Whether lyrical or instrumental, music is a creative combination of rhythm, harmony, and the expression of emotion. Numerous studies can also attest to its many health benefits.

A 2013Trusted Source study, for example, found that music can have a relaxing effect prior to stressful situations and help the nervous system recover quicker. Another study from the same year found that listening to music helped reduce pain and anxiety for children in hospital.

Besides its physiological benefits, research has also found evidence of music’s positive impact on cognitive health.

A recent study suggested that practicing and actively listening to music may help slow the decline of cognitive function in people ages 62–78 years. The researchers found that engaging in musical activities increased the brain’s gray matter in some areas, which increased its neuroplasticity—the brain’s ability to rewire itself, which is crucial for learning, and forming memories.

In terms of actively practicing music, a 2023 study also suggested that long-term music training may provide potential functional benefits to the brain and help keep it young.

Such findings make music a potentially powerful tool in treating dementia, which is characterized by an array of symptoms that include memory loss and difficulties with thinking, language, and problem-solving.

One other way music may help cognitive health is by becoming a medium for connection. Multiple studiesTrusted Source have shown that social isolation and loneliness can speed up the progression of dementia.

“I feel like music is the most powerful instant connector, almost of any experience and, and of the arts,” said Beatie.

The singer/songwriter said she believes the arts, in general—not just music—can bemedicinallypowerful, extending its power beyond a form of entertainment.

“Because [music is] all-pervasive, it’s not something that requires the person to get up and dance or draw. Someone can just absorb the frequencies and the words and this whole soundscape. For me definitely, music was always this kind of powerful resource that I use to feel good. [W]hen you have seen the responses I’ve seen to music, you have infinite respect and appreciation for it,” she said.

However, as much as sound and music have an impact on our health, the lack of it—silence—is just as, if not more impactful. A 2020Trusted Source study found that silence can be relaxing and therapeutic, reducing brain wave frequency all the while lowering blood pressure.

In fact, research has also shown the detriment of too much noise and loud sounds on cognitive health. A 2022Trusted Source study indicated that chronic exposure to loud sounds, such as heavy traffic, may be a specific risk factor for dementia.

Our guest Beatie shared her thoughts on how complete silence impacted her by recounting her experience in what was the world’s quietest room where she recorded her “Raw Space” album in the Bell Labs anechoic chamber.

“It was one of the most profound experiences I think I’ve ever had, and it’s something that I continually return to. Even now it feels like it’s almost become more relevant today. As the world’s just got noisier, both literally in terms of sonically but also informationally—we’re getting bombarded from all angles, with social media and notifications, and all of these things that are hitting us that are kind of frazzling us,” she said.

THE QUIETEST ROOM

“You feel silence; it’s almost like you feel this entire sensory reset, and your nervous system calms down and you hear sound in this pure way with no echo and no reverb and no enhancements. And you realize [that] we use technology almost now so excessively, to iron out all of these things that are actually what make us human beings to begin with?”
— Beatie Wolfe, singer/songwriter

Beatie seemed to enjoy the experience much more than most people do and ended up spending quite a few hours in that very chamber.

“I was told that I’d probably be able to stay in there for 15 minutes, because you hear the blood rushing through your veins, and the engineers typically had to take breaks because it was so intense. I ended up spending, I think it was 100 hours or more,” she said.

“I ended up being in there for the first time for several hours, just found it so calming, maybe I’m an anomaly. But I had the opposite reaction to [the] freakout that people have, which I think is also about really being with yourself. I do think there’s an element of it in the chamber, you are there very much with yourself, there are no distractions, there’s nothing to pull you out of that internal space,” she continued.

On the topic of recalling song lyrics but not remembering one’s own children’s names for people with dementia, Dr. Guite drew attention to repetition and how music can activate many brain regions and networks simultaneously.

“We’ve talked about this, the globality of music in the brain, but the repetition of a child’s name is something that’s happened through life, whereas the song may be kind of once a month or, once a year. How can we explain that?” she asked.

Dr. Jakubowski said the ability to fill in words of songs was related to procedural memory.

“So procedural memories [are] something like remembering motor sequences, like being able to ride a bike, right? So, when people might not have this kind of semantic memory anymore for names and places, they still have this kind of memory for the motor sequence of singing along lyrics, probably because they’ve sang along to that song lots of times before, or at least sang along in their minds lots of times before to that piece of music,”
she said.

She also said that the brain may spare certain parts of this type of memory, which could explain why some people are able to recall lyrics or play an old song on an instrument even though they have dementia.

“[I]f someone had played the piano previously, often they can continue to play those familiar pieces on the piano, even quite far into the disease,” she said.

In 2014, Beatie established a research project called “The Power of Music” in a group of care homes in the U.K. run by the Priory Group.

It is easy to see in the video and snapshots of that experience how the people with dementia in those care homes start tapping their feet, clapping their hands, and singing along, some with their eyes shining.

She told us about how it all started with the experience of playing original songs in English in a Portuguese nursing home.

“[I]n the case of my father-in-law, I was going to play just to him, but I ended up playing to this whole ward of 100 or so people with dementia and Alzheimer’s, who were all Portuguese. None of them spoke English apart from this relative. And I was playing new songs, songs in English that they didn’t have any prior connection with. And I was seeing people singing along as much as they could, and clapping and waking up,” she said.

This gave Beatie the idea to test out the hypothesis that music itself was powerful, whether you were already familiar with it or not. She was inspired by neurologist Oliver Sacks who predicted in his book Musicophilia that prior knowledge of music was not a pre-requisite for its influence.

When she played original songs to people in the care homes in the U.K., one particular song’s effect on the audience stood out.

Dr. Jakubowski weighed in on why she thinks the song ‘Wish’ was a particular hit with the residents of the care home Beatie visited.

“[S]o, in particular, Beatie uses quite short phrases. [Y]ou can almost predict what the next word or the next rhyme might be, which is really nice for encouraging people to try and sing along. There’s a lot of repetition. So you start to anticipate, and so it provides this nice scaffold, for people to be able to join along,” she said.

Apart from rhyme and alliteration, Dr. Jakubowski said the very clear beat is another contributing element.

“The tempo of the piece of music is actually very close to what we call the sort of preferred tempo for humans. We have what we call a sort of spontaneous motor tempo, which is, basically if I asked you to just tap a beat without hearing anything, usually, people will tap around 120 beats per minute, which is around the speed of that piece of music,” she said.

“[I]t’s a very easy piece to clap along with because we feel comfortable clapping at that speed. So I think that invites participation as well,” she added.

Dr. Jakubowski also said that the structure of the music makes it easy to follow.

“[I]f you don’t have complicated lyrics, and you occasionally have this, ‘oh, oh,’ that’s quite easy to grasp,” she said.

Dr. Jakubowski has been researching MEAMS, or music-evoked autobiographical memories, in general, but believes there are various implications for its connection to dementia as well.

She first talked about music’s chain effect on memory recall.

“When music or any cue activates a memory, that can then activate other memories that are related to that. So, the idea is that, if music can evoke a memory related to that music, that might also help us to bring back other memories from that time period or memories that are linked,” she said.

In one of her works, Dr. Jakubowski compared music to other types of cues for autobiographical memories.

“We found quite consistently across several studies that music tends to, across the board, evoke more positive memories from our lives than other cues. So I think this is one clear potential therapeutic benefit— [it] is that music seems to be a particularly effective cue for bringing us back to positive memories from our lives. And this actually seems to be even boosted further in older adults,” she said.

Dr. Jakubowski hopes this encourages more research to be done in this area and to see whether these findings are valid for people with dementia, especially in the later stages of the condition.

Memories, music, and identity

Dr. Jakubowski also explained how music can help give back people with dementia a sense of identity which often starts to slip away with lost memory.

“I think beyond that, the importance of autobiographical memories is that when we are able to recall a snippet of something from our lives, it really enhances our sense of identity and personhood, and reminds us of who we are and where we came from. And that’s quite important to people who have some sense of, semblance of memory loss, because then they feel kind of stuck in the moment, and they can’t reconnect with their past selves, which can then impact their mental health,” she said.

“This sense of reconnecting, sense of personhood, and past also influences carers as well as family members. So seeing that glimpse of the person you used to know is really, really important. For family members and carers, [this] helps them to realize this is still a person, they have a past and they have this rich history.”
— Dr. Kelly Jakubowski

Dr. Jakubowski noted that while music’s immediate benefit to health is quite apparent, to talk about a lasting benefit, consistent exposure is needed.

“[If] you hear music, you can’t expect there to be a lasting benefit forever, for years later, because you heard one song, three years ago. [H]aving more sustained engagement with some kind of music has more benefit than hearing music and then never hearing it again,” she said.

She also pointed out that people can engage with music in various ways.

“[E]ven listening to recorded music, in a kind of regular way, has lasting benefits for people with dementia— reducing agitation, reducing apathy, improving mood, sometimes enhancing [a] sense of identity, and so on. So I think, there [are] different ways you can engage with music,” she said.

Dr. Jakubowski underscored that music therapy may also have potential downsides in the treatment of dementia.

“There are potential downsides of music for any person regardless of whether they have dementia, in that occasionally music can be, for instance, linked to a traumatic memory from your life,” she said.

“[E]ven if it’s not a traumatic memory, it could sort of remind one of a funeral or loss of a family member. So, we need to be careful when we’re thinking about selecting music that we think about these things,” she continued.

She also touched on preference and all the different genres of music out there. This may produce unwanted effects, especially for people with dementia. She said music therapists have to think carefully about selecting the music they use in their sessions.

“[If] someone absolutely hates some music, it’s less likely to be effective for managing agitation and mood. This comes back to what we talked about at the very beginning of the conversation that sometimes sounds in our environment can be detrimental and annoying. So we don’t want to make people listen to music that they don’t particularly like, or don’t connect to [w]here they may have a negative reaction,” she said.

Likes and dislikes aside, such experiences are a testament to music’s power on health and well-being. Whether it can actually help delay the progression of dementia is a topic that needs further study, however

In ending, I’d like to leave our readers with one question: What is that one song that never fails to trigger an emotional response for you — whether it’s bringing back memories from the happiest day in your life or reminding you of a crushing heartbreak?

Dr. Hilary Guite: Let’s start with an overview of dementia and its causes.

Dr. Kamar Ameen-Ali: I always think that it’s good when we are discussing dementia to start off with a definition of what we mean by it. Often you might hear people use it interchangeably with things like Alzheimer’s disease, but they’re very distinct things.

Dementia, we kind of describe it as an umbrella term. It describes a set of symptoms, it’s a clinical syndrome — those symptoms are often associated with memory impairment. But for a diagnosis of dementia, you also have to have an impairment in one or more other cognitive domains as well — this might be personality, it might be visual-spatial skills, for example.

And as I mentioned, dementia as a clinical syndrome is distinct from something like Alzheimer’s disease, which is a type of brain disease that leads to dementia.

Dr. Guite: Is dementia hereditary?

Dr. Ameen Ali: It depends on what brain disease we’re talking about. So if we’re going to talk about Alzheimer’s disease — which I think is a good idea, because it’s the most common brain disease that leads to dementia — there are some types of Alzheimer’s disease that are hereditary and some types that aren’t.

The most common type of Alzheimer’s disease is what we call sporadic Alzheimer’s disease, and that counts for 97% of Alzheimer’s disease cases. So 3% of cases of Alzheimer’s disease will have that known genetic origin, and this is caused by genetic mutations.

So only a small percentage of actual Alzheimer’s disease cases have got that genetic, known hereditary link.

Dr. Guite: Thank you. So Paula, you’ve been looking after your mother with dementia alongside working. Can you tell us what you first noticed?

Paula Field: Yes, I am. I think my sister and I first noticed that there were some issues with her memory after my father had died. I think that she had started to develop some form of dementia before that, but [our parents] sort of helped each other out. And I think [our father] helped her through a lot of those daily things.

After he died, I think it became much more obvious [that something was wrong], but, you know, at that stage, we weren’t sure whether [her symptoms were] sort of a grief thing. But it gradually progressed. And it probably took us about 6 months or so after he died to realize that, you know, we probably did need to take her to the doctor, and to find out what was happening.

Dr. Maria Cohut: Paula, how did this affect you and your sister financially and during day to day life?

Paula: Well, I think in the early days, you could have a conversation [with our mother]. [My sister and I] were both working full-time, we’d go visit weekends, so we were there really regularly. In terms of financial impact, at that stage, there wasn’t very much, we just carried on as usual. We didn’t have any [additional] carers or anybody at that stage, we used to just go in as often as we could.

Then, once it got to the point when we had to take her to the doctors for her first memory test, and once the results came back, that’s when we had to start thinking about [arranging] more care. And that’s resulted in my sister having to take a day off a week from her work and spend two afternoons a week with my mom.

She has been doing that for nearly 4 years now. And we have other carers going in about twice a day now want to make sure that she gets up, and give her some lunch and the other one in the evenings, to give her some dinner. They do that about 4 days a week, and we pick up the rest.

Dr. Guite: What sorts of scans and diagnostic process happens nowadays?

Dr. Ameen-Ali: There are different types of scans that can be done, [such as] PET scans and MRI scans.

In terms of how well they can contribute to the diagnosis of brain diseases? Questionable, I think, because if we’re looking for brain changes that are associated with Alzheimer’s disease, for example, the question is how well can we see that pathology in the brain in life. Something like Alzheimer’s disease can actually only be diagnosed post mortem, when we can confirm that those pathological changes in the brain are actually there.

But something like a PET scan or a CT or an MRI scan, they can see whether there is that general atrophy in the brain, and that is something that we would expect to see in something like Alzheimer’s disease, particularly atrophy around the hippocampus, which is the part of the brain that is responsible for different memory processes.

So to a certain degree, these brain scans can help with the diagnosis of a certain brain disease that is leading to dementia, but we have to remember that it can only ever be confirmed post mortem.

Dr. Guite: You mentioned there atrophy, what does that mean?

Dr. Ameen-Ali: Atrophy is basically where the brain tissue degrades. If you were to see a brain that had atrophy, you’d see essentially shrinkage of certain areas of the brain.

Dr. Guite: My understanding is that the new PET scans can look at how the brain metabolizes nutrients, like sugar, and that they can show whether or not there are are some some proteins that get misfolded. Can you just explain what those proteins are — amyloid and tau — and how important they are?

Dr. Ameen-Ali: Amyloid and tau are the kind of characteristic pathological features of Alzheimer’s disease. Amyloid is a protein that will aggregate and clump together in the brain and form plaques, and that’s what we see in Alzheimer’s disease.

These plaques then disrupt neuronal cell function, and then that leads to a lot of those cognitive issues that we talked about earlier.

There’s also tau, which is [another] protein in the brain. Again, it’s another characteristic pathological feature of Alzheimer’s disease. Normally, it’s a protein within axons of nerve cells, and it helps to form what we call microtubules that are responsible for transporting nutrients within the cells.

What we see in Alzheimer’s disease, is that it aggregates into these tangles, and it disrupts cell function in that way, and it affects how cells communicate with one another.

Dr. Guite: Paula, after that initial phase and the the memory loss, what else did you start to notice [in your mother]?

Paula: Well, we noticed that she became quite isolated. She didn’t leave the house, she did start to leave her peas on the cooker. And I think, you know, that was the point where we started to go, “Eek, this is getting quite serious.”

She still has some sort of instinctual habit, so she’ll still switch off the switches at the end of the day. That’s something that she’s done forever. But pretty much everything else…

She knows there’s a fridge in her house, and she knows that there should be something on the shelves, and she will put stuff in the fridge. It could be a packet of crisps or it could be a cup. She has this sort of visual memory of the fridge, she sort of knows what it’s for, but she doesn’t quite know how to use it.

But that’s about it. She doesn’t feed herself. If she won’t drink water, she certainly couldn’t take medicines. She does not wash [on her own]. If we ask her to wash her face or something, she’s quite canny, she’ll go in the bathroom, close the door, won’t let you in, and then come out again.

She still believes that she cooks her own dinner, she still believes that she can do all the things that she’s always done. I don’t think it’s denial, necessarily. I think she just [thinks that] it’s happened, therefore, she must have done it.

She has no idea who myself and my sister are — she recognizes us [as familiar faces], but she doesn’t know who we are. She has no knowledge of people going in every day to help her.

She’s not very active, she pretty much sits on her chair everyday with the TV on and looks into space.

Dr. Guite: Kam, can I come back to you from that devastating description of change in personality change in behavior, what’s actually happening in the brain? Because earlier you said [changes] started in the hippocampus, which is the area related to managing memories. But it sounds like more things are happening. What what would actually be happening as the dementia progresses?

Dr. Ameen-Ali: This is one of the complexities of these types of brain diseases that lead to dementia: First of all, how they can affect people very differently based upon the parts of the brain that are affected by the disease.

With something like Alzheimer’s disease, we we know that the pathology progresses into certain areas. And as the disease progresses, it starts to affect more areas of the brain, which is why you might initially see some memory problems.

But a lot of people might dismiss them as just getting older until then the disease progresses, and more and more cognitive domains start to be affected. So as the disease progresses to more of the cortical areas, you might see more issues around language around personality, and then visual-spatial issues that you might see later on as the disease progresses into those cortical areas.

Dr. Guite: Can we just look back to and understand why these things are happening? What are the risk factors related to chronic disease and exposures?

Dr. Ameen-Ali: If you remember, earlier on I mentioned sporadic Alzheimer’s disease — the Alzheimer’s disease that occurs in most cases. And it’s usually over the age of 65 that we would see that, so that when we’re talking about risk factors, they’re associated with that type of Alzheimer’s disease.

We have what we call non-modifiable risk factors. Those are those risk genes that I mentioned earlier on. Age and sex are also non-modifiable risk factors. Age is actually the biggest risk factor for something like Alzheimer’s disease.

But we also have these 12 modifiable risk factors. These are things that we do in our life that potentially we could change that can reduce our risk of dementia. And there are also, generally, things that we can do to promote good brain health, generally.

These modifiable risk factors include things like obesity, hypertension, diabetes, smoking, physical inactivity, loneliness… Brain injury is a big one as well.

Dr. Cohut: So some of the risk factors, but also the preventive interventions that get a lot of press are education and social activity. Presumably, the the longer you stay in education, and the more socially active and involved that you are the lower the risk of dementia. What about your mom, Paula? What was her experience of education and also social life?

Paula: Education minimal, if at all. You have to remember, she was born in the early ’30s. Her social social life was pretty good. [My parents] did have a group of friends when they were into their 50s–early 60s. They’d go on holidays together and and stuff like that. But that was quite sporadic.

And then they might see their friends every now and then. But predominantly, I would say they sort of stuck together. My dad was the social one, he had a much more active life.

Dr. Guite: How old was your mom when she left school?

Paula: Certainly no more than about 13. She wasn’t there very often. You’ve got to remember the [impact of the] war and evacuation and all that sort of stuff.

Dr. Guite: What is happening when we’ve got these elements of education, hearing impairment, social contact — how are they protecting against or reducing the incidence of dementia?

Dr. Ameen-Ali: These risk factors that we’ve talked about, we know that they’re associated with an increased risk of dementia. But what we’re trying to work out as scientists and as researchers is: What actually is the mechanism that is linking these risk factors with the kind of the disease that we see that then leads to dementia?

Because we can do studies where we can find out whether there is a significant correlation between these factors and dementia, but what exactly is causing something like brain injury to increase somebody’s risk significantly to then develop dementia?

The way that I like to imagine it is that our research into trying to understand these mechanisms is like the black box, that we’re trying to work out what’s happening inside that black box. So we’ve got these risk factors on one side, which is the input, and then the disease and the pathology, which is the output, but what is happening on the inside?

It’s almost like you’ve got risk factors and protective factors. And, you know, it’s all about that balance between minimizing your risk factors and maximizing the protective factors.

And it’s a game of probability, really, because there’s no guarantee that doing any of these things, you will get dementia. And there’s no guarantee that if you don’t do any of the things that you’ll be protected from it, but it’s all about managing risk, essentially.

Dr. Guite: I read that all of those 12 risk factors only account for 40% of dementia cases. So you’ve got the other 60%, which is in your black box. Can I come back to your black box now? Because we’ve got amyloid and tau, and we’ve got these risk factors, but what else is going on?

Dr. Ameen-Ali: Neuroinflammation is quite a significant area of research in terms of looking at a potential mechanism that would be driving brain diseases that lead to dementia.

Neuroinflammation is something that I’m interested in. There is a type of immune cell in the brain called microglia, and they’re involved in an inflammatory response in the brain.

A lot of the research that I’ve done is around brain injury. So I’ve looked at these cells, these microglial cells, and both the acute inflammatory response and also a chronic inflammatory response as a result of brain injury, and how that might be the mechanism that is increasing the risk of dementia after brain injury.

So it’s all about how the cells respond as part of a neuroinflammatory response in the brain. And how, over time, if there is a chronic response, because we know that neuroinflammatory responses are originally designed to be protective, but if it’s if the cells are activated long term, as in chronic activation, could they actually be causing damage? And could that be what is then leading to the development of the pathology that we see in something like Alzheimer’s?

Dr. Cohut: I was also thinking about some recent research that’s been looking at the gut-brain axis, so the link between the bacteria in our gut and what goes on in our brain. And there’s been some talk about the influence of gut bacteria on the brain in the context of dementia. So I’m wondering if that might have anything to do with neuroinflammation at any level?

Dr. Ameen-Ali: It’s possible, because when we’re talking about neuroinflammation, this could be systemic inflammation. It could be inflammation that’s happened at some point in a person’s life. It could be inflammation that has happened and then affected the brain.

So there is the possibility of inflammation that’s happened somewhere else in the blood, in the body that has then led to an inflammatory response in the brain. It doesn’t necessarily have to be from an injury that I look at in the brain, it can be systemic inflammation as well.

Dr. Guite: How are you feeling about the future for dementia and Alzheimer’s?

Paula: It’s a tricky one. I think, in our situation, if we’re to be brutally honest, it’s too late for any sort of treatment for my mom. For us, it’s just about keeping her safe, making sure she’s fed, making sure she drinks…

You know, my question is at what point do you think that people should approach their doctor for a diagnosis or a brain scan? Because, you know, in her case, we didn’t notice it, it was too late. I’m not saying they could have stopped it.

But at what point do you think that we need to get on top of this, and actually not wait until the diagnosis? Because once you’ve got a diagnosis, you know, there’s pretty little that you can do, and it’s sad, it’s a waiting game, and we don’t know what to expect. We had no warning, there was nothing that we could do about it in advance.

Dr. Ameen-Ali: I would say that [obtaining a] diagnosis as early as possible is the best thing to do, really. And that can be really challenging, because often, those early signs can be just dismissed as getting older or not really significant enough.

[However,] the earlier the diagnosis, the better, because [then] treatments will be the most effective. They can’t stop the disease, but they can have a much more significant impact on symptoms the earlier that they’re delivered.

I do think that going forward, we need to be able to diagnose much earlier, if we want to have effective treatments. And in terms of developing treatments, it’s unlikely that we’re going to have one single drug that is going to have a significant impact. Because there’s lots of these different potential disease mechanisms, it’s likely that we’re going to need different drugs that administered together, in parallel that will have any significant effect on disease progression.

Paula: Do you think that, potentially, we could get to a place where testing for or diagnosing dementia will be something like you’d have for breast cancer screening that becomes a routine part of your everyday medical self-care?

Dr. Ameen-Ali: I think so. I think if we have better cognitive tests that are more sensitive to certain types of memory decline, because different types of memory decline at different rates.

If we have sensitive tests, then we can certainly administer them at a certain age when your risk increases. And then hopefully that will start picking people up at an earlier rate when the disease is in its earliest stages. And that’s what I think will have a significant effect on on dementia in the future.