Familiar melodies hold the key to unlocking connection and cognition
Story by John Lorinc
The petite, elderly woman, her straight blonde hair cut in a pageboy, hangs her head over the armrest of her wheelchair as an aide sets the volume on an iPhone. She listens through the headphones and, with a slight gesture, moves one arm weakly as the music begins, but then allows it to fall back in her lap as she shakes her head, seemingly defeated. Her helper presses on, gently kissing the back of the woman’s other hand as a familiar refrain swells.
Suddenly, as the ups and downs of the dramatic finale of Tchaikovsky’s Swan Lake take shape, her arms move with all the grace and expression of the ballerina she once was. Her face is etched with the emotion of the music, and her upper body sways forward with practised movements.
Marta Cinta Gonzáles, who performed in Cuba and New York, was living with Alzheimer’s disease in a nursing home when a music therapy organization made a video of her and posted it on YouTube. Gonzáles died in March 2020. Later that year, the video went viral, prompting not just a search for Gonzáles’ background, but also a surge of public interest in the power of music to reach individuals living with the heavily stigmatized and often dehumanizing disease.
“Music memories seem to be better preserved in Alzheimer’s patients than non-musical memories,” says Michael Thaut, a University of Toronto music professor who is the director of the Music and Health Science Research Center at the Faculty of Music. Even for individuals who have lost much of their cognitive ability, music can trigger speech, movement, memory and expression.
Corinne Fischer (MD ’93, PGME ’94) is a Temerty Medicine associate professor of geriatric psychiatry who runs the St. Michael’s Hospital Memory Disorders Clinic. At the clinic, Fischer and Thaut are co-leading a pair of studies exploring if exposure to deeply familiar music — for example, from a person’s youth — can unlock autobiographical memories and improve cognition. “The vision was to see if we could establish what is it about music that’s so well preserved in the brains of patients with cognitive decline,” Fischer says.
Imaging shows that the parts of the brain that respond to music or movement tend to be less affected by dementia and Alzheimer’s physical manifestations, such as the buildup of amyloid deposits. But the findings of these and other research studies go well beyond neuroscience and the modes of therapy designed to mitigate some of the distress and agitation that individuals with Alzheimer’s and dementia experience.
Indeed, the fact that people living with these conditions have alternative ways to express themselves suggests a means of breaking down the crushing stigma associated with dementia. “People become isolated, and some people don’t even want to learn that they have this disease because there’s so much stigma around it,” observes Julia Gray, an assistant professor, teaching stream, of health humanities at University of Toronto Scarborough. For many years, Gray has used theatre to break down barriers and improve understanding.
Exposure to familiar music appears connected to improved cognition and memory. The use of long-familiar music is “absolutely key”
“The capacity of people living with dementia for meaningful engagement is sorely underestimated; the assumption is that dementia leads to an erasure of the person,” adds Pia Kontos (PhD ’03), a senior scientist at the KITE Research Institute and a professor at U of T’s Dalla Lana School of Public Health. Her research focuses on stigma and how the arts can lead to more just, caring and inclusive policies and practices.
Last fall, Fischer, Thaut and colleagues reported on their work with a group of patients who spent several weeks listening to a daily playlist that included music they had heard recently as well as long-familiar songs. The group included musicians and non-musicians. The study was published in the Journal of Alzheimer’s Disease.
The results showed that exposure to familiar music appears connected to improved cognition and memory. The use of long-familiar music is “absolutely key,” says Thaut, noting that therapists who work with dementia patients now seek out these kinds of musical touchstones, often in collaboration with family members. “We can’t reverse the disease, but we think we can create brain-based cognitive boosts that increase function,” he says.
Listening to music, adds Fischer, is an easy, enjoyable activity that seems to spark cognitive stimulation.
The evolutionary reason for why music, in particular, has this effect is still something of a mystery. However, evidence of human attraction to music reaches back many of thousands of years, to archeologists unearthing flutes with precisely spaced holes, says Thaut. But he adds, “The auditory brain is [still] much less understood than the visual brain.”
Apart from the neurology involved, Kontos argues that research on dementia and creative endeavours, such as dance and music, challenges assumptions that dementia entails only loss and incapacity.
Gray, a former theatre director, is the lead creator of Cracked, a play about dementia for individuals with the condition, their family and caregivers. The shared, intimate experience of the play and the discussion that follows allow conversations not just about the stigma, but the ways in which cultural activities provide new forms of expression.
“In a way,” she says, “dementia challenges us because culturally, we’re so caught up in the Enlightenment era, in thinking that personhood is about thinking, whereas personhood is about so many different ways of being in the world. The arts really do help us live full lives.”
These findings also raise philosophical questions about the very seat of the self. Based on her research on people living with dementia, Kontos says that certain ways of knowing are clearly encoded in the body, not the brain. The fact that dementia may disable or destroy some higher-order functions, such as speech and autobiographical memory, doesn’t mean it has fully made off with other core elements of an individual’s humanity.
“My research challenges the assumption that there’s existential loss,” she says. “There is creativity, relationships, humour, the development of new skills. There is so much more to living with dementia than just neuropathology.”