Sunday, June 2, 2013

Prevent Alzheimer’s by Learning to Play Musical Instruments

One of our previous posts was wholly devoted to the Music Therapy, and its positive effect on the Alzheimer’s patients on all studies of the disease, but at various degrees. However, scientists made a new discovery, confirming that active participation in the Music Therapy may be even more useful in process of prevention and delaying onset of visible and perceived symptoms, even when negative chemical processes in the brain are already ongoing.

Playing Music and Alzheimer’s

Research has indicated that learning a musical instrument may help prevent Alzheimer’s disease.  Music and cognition are inexorably linked; we know that perceiving and creating music require complex neural (brain) activity.  Alzheimer’s disease is characterized by a loss of neurons and the connections between them.  Interestingly, a clinical study showed that older adults who were more active, including those who played an instrument, were less likely to develop Alzheimer’s disease than less active older adults.  The cognition involved in learning to play an instrument fosters the growth and strength of the brain’s neural network, and as such can act as a deterrent for Alzheimer’s disease as well as other forms of dementia.

Other research with Alzheimer’s patients further elucidates the relationship between cognition and music.  The most recognizable trait of Alzheimer’s disease is memory loss.  However, studies have shown that the ability to play an instrument may be spared by Alzheimer’s disease; some musicians with the disorder retain the ability to play their instrument, even if they are unable to learn new songs or identify familiar melodies.  Further, it has been suggested that Alzheimer’s disease exists to a lesser degree among musicians (specifically, orchestral musicians) than among non-musicians.

One study showed that incorporating music into a memory task helped Alzheimer’s patients to remember, while it had no discernable effect on the memory of healthy participants.  Similar correlations between music and increased cognitive functioning have been observed in stroke victims who suffer from aphasia (those who have trouble understanding or producing language).  The connections between music and cognition run deep and we still have a lot to learn.  But one thing we are pretty certain of is that the experience of learning how to play an instrument acts as a buffer against cognitive decline—particularly Alzheimer’s disease.  So, if you are a musician—great!  If you are not a musician, you should give it a try! 

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Emory University's Department of Neurology Study, 2010

Children who learn to play a musical instrument and keep playing for many years will enjoy a better brain when they age. Not only will they retain cognitive skills that others may lose, they may enjoy special protections against some effects of Alzheimer's disease, according to a study conducted by Brenda Hanna-Pladdy, PhD., a clinical neuropsychologist in Emory University's Department of Neurology.
"Natural aging of the brain and the effects of the more accelerated decline found in neurodegenerative conditions such as Alzheimer's Disease may be delayed or diminished,” said Hanna-Pladdy.

Her study used a comprehensive battery of neuropsychological tests on individuals age 63 to 80. Those with more than ten years of experience playing a musical instrument performed best in tests. Those with less than ten years experience score lower. Those with no experience tested lowest. Subjects were tested on spatial memory, naming objects, and cognitive flexibility, the brain's ability to adapt to new information. These abilities typically decline as the brain ages or affected by conditions such as Alzheimer's disease

In her continuing research at Emory, Hanna-Pladdy is using functional MRI brain imaging done during cognitive testing to show the intensity and location of brain activity, demonstrating the differences between those with significant musical training and those with little or no such training.

"Based on previous research and our study results, we believe that both the years of musical participation and the age of acquisition are critical," Hanna-Pladdy said. "There are crucial periods (during childhood) in when brain plasticity can enhance learning, which may make it easier to learn a musical instrument before a certain age, and thus may have a larger impact on brain development that could compensate for cognitive declines as we get older."

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University of Central Florida Study, 2012

While the previous study addressed the therapeutic effectiveness of playing musical instruments to prevent the disease, this study has been directed to the people who are already affected. For the study, William Kang, a third-year medical student at the University of Central Florida in Orlando, divided a cohort of 15 patients with Alzheimer's disease into 2 groups: a control group of 7 patients who received biweekly sessions of "passive" music therapy, involving only listening to violin music; and an intervention group of 8 patients who received biweekly sessions of instructional violin lessons in addition to the passive music therapy.

None of the patients had played the violin before. The lessons were taught by Kang, who is himself a former professional violinist. Four of the patients, with Mini-Mental State Exam (MMSE) scores ranging from 7 (severe impairment) to 28 (mild impairment), were able to learn skills including plucking strings and holding the bow with assistance, 2 were able to produce sound, and 1, with an MMSE score of 22, was able to learn to play the song Twinkle, Twinkle, Little Star.

Although qualitative results between the 2 groups after 8 weeks were not statistically significant, Kang said several observations were striking. For one thing, the results indicated that patients in the intervention group were capable of learning the violin. "We learned that Alzheimer's disease patients can learn to play the violin. Even someone with the [MMSE] score of less than 15 was able to it learn it to a certain extent."

Second, those learning the violin demonstrated improved abilities in relation to everyday tasks such as remembering names and faces. In the most dramatic example, one patient recalled the name of a nurse she'd long forgotten."She'd had the same nurse for 10 years but could never remember the nurse's name, but after just 3 weeks of learning to play the violin, she greeted the nurse one morning by her name," Kang said.

Third, the patients who received violin lessons showed observable improvements in mood, memory, and cognition. "The nurses, families, physicians, and I observed improvements in mood and energy and decreases in agitation," Kang said. "Patients who had sundowners syndrome and were out of control, for instance, were able to calm down and improve cognitively after just 8 weeks, which is a relatively short time."

Kang noted that previous studies involving music therapy with Alzheimer's patients have involved more basic responses, such as listening, clapping, and following a rhythm, but he is not aware of any other research evaluating the effects of learning to play a complex musical instrument. He speculated that the nature of the violin itself could be an important part of the equation, providing different challenges than, perhaps, learning to play a saxophone.

"I think the difficulty of the violin is the most important asset," Kang said. "If you think of the violin, you're using aural, visual, vibration sense, pain and temperature sense, proprioperception, and an emotional sense."

"Every song they play has an emotional quality. Previous studies have even shown increases in the corpus callosum, connecting the left and right cerebral hemispheres, in relation to music," he explained.
Famed neurologist and author Oliver Sacks, MD, has written extensively on the profound and fascinating way that music resonates with dementia and Alzheimer's patients.

According to psychiatrist Angela Scicutella, MD, PhD, associate professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine, in the Bronx, New York, and a member of the American Academy of Neurology, one reason Alzheimer's patients respond to music might be that the part of the brain that understands music is not the first target of the disease. "The processing of music is thought to involve frontal subcortical circuits," said Dr. Scicutella. "The orbitofrontal cortex is important in social interactions, and the medial prefrontal cortex is important in attention and motivation of human behavior. These areas, which are more involved in the emotional aspects of human behavior, are usually preserved until later in the course of Alzheimer's dementia, as opposed to the hippocampus and entorhinal cortex, which are involved in factual memory and are the first areas to be affected by the pathology of Alzheimer's disease. Therefore, these cortical/subcortical circuits, which tap into brain areas that are relatively preserved, can serve as another route for learning."

Music has a unique ability to engage patients on multiple levels, which makes it highly useful on a therapeutic level, she added.
"Music may be able to benefit Alzheimer's patients because it increases arousal and attention, which may help them to encode information and improve their recall of that information."

Dr. Scicutella explained that using music as a participatory exercise is often beneficial, whether it's learning to play an instrument or just singing some favorite old songs. "I would suggest engaging the patient in whatever music that the person liked prior to the diagnosis of dementia or music that was popular in their youth/teenage years/early 20s," she said. "Engaging patients in active participation, such as a sing-a-long or playing a simple instrument like cymbals or drums is preferable to passive activities, where they are just sitting in an audience listening to music."

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