Quit Playing Games with My Heart - The Backstreet Boys and Dementia

Do you sometimes hear a song on the radio that takes you back to the place you were when you first heard it? The emotions well up, even the sounds and smells of that place? When I hear ‘Quit Playing Games with My Heart’, I still go back to my living room, my best friend and I sitting on a beige shag carpet in front of the stereo singing our hearts out while clutching two halves of a towel that our favourite Backstreet boy had used to wipe the sweat off his face (I shudder to think of the hygienic implications of that now). It was an autumn day and sunlight was streaming in through the balcony door. I can still feel the heat on my face and the bubble of teenage excitement bouncing around in my chest cavity.

Well, music not only soothes the teenage spirit, but also soothes behavioural outbursts in dementia patients and may help recall memories that appear all but lost.

Explicit music memory, being able to consciously and intentionally recognize music, is thought to be in the temporal lobes of the brain*.  The temporal lobe is also involved in memory formation and navigation.  Sadly, in Alzheimer’s Disease (AD), neuronal loss and damage occurs primarily in the temporal lobe resulting in the hallmark memory loss we associate with AD.   Implicit music memory on the other hand, which is more a latent unconscious recall of music, resides in a different part of the brain that remains largely intact until the very late stages of AD.  It is implicit music memory that is thought to be tapped into through music therapy which results in behavioural and memory recall improvements in dementia patients. 

There is little research on implicit music memory therefore the mechanisms by which music influences dementia patients is still not well understood, but there are several possible theories.  The ability to recall memories from your past, termed autobiographical memories, has been examined in several studies.  They have found that music enhanced dementia patients’ ability to recall autobiographical memories, some even in the case of severe dementia.  

One theory is that music reduces anxiety levels which enhance AD patients’ ability to recall autobiographical memories.  Others have proposed that the effect of music is linked to emotional factors.  Emotions can modulate verbal and visual memories.  Theoretically, in my case, the emotion of teenage infatuation with the Backstreet Boys modulated my visual memory of that autumn day, enhancing the coding and consolidation of that memory.

A better known effect of music is on behaviour.  Angry, frustrated outbursts can be frequent in people with dementia.  Often, the inability of caregivers to handle these behavioural changes is what leads to institutionalization.  Studies have shown that AD patients who receive music stimulation demonstrate more social participation such as smiling, singing, dancing movements and more positive emotional states.  People with dementia have also been shown to derive pleasure, even at advanced stages, from self-identity and music stimuli.  It is thought that the secretion of certain hormones such as estrodiol and testosterone have protective effects in AD and that patients who received music therapy have higher levels of these hormones as well as decreased behavioural outbursts.

Finally, further support for the powers of music come from brain structural imaging studies.  These have shown structural differences in the brain between musicians and non-musicians.  Those regions are typically not affected at early to mid-AD, which may explain why musicians with AD are sometimes still able to recall how to play an instrument.  More interesting is the theory that knowing how to play a musical instrument is associated with a reduced risk of dementia, though better studies need to be conducted in this area.

The results of music therapy are encouraging and uplifting.  A recent documentary, ‘Alive Inside’ follows the stories of long-term care residents with dementia in the US whose lives are transformed by music therapy. 

Music therapy has been in use for a while in other medical conditions and has been slowly gaining traction as a non-pharmacological treatment for individuals with AD.  Given the lack of understanding of how music therapy works and the culture of pharmaceutical dependence for treatment of dementia in North America, this is going to be a slow adoption process.  However, other European and Nordic countries are leading the way in innovative forms of dementia care and perhaps Canada will follow suit soon.  In the meanwhile, I'm making a When-Saskia-Develops-Dementia Playlist, and you can bet the Backstreet Boys are going to be on there.

*our understanding of this comes from fascinating research done on intractable epilepsy patients who have had temporal lobe resections to control their seizures and people who have had temporal lobe damages for other reasons