
matter what culture we're from, everyone loves music.
Some say math is the language of the universe, but on earth it
is music. Bone flutes, jaw harps, and percussive instruments were
already being used more than 30,000 years ago to express qualities
of human experience. Music, like food, is central to virtually
every culture on earth, and in fact might be considered a type of
food for the brain. Ancient Greeks believed music's mathematic
progressions and its harmonic qualities, ratios, and scales made
for a better mind, so its study was required as part of a good
The modern method of using music to heal, called "music
therapy," was born after World War II when physicians and nurses in
veterans hospitals noticed their patients improved after listening
to music. Today, more than seventy music therapy programs are
accredited in the United States by the American Music Therapy
Association, which defines music therapy as "the clinical and
evidence-based use of music interventions to accomplish
individualized goals within a therapeutic relationship…" Whereas
words are the psychotherapist's medium, music is the medium of the
music therapist, who is typically a trained musician.
"[Music therapy] is not going to change the course of the
disease," cautions Hanser, "but it will allow the person to
temporarily engage and be much more capable of communicating more
Two Types of Music Therapy
Hanser and her more than 3,200 colleagues of the American Music
Therapy Association practice two types of music therapy: active and
passive. Familiar and, most importantly, likable, music elicits the
best responses. For example, Big Band music motivated social
interaction more than making a puzzle in one 1993 study, and
another study that same year found playing music of a patient's
choosing six days a week reduced his or her agitation.
Music therapists work directly with family members, caregivers,
and patients to find the best music for a desired goal of dementia
therapy, such as to "improve memory," "lower agitation," or
"improve cognitive skills." According to Tomaino, music can be used
mnemonically to "retune" the brain to remember certain tasks during
early stages of Alzheimer's
and dementia. But in later stages, music is most helpful in
maintaining motor skills. In all cases, music is known to reduce
anxiety and stress while increasing attention, motivation, and
Unlike passive music therapy, or simply listening to live or
recorded music, active music therapy uses real instruments, such as
drums, harps, harpsichords, or the voice, to engage a patient in
play. Hanser once helped a man with Alzheimer's and his wife dance
for the first time in years after Hanser played some familiar
ragtime music and had his wife strum an autoharp. The sound and
vibration of the autoharp motivated the man to move his legs to the
music, whereas before the music began he only stared into
Tomaino has found that active music therapy can have immediate
physical benefits. "Say a person doesn't use their hands to pick up
things very much any more," she says. "Engage them in a drumming
circle for a while, and in the process of hitting the drum they can
maintain the strength of holding a fork or glass."
The Scientific Evidence: Still Inconclusive
For all the anecdotal clinical evidence that dementia therapy
using music helps people who suffer from Alzheimer's and dementia
maintain quality of life, and despite the medical community's
general regard of likable music as a "good thing," music therapy
still lacks the rigorous statistical evidence that shows it works
for everyone. In 2003 the Cochrane Collaboration, an independent
non-profit reviewer of medical research, reviewed five well-known
music therapy studies and found their methods "too poor to draw any
useful conclusions." Its report states, "There is no substantial
evidence to support nor discourage the use of music therapy in the
care of older people with dementia."
It should be emphasized that musical dementia therapy has not
been shown to fail in these studies, either. And the good news is
that it's been shown to have little to no patient risk when
administered properly by a trained music therapist. Since 1994,
Medicare has reimbursed for the treatment, and in specific cases so
has Medicaid. Both policies are fortified by the Music Therapy for
Older Americans Act, passed into law by the U.S. Senate on Sept.
18, 1992, eleven years before the Cochrane review was
Hanser says the effects on quality of life that music therapists
observe in their patients every day are difficult to statistically
quantify because each case is unique. "To be most effective, music
therapy procedures must be tailored to the individual needs of each
person with dementia," she says. "Each music therapy
strategy must also reflect the person's history, preference, and
ability to engage with a certain type of musical experience. These
are some of the factors that make it extremely challenging to
conduct randomized controlled trials."
Finding a Music Therapist Near You
The American Music Therapy Association maintains a list of
board-certified music therapists, and its web site offers
informative FAQs and brief articles about music therapy. To find a
music therapist near you, contact them at:
American Music Therapy Association
8455 Colesville Road, Suite 1000
Silver Spring, MD 20910