How Music Therapy Helps People With Dementia Access Buried Memories

Throughout his last public performances in early 2020, singer Tony Bennett, who was diagnosed with Alzheimer's four years prior in 2016, could be confused about his whereabouts when waiting backstage, Bennett’s wife Susan told AARP magazine. But as soon as he heard his name announced, he would strut on stage and perform like nothing was amiss. At his neurologist’s urging, the family arranged for him to have biweekly rehearsals from his apartment's grand piano up until his death earlier this summer. 

These aren’t coincidences. A growing body of research suggests that music therapy allows people with dementia to access memories and skills that seem to have disappeared.

“Music is arousing the parts of the brain that are either deteriorating slower or still healthy. Things like sense memory, motor memory, that are deeper than conscious memory,” says Kristen Stewart, MA, LCAT, MT-BC, assistant director of the Louis Armstrong department of music therapy at Mount Sinai Beth Israel Hospital.

And the benefits of music therapy extend beyond memory, improving language, reducing agitation, and even increasing caregiver satisfaction. Perhaps most importantly, music therapy provides a vehicle for self-expression and connection with loved ones, even when language fails. 

Music therapy can look (and sound) many ways in practice, but it involves a trained professional who delivers a music-based intervention tailored to an individual’s abilities and goals. Desired outcomes might include pain management, stress reduction, self-expression, or improved memory.

In the early stages of dementia, music can be used to cue memories and exercise language skills

A systematic review from this year found that music therapy improves cognitive function in people with Alzheimer’s, with many studies supporting improved memory specifically. An earlier systematic review revealed similar results in participants with dementia 1more broadly. Because music engages all parts of the brain (or at least those we’ve mapped so far), it can tap the areas untouched by dementia, Stewart says.

Stewart has one client who will look through his high school yearbook while she plays music popular during his teens and twenties. She’ll ask him questions about early experiences with music, and what was popular in high school or when he first started dating. “We deepen the memories through songs associated with that era. The stories will come connected to that musical memory,” Stewart says. 

These kinds of long-term memories tend to be easier for people with dementia to access. But even short-term memories, which are often the first to go when dementia takes hold, may be enhanced by music therapy. A very small 1997 study tested the effects of singing on Alzheimer’s patients’ ability to recall the names of their caregivers. They were shown pictures of their caregivers, waited a few minutes, and then were asked to match the photos with names. For three out of four participants with Alzheimer's, scores improved when the time between seeing pictures and pairing them up was spent singing. 

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Language skills, which decline as dementia progresses, seem to also benefit from music therapy.

In one study, people living in an Alzheimer’s care facility participated in eight sessions during which they were asked to recall memories based on either photos or music. Those in the music group showed significant improvements in their speech content and fluency, more so than those in the photo group, though differences didn’t reach statistical significance. 

Melita Belgrave, PhD, a music therapist and associate dean of the School of Music, Dance and Theatre at Arizona State University, says that even in people whose participation seems limited to humming, “after 15 to 20 minutes of highly engaged music making, you may see some verbal skills pop out.”

To be clear, music therapy cannot stop the loss of language altogether. But as verbal communication becomes more fraught and eventually unavailable, music can offer an alternative form of expression and a way to find meaning. 

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One 1986 study compared sessions in which participants were asked questions about their past, played music from their past and then asked questions, or played music followed by no questions. Both sessions involving questions resulted in improved language skills. However, researchers noted that these session sometimes provoked anxiety. "Participants would start to respond coherently and then find that their ideas evaporated mid-sentence," researchers wrote. In the end, only the session involving music alone improved participants' mental states. 

This loss of verbal skills should not be conflated with a complete loss of cognitive function. In middle and late stages of dementia, people can still understand what is said to them and learn new things, even if they’re not able to respond with words, Stewart says. 

Belgrave recalls working one-on-one with people with late-stage Alzheimer’s as part of her master's research. She would use different cues to prepare clients for the sessions, like asking their caretakers to have them seated in a chair when she got there, or offering them something textured to touch. One time, after Belgrave placed an instrument in their lap, the client began laughing. “There's someone in there,” Belgrave says. “It just takes longer to reach them.”

Stewart notes that music and movement groups can be particularly powerful for people who are nonverbal. “They will just become alive…It can just have someone feel ‘oh, I know this. I don't know how I know it. I don't know who I am in it.’ But there's a deeper knowing,” Stewart says.

In moderate and late-stage dementia, agitation is common. People with more severe stages of dementia may also begin to communicate through behaviors seen as disruptive. Again, music therapy can help.

One 1998 study found that playing preferred music during bathtime decreased aggressive behaviors2 in people with dementia. Another study found that people with Alzheimer's were less agitated during music therapy and for at least 20 minutes after, as observed by both music therapists and caregivers.

This can make the job of a caregiver easier, while also offering an opportunity for connection. One of the most heartbreaking aspects of dementia is the possibility that the afflicted will cease to recognize loved ones. Spouses and adult children may find their family roles dissolving as their loved ones recognize them only as caregivers. 

But through music, they can connect, even if the person with dementia isn’t aware of the history they share. “It gives a break for that caregiver to just be the person that they used to be in that role,” Belgrave says. “We're making new memories together instead of just being sad that we can't operate the way we used to.”

Stewart is currently working with one client to write a love song for his wife. It’s given him an opportunity to reflect on how their relationship has changed over the years and remember how they’ve cared for each other during different times of need. She plans to record the song so that it can continue to serve as a source of connection as his abilities change.

“It's possible that their partner will not recognize them at times,” Stewart says. “But to have moments, current, that can celebrate who they are together, it's like cheating time.” 

If you're caring for a loved one with dementia and would like to introduce music into your routine, Belgrave suggests "traveling through music," by using Tune in radio—a site that allows you to access radio stations from all over the world. You can also visit a site called Timeslips, which offers a music-based storytelling experience. Lastly, if you're hoping to use music to disrupt agitation, Belgrave suggests noting common times that agitation occurs and beginning to play music 30-60 minutes beforehand.

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